Alzheimer’s disease and other dementias present unique challenges for both patients and their loved ones. These conditions encompass a range of cognitive impairments that affect memory, language, problem-solving, and daily functioning. While Alzheimer’s is the most common type, there are five most common types.
Types of Dementias
According to the Alzheimer’s Association, dementia is an umbrella term covering a wide range of diseases and conditions characterized by a decline in memory, language, problem-solving, and other thinking skills that affect a person’s ability to perform everyday activities. If a person has Alzheimer’s disease, they have a type of dementia. The five most common types of dementia include:
Alzheimer’s disease – Alzheimer’s disease is the most common type of dementia. Early symptoms may include difficulty remembering names and recent events, apathy, and depression. As the disease progresses, symptoms may include impaired judgment, disorientation, confusion, personality changes, difficulty speaking, swallowing, and walking. For example, a person may mistake a post office for a bank and attempt to cash a check at the post office, or someone who has always been very organized may miss paying utility bills and have
Vascular dementia – Vascular dementia decreases blood flow to parts of the brain. Due to a series of small strokes that block the arteries, vascular dementia’s symptoms typically overlap with Alzheimer’s disease. Memory loss may not be as apparent, but the slowness of thinking is common.
Dementia with Lewy bodies – The Lewy body dementia pattern of decline is similar to Alzheimer’s disease. Alertness and severity of cognitive symptoms can fluctuate over a few hours. Symptoms may include physical tremors, stiffness, visual hallucinations, and excessive daytime sleepiness.
Mixed dementias – Although Alzheimer’s disease is the most common type of dementia; evidence indicates many people living with dementia have brain abnormalities associated with more than one type of dementia. One common example of mixed dementia is Alzheimer’s disease plus vascular dementia.
Frontotemporal dementia – This type of dementia begins inside the forefront of the brain. Typical symptoms include changes in personality, behavioral shifts, and language difficulties. It is essential to understand that the symptoms of dementia are different for each person. Experiences can differ significantly from person to person.
Mild Cognitive Impairment (MCI)
MCI is not dementia but a condition where an individual has mild changes in thinking abilities that are noticeable to the person affected and their loved one; however, these changes are not severe enough to interfere with the individual performing their daily activities. People with MCI are at higher risk of developing dementia than people without MCI. However, MCI does not always lead to dementia.
Recognizing Early Signs and Symptoms
Early detection is crucial for effective management. Warning signs include memory loss, difficulty with familiar tasks, confusion about time and place, and changes in mood or personality. Seeking medical attention for diagnosis is essential, as some conditions masquerade as dementia but are treatable, such as depression or thyroid problems.
Understanding Risk Factors
While advancing age is the primary risk factor, genetics, family history, and lifestyle choices also play significant roles. A healthy diet, physical and mental activity, and social engagement may help reduce the risk or delay onset.
Stages of Alzheimer’s Disease
Alzheimer’s progression is divided into early, middle, and late stages, each presenting unique challenges. Caregivers must adapt support to accommodate changing abilities, from cueing and reminders in the early stage to full assistance with daily tasks and communication in the late stage. It can be difficult to classify a person living with Alzheimer’s in one specific stage as the pace at which symptoms advance from early to middle to late varies from person to person. There is also fluidity between the stages, and at times they may overlap. The average length of life following diagnosis is 4-8 years. However, some people can live up to 20+ years with a diagnosis.
According to the Alzheimer’s Association, there are three different stages of Alzheimer’s disease. In scientific settings, they are referred to as mild, moderate, and severe. It is more appropriate in caregiving settings to discuss them as early, middle, and late.
Early-stage: Most people can function independently in many areas but are likely to require assistance with some activities to maximize independence and remain safe. The individual may still be able to drive and participate in favorite activities. Typically, they will need cues and reminders for:
- Keeping appointments
- Remembering words or names
- Recalling familiar places or people
- Managing money
- Keeping track of medications
Middle stage: This is the longest stage for some individuals. They may need assistance with performing daily tasks, like the things we all did to get out of the house this morning: bathing, dressing, using the restroom. They may start having trouble communicating with words,
become confused about where they are, engage in wandering, and demonstrate personality and behavioral changes.
- Changes in behavior: These can be some of the most challenging symptoms for caregivers and family members. Individuals living with dementia may experience depression, anxiety, agitation, irritability, suspiciousness, and repetitive behaviors. Other changes may occur as the disease progresses, including sleep changes, physical and verbal outbursts, and wandering. Understanding the underlying cause of these expressions can help provide an appropriate response to assist the person living with dementia. It is also important to remember that it is the disease that is causing a change in behavior due to the changes happening in the brain.
- Daily care needs: Tasks such as eating, dressing, and grooming will require more assistance as dementia progresses. This loss of independence and privacy can be a tough transition for the person living with dementia. The caregiver’s patience and sensitivity will go a long way in helping them through it. Once assistance is needed, think about the person’s current abilities. Encourage them to do as much as possible but be ready to help when needed. Consider opportunities for “doing with” instead of “doing for.”
- Communication: Increasing difficulty with word-finding, conversation, and thought expression are typical experiences for individuals in the middle stage of Alzheimer’s disease. During this stage, communication changes also include repeating questions, losing the train of thought, reverting to a native language, and relying on non-verbal communication (behaviors). These changes in communication often happen gradually. A doctor should be consulted when sudden changes occur as they may indicate a medical problem or medication side effect.
Late-stage: In the final stage of this disease, individuals experience significant declines in the ability to respond to their environment, to carry on a conversation, and, eventually, to control movement. As the disease advances, the needs of the person living with Alzheimer’s disease will change and deepen. As memory and cognitive decline worsen, significant personality changes may occur, and individuals will need complete assistance with necessary daily activities. Alzheimer’s disease is ultimately fatal, and hospice care is usually started. Typical late-stage Alzheimer’s symptoms include:
- Physical health declines. Because of damage to areas of the brain involved in the movement, individuals eventually lose motor skills. Round-the-clock full support with bathing, dressing, and using the bathroom is usually required. The individual will require assistance with sitting, walking and eventually become bed-bound, which leaves them vulnerable to blood clots, skin infections, pneumonia, and sepsis (a body-wide infection that results in organ failure and sometimes death).
- Difficulty eating and swallowing. Food can be swallowed into the trachea (windpipe) instead of the esophagus (food pipe). The food particles may get into the lungs and cause aspiration pneumonia, an infection that is a contributing cause of death among many individuals living with Alzheimer’s. This change in eating ability can lead to insufficient nutrition intake, which further compromises the individual’s ability to fight off infections and heal skin wounds.
- The ability to communicate is limited. Some individuals may still be able to use words or phrases, but communicating pain becomes difficult. Caregivers must learn to read facial expressions, body language, and sounds, which become the new form of
communicating, e.g., wincing, clenched mouth/jaw, curled up body, moans, or sharp intake breaths.
Person-Centered Care Approach
A person-centered care philosophy emphasizes understanding the individual beyond their diagnosis. Knowing their life history, preferences, and interests guides meaningful activities, minimizes behavioral issues, and preserves dignity and respect throughout the caregiving journey.
Effective Communication Strategies
Verbal and non-verbal communication techniques are crucial for successful interactions. Using simple language, giving one-step directions, and maintaining patience help bridge communication gaps. Non-verbal cues like eye contact and facial expressions convey empathy and understanding.
Preserving Dignity and Respect
Caregivers must prioritize dignity and respect, treating individuals with compassion and empathy. This includes validating their reality, avoiding arguments, and setting them up for success by allowing independence whenever possible.
Alzheimer’s disease and other dementias pose significant challenges, but with early detection, personalized care, and effective communication, patients and caregivers can navigate this journey with compassion and dignity. At Home Instead Toronto, we emphasize personalized support that respects each person’s unique journey. Our Caregivers prioritize dignity, respect, and compassionate communication, ensuring that every individual receives the care and attention they deserve throughout their journey with dementia. Call us today to discuss your care needs with one of our Nurse Managers.