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Stages of Alzheimer’s Disease

Stages of Alzheimer’s Disease

“Memories are the threads that weave the fabric of our lives, shaping who we are and who we become.” – Elizabeth Loftus

    Stages of Alzheimer’s Disease

    Alzheimer’s disease is a complex condition that affects millions of individuals worldwide, impacting not only those diagnosed but also their families and caregivers. Understanding the progression of Alzheimer’s is crucial for providing appropriate care and support at each stage of the disease. In this article, we’ll explore the seven stages of Alzheimer’s Disease, highlighting the areas of the brain affected, common symptoms experienced, and available treatments for each stage.

    Stage 1 – No Impairment

    Area of the Brain: No noticeable changes.

    Symptoms: No memory problems or cognitive decline.

    Treatments: Focus on maintaining a healthy lifestyle, including regular exercise, a balanced diet, and mental stimulation.

    Stage 2 – Very Mild Decline

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    Area of the Brain: Minimal changes, primarily in the hippocampus.

    Symptoms: Occasional forgetfulness, such as misplacing keys or forgetting names.

    Treatments: Continued emphasis on lifestyle factors, along with memory aids and cognitive exercises.

    Stage 3 – Mild Decline

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    Area of the Brain: Further deterioration in the hippocampus and other regions involved in memory and learning.

    Symptoms: Noticeable memory lapses, difficulty finding the right words, and challenges with planning and organization.

    Treatments: Introduction of medications such as cholinesterase inhibitors to help manage cognitive symptoms, along with support from caregivers and memory care programs.

    Stage 4 – Moderate Decline

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    Area of the Brain: Significant damage in multiple brain regions, including the frontal and temporal lobes.

    Symptoms: Increased memory loss, difficulty performing tasks independently, mood swings, and confusion about time and place.

    Treatments: Additional medications, such as memantine, may be prescribed to manage cognitive symptoms. Occupational therapy and support services become more important for daily functioning.

    Stage 5 – Moderately Severe Decline

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    Area of the Brain: Extensive damage throughout the brain, affecting communication between neurons.

    Symptoms: Severe memory impairment, inability to recall personal details, challenges with basic activities of daily living, and behavioral changes.

    Treatments: Intensive support from caregivers, including assistance with personal care and supervision. Behavioral interventions and communication strategies are crucial.

    Stage 7 – Very Severe Decline

    Area of the Brain: Severe neuronal loss and widespread brain damage, resulting in complete dependence on others for care.

    Symptoms: Loss of verbal communication, minimal responsiveness, and severe physical impairment.

    Treatments: End-of-life care focuses on comfort and dignity, with a focus on pain management and emotional support for both the individual and their loved ones.

    Stage 6 – Severe Decline

    Area of the Brain: Severe atrophy and damage in all brain regions, leading to profound cognitive and physical decline.

    Symptoms: Loss of awareness of surroundings, difficulty recognizing familiar faces, incontinence, and limited mobility.

    Treatments: Palliative care focuses on maximizing comfort and quality of life. Supportive therapies, such as music and art therapy, can provide comfort and stimulation.

    Bottom Line:

    Understanding the stages of Alzheimer’s disease is essential for navigating the challenges and providing appropriate care and support throughout the journey. While there is currently no cure for Alzheimer’s, early diagnosis and intervention can help manage symptoms and improve quality of life for individuals and their families. With ongoing research and advancements in treatment, there is hope for a future where Alzheimer’s is more effectively managed and ultimately cured.

    Warning Signs of Dementia

    Warning Signs of Dementia

    “Memory is the diary that we all carry about with us.” – Oscar Wilde

    Warning Signs of Dementia

    Memory changes as we age can be unsettling, leaving many of us wondering if what we’re experiencing is just a normal part of getting older or something more serious, like dementia. It’s important to recognize that there’s a subtle overlap between age-related memory changes and the warning signs of dementia. In this article, we’ll explore these warning signs in a way that’s easy to understand.

    Consider the following symptoms of Dementia: 

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    What can ‘offset’ these changes or help you cope with them?

    Intelligence, expertise, and using compensatory strategies can help cope with memory changes.

    Examples: 

    • Using tools like calendars or setting reminders on your phone to help remember important dates or tasks.
    • Using mnemonic devices to remember important information.
    • Writing notes to yourself to remember tasks or appointments.
    • Creating a daily routine to help remember daily tasks and activities

    Note: Memory specialists are trained with information that greatly exceeds these very simple everyday strategies found on the internet. Clinical oversight is recommended if you feel some of these symptoms have described you. 

     

    Bottom Line:

    If you or a loved one are experiencing these warning signs of dementia, it’s essential to seek help from a local memory specialist. While it can be challenging to confront these changes, getting an evaluation and discussing options early on can lead to better outcomes and quality of life. Remember, you’re not alone, and there are resources available to support you through this journey.

    References

    Baddeley, A. D., Kopelman, M. D., & Wilson, B. A. (2004). The essential handbook of memory disorders for clinicians. Chichester, West Sussex, England ;: J. Wiley.

    Cohen, C., Culver, C., Gomberg, D., Magai, C., & Malatesta, C. (1996). Emotional Expression During Mid- to Late-Stage Dementia. International psychogeriatrics, 8(3), 383-395. doi:10.1017/S104161029600275X

    Early Signs of Dementia in Women

    Early Signs of Dementia in Women

    “Memory is the treasure house of the mind wherein the monuments thereof are kept and preserved”.  Thomas Fuller

    Early signs of dementia in women:

    Early: This refers to the beginning stages or the initial phase of something. In the context of “early signs of dementia,” it means recognizing symptoms at an early stage before they become more severe or noticeable.

    Signs: Signs are indications or signals that suggest something is happening or present. In this case, “early signs” of dementia are the first noticeable changes or behaviors that may indicate the presence of dementia.

    Dementia: Dementia is a general term used to describe a decline in cognitive function (thinking, memory, and reasoning) severe enough to interfere with daily life. It is not a specific disease but rather a set of symptoms associated with various underlying causes.

    Introduction

    You may have heard that more women than men show early signs of dementia, but let’s set the record straight. Recent studies suggest there’s not enough evidence to support this claim. So, if you’re a woman, don’t fret – your risk of dementia isn’t higher just because of your gender (Beam et al., 2018).

    Understanding early signs of dementia in women isn’t easy. Dementia affects everyone differently, no matter their gender, but let’s try to develop our understanding of it!

    The Facts:

    Let’s start by looking at what recent studies tell us about dementia and its risk factors.

    According to Neergaard et al. (2016), there are certain things we can’t change (non-modifiable risk factors), like getting older and genetics that might make us more likely to develop dementia.

    There are other things we can change (modifiable risk factors), like how much we exercise, nutrition, chronic stress, sleep, and whether we smoke that play a big role in whether or not we begin experiencing early signs of dementia. Norton et al. (2014) found that things like not exercising enough and smoking could make us more likely to get dementia.

    Surprisingly, Neergaard et al. (2016) discovered that being a bit overweight when we’re older might not matter as much as we thought! Being obese doesn’t seem to make much of a difference according to the evidence. So, it’s not just about being thin or fat – it’s more complicated than that!

    Sex Differences in Early Symptoms:

    Now, let’s talk about the early signs of dementia and whether they’re different for women and men.

    In a study by Edahiro et al. (2023), they found that women with early-onset dementia were more likely to have trouble with their memory. Men, on the other hand, were more likely to feel irritable.

    Mendez (2012) also discovered that the first signs of dementia might not always be about forgetting things. Sometimes, they can be about having trouble with things like seeing things around us and paying attention.

    The most common symptoms of early-onset dementia across gender are as follows:

      1. Loss of memory (Edahiro et al., 2023)
      2. Difficulty in word generation (Edahiro et al., 2023)
      3. Loss of motivation (Edahiro et al., 2023)
      4. Increased mistakes in the workplace or domestically (Edahiro et al., 2023)
      5. Unusual behaviors or attitudes (Edahiro et al., 2023)
      6. Visuo-spatial dysfunction (Mendez, 2012)
      7. Executive dysfunction (Mendez, 2012)
      8. Attention impairment (Mendez, 2012)

    What can you do?

    Stay physically active: Engage in regular physical activity, such as walking, swimming, or dancing, to promote brain health and reduce the risk of dementia

    Manage depression: Seek support and treatment for depression if needed, as depression has been identified as a potential risk factor for dementia

    Stay mentally active: Keep your brain stimulated by engaging in activities that challenge your cognitive abilities, such as puzzles, reading, learning new skills, or socializing with others

    Monitor and manage other health conditions: Take steps to manage other health conditions that may increase the risk of dementia, such as diabetes, hypertension, and smoking

    Be mindful of early signs: Pay attention to any changes in memory, cognition, or behavior, and seek medical advice if you notice any concerning symptoms. Early detection and intervention can be crucial in managing dementia

    Bottom Line:

    So, what’s the bottom line? Even though some studies say women might show early signs of dementia more than men, it’s not necessarily the case. That said, there are some gender differences like women being more likely to experience memory difficulties in the early stages of dementia than men.  Dementia is a complicated thing, and lots of factors can play a part in whether we get it or not.

    I will forever tell everyone I know that there is no harm in seeking functional oversight of your cognition! Find a board-certified medical professional trained in memory, cognition, and neurological-based pathologies to evaluate you. This will allow you to remain in control of your brain health and manage modifiable risk factors.

    References

    Beam, C. R., Kaneshiro, C., Jang, J. Y., Reynolds, C. A., Pedersen, N. L., & Gatz, M. (2018). Differences Between Women and Men in Incidence Rates of Dementia and Alzheimer’s Disease. J Alzheimers Dis, 64(4), 1077-1083. doi:10.3233/jad-180141

    Edahiro, A., Okamura, T., Arai, T., Ikeuchi, T., Ikeda, M., Utsumi, K., . . . Awata, S. (2023). Initial symptoms of early‐onset dementia in Japan: nationwide survey. Psychogeriatrics, 23(3), 422-433. doi:10.1111/psyg.12949

    Fitzpatrick, A. L., Kuller, L. H., Lopez, O. L., Diehr, P., O’Meara, E. S., Longstreth, W. T., Jr., & Luchsinger, J. A. (2009). Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol, 66(3), 336-342. doi:10.1001/archneurol.2008.582

    Mendez, M. F. (2012). Early-onset Alzheimer’s disease: nonamnestic subtypes and type 2 AD. Arch Med Res, 43(8), 677-685. doi:10.1016/j.arcmed.2012.11.009

    Neergaard, J. S., Dragsbæk, K., Hansen, H. B., Henriksen, K., Christiansen, C., & Karsdal, M. A. (2016). Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study. Medicine, 95(11). Retrieved from https://journals.lww.com/md-journal/fulltext/2016/03150/late_life_risk_factors_for_all_cause_dementia_and.64.aspx

    Norton, S., Matthews, F. E., Barnes, D. E., Yaffe, K., & Brayne, C. (2014). Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol, 13(8), 788-794. doi:10.1016/s1474-4422(14)70136-x

    Stroop and Hurdles | Occupational Therapy Interventions

    Stroop and Hurdles | Occupational Therapy Interventions

    Cognitive Dual Tasking – Stroop and Hurdles

    Occupational Therapy Intervention : Cognitive Dual Tasking

    Documentation and Activity Rationale

    The patient engaged in a dual-tasking activity requiring the ability to recruit executive functioning components while alternating between movement-based performance. This task utilized the stroop color and word test (SCWT) to maximize the ability to inhibit cognitive interference when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. The movement-based component required the ability for the patient to clear 5/5 hurdles approximately 8″ in height to improve reaction time, visual-perceptual functions, reaction time, eye-foot coordination, neuromuscular communication, and the ability to process sensory-motor stimuli s/p executive-function based activity in order to elicit neuronal excitation and maintain cognitive reserve.

    .

    Grading Strategies

    Grading Up: 

    • more complex stroop
    • more hurdles

    Grading Down: 

    •  begin with larger stroop with less words
    • decrease amount of hurdles
    • start with just the stroop

    Appropriate Diagnoses / Deficits

    • Alzheimer’s
    • Dementias
    • Memory Changes
    • Attention deficits [alternating/divided]
    • CVA
    • TBI

    Lewy Body Dementia and Rehabilitation

    Lewy Body Dementia and Rehabilitation

    Lewy Body Dementia is a condition that looks different for each person, but the way the disease works in the brain, known as pathogenesis, follows the same general pattern. Some specialized physical, occupational, and speech therapists are trained in understanding how the disease spreads through the brain and how it impacts different functions over time. These changes are specific to Lewy Body Dementia, making your journey with LBD different from someone with Alzheimer’s, frontotemporal dementia, or Parkinson’s.

    If you’ve been diagnosed with LBD, it’s important to start building your long-term management team. While you won’t need therapy or medical appointments all the time, you will benefit from having periods of therapy when changes in your body or function start to appear. Having someone to contact when these changes happen ensures you can get the right support at the right time. Early diagnosis and intervention are key to maintaining as much independence and function as possible throughout the course of the disease.

    What is Lewy Body Dementia?

    Lewy Body Dementia (LBD) is the second most prevalent progressive neurodegenerative diagnosis causing dementia. It is second to Alzheimer’s disease (AD), but differs in many ways. It is signified by lewy body proteins that appear in various parts of your brain affecting thinking, functional activities, judgement, executive function, functions of the autonomic nervous system, and mobility.

    The Lewy Body Association  has more information regarding the difference between Alzheimer’s Disease (AD) and Lewy Body Disease (LBD).

    What do I do if I’ve been diagnosed with Lewy Body Dementia (LBD)?

    After receiving an LBD diagnosis, it is important to establish a long-term therapy team including occupational therapy, speech therapy, and physical therapy familiar with the progression of this diagnosis. By establishing a small therapy team that will be able to remain with you throughout the stages of Lewy Body Dementia, you will be able to maximize your physical function, maintain your performance in functional activities, and ensure you remain in control of your symptoms instead of the other way around.

    Symptoms of Lewy Body Dementia

    • Runny Nose
    • Visual hallucinations (detailed)
    • Delusions 
    • Agitation and frustration
    • Difficulty multi-tasking or remaining on task 
    • Information processing difficulties 
    • Stooped posture (similar to Parkinson’s disease)
    • Overall movements and mobility slowing down
    • Balance and coordination decline 
    • Walking turns into a ‘shuffle’ 
    • Voice becomes more quiet 

    For more symptoms of Lewy Body Dementia, head to Alzheimer’s Association

    What are my options after receiving an LBD diagnosis?

    Although there are neurocognitive enhancement medications, one of the most important things you can do for yourself is to seek out a team of therapists as early as possible. With the right early intervention strategies you can improve your symptoms and/or control the speed at which you experience decline.

    What type of intervention is used by a neuro-centered rehabilitation team?

    How can outpatient occupational therapy help after a dementia diagnosis?

    • Once given a dementia diagnosis, we can ‘stage’ your dementia progression through specific screens and assessments so that you always feel in control of your circumstances.
    • Make recommendations for adaptive equipment, durable medical equipment, and mobility aids throughout each stage
    • Provide a hybrid approach to rehabilitation and maintenance grounded in neurocentric principles offering you an inclusive rehab program.