> To all in this group:
>
[quoted text clipped - 9 lines]
> nursing home for her to go to. Any help and information would be greatly
> appreciated.
A list of descriptions of stages has been posted here several times you
might find it by googling or maybe someone will post it again, but from what
you say, "trouble swallowing", that is way later, in about stage 6 or 7 IIRC
rather than stage 3.
But I wouldnt get too hung up about it these are just general descriptions,
they are not a presecribed series of stages that people pass through in a
definitive way with definitive times to each. Your mother might have trouble
swallowing for a short time or a long time, some people described here go
from diagnosis to death within a couple of years, others might take 15 or
more.
It might also be that be the difficulty is swallowing is nothing to do with
Az, maybe its n different complication caused by her age or another illness?
Good luck.

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Tumbleweed
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>My mother (age 97...yes she is 97 to be 98 in July) has had dementia for the
>last several years, and now the doctor feels it is alzheimers. She has had
[quoted text clipped - 7 lines]
>nursing home for her to go to. Any help and information would be greatly
>appreciated.
I wonder whether the inability to swallow is simply a function of her
age or perhaps related to her seizures and/or medication. This
inability would suggest a later stage yet her ability to recognize you
(and other?) suggests an earlier stage.
Mary posted a synopsis of the Stages of AD a while ago. Here it is
(also available through http://groups.google.com search for
"alt.supports.alzheimers stages")
Darryl.
==========
Stages of Alzheimers
In 1982 Dr. Barry Reisberg published what was to become the best and
most widely accepted description of the stages of Alzheimer's disease.
Even today, twenty one years later, when experts refer to a person
being in stage 5 or stage 6, they are referring to Dr. Reisberg's
scale of seven stages.
Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of Psychiatry, 1982
Level 1
No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.
Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well. No objective evidence of
memory deficit on clinical interview. No objective deficits in
employment or social situations. Appropriate concern regarding
symptoms.
Level 3
Mild cognitive decline (early confusional or Early AD). Earliest
clear-cut deficits. Manifestations in more than one of the following
areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only
with an intensive interview. Denial begins to become manifest in
patient. Mild to moderate anxiety accompanies symptoms.Deficits
noticed in demanding employment situations.
Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut
deficit on careful clinical interview. Deficit manifest in following
areas:
(a) decreased knowledge of current and recent events; (b) may exhibit
some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions; (d)
decreased ability to travel, handle finances, etc.
Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations. Inability to perform
complex tasks. Denial is dominant defense mechanism. Flattening of
affect and withdrawal from challenging situations occur.
Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know their own
names and generally know their spouse's and children's names. They
require no assistance with toileting and eating, but may have some
difficulty choosing the proper clothing to wear.
Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD).
May occasionally forget the name of the spouse upon whom they are
entirely dependent for survival. Will be largely unaware of all recent
events and experiences in their lives. Retain some knowledge of their
past lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to familiar locations. Diurnal rhythm frequently
disturbed. Almost always recall
their own name. Frequently continue to be able to distinguish familiar
from unfamiliar persons in their environment. Personality and
emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., paatients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment,
or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may
continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.
6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence
Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal
abilities are lost. Frequently there is no speech at all - only
grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control. The brain appears to no longer be able to tell the
body what to do. Generalized and cortical neurologic signs and
symptoms are frequently present.
7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost
==========
Dr. Reisberg's definition of the stages are the ones that are most
commonly referred to, but various other experts have divvied up the
stages other ways and even chunked the stages into bigger pieces (i.e.
5 or 3 stages instead of Dr. Reisberg's 7). Its pretty arbitrary,
given that nothing natural really progresses in cut and dried stages -
its always a messy continuum, and no individual is always going to
slot neatly into a box (i.e. they'll always end up straddling two or
three stages at once.
But just to give you a flavour of how some of the other experts have
defined the stages of progression (I save assorted sets of
definitions, since sometimes the verbiage is helpful):
Howard Gruetzner's book (Alzheimer's, A Caregiver's Guide and
Sourcebook 1992) categorized the stages as follows (this is very
condensed):
Stage 1 Early Confusional - (forgetfulness becomes a problem,
confusion and slower responses affect driving, early problems with
social conversation surface, personality changes appear, denial
conceals recognition of early problems, early emotional symptoms may
be brought to the attention of the doctor, disease results in changes
in abilities and actions)
Stage 2 Late Confusional: (memory problems are more evident, decision
making and financial management deteriorate, denial of the problem
makes the family's job more difficult, driving becomes riskier,
orientation in time and place is affected, supervision and daily
support is needed, victim may become self absorbed and depressed).
Stage 3: Early Dementia (person is very dependent on the caregiver,
victim should not drive, memory gaps trigger insecurity and defensive
behaviour, emotional reactions become more prominent, memory deficits
progress but may seem to fluctuate, logical sequential reasoning and
actions diminish (i.e. dressing), simple decisions become
overwhelming, social withdrawal is accompanied by impaired thinking
capacity.
Stage 4: Middle Dementia (victim reacts more severely to loss of
abilities, sleep disturbances may emerge, repetitive behaviour,
movement and coordination difficulties, help with daily activities and
routine becomes essential, catastrophic reactions may happen (person
becomes very upset and even violent when frustrated or if too many
demands are made) bathing problems emerge (the person may be afraid of
bathing and requires complete supervision), loss of touch with events
and experiences, caregiver usually must hire help or place the victim
in an institution.
Stage 5: Late Dementia (less of everything - motor abilities
deteriorate, ability to walk, talk, sit, smile, bladder and bowel
control, eating difficulties, ability to recognize people, person
sleeps a lot etc. etc. )
And finally Lisa Gwyther from her "Care of Alzheimer's Patients: A
Manual for Nursing Home staff." Page 25-27, 1985.
First Stage 2 - 4 years leading up to and including diagnosis:
Symptoms:
Recent Memory loss begins to affect job performance
Confusion about places - gets lost on way to work.
Loses spontaneity, becomes withdrawn, disinterested
Mood/personality changes - becomes anxious about symptoms, avoids
people.
Poor judgment - makes bad decisions.
Takes longer with routine chores
Trouble handling money, paying bills.
Examples:
Forgets which bills are paid and phone numbers that are called
frequently.
Loses things. Forgets grocery list.
Arrives at wrong time or place, or constantly rechecks calendar or
clock.
Second Stage 2 - 10 years after diagnosis (longest stage):
Symptoms:
Increasing memory loss and confusion - shorter attention span.
Problems recognizing close friends and/or family.
Repetitive statements and/or movements.
Restless, especially in late afternoon and at night.
Occasional muscle twitches or jerking.
Perceptual-motor problems
Difficulty organizing thoughts, or thinking logically.
Can't find right words - makes up stories to fill in the blanks.
Problems with reading, writing, and numbers.
May be suspicious, irritable, fidgety, teary, or silly.
Loss of impulse control - sloppy - won't bathe or afraid to bathe -
trouble dressing.
Gains and then loses weight.
May see or hear things that are not there.
Needs full-time supervision.
Examples:
Can't remember visits even though the visitor just left.
Mixes up day and night, may get up and wander.
Difficulty getting into a chair, setting the table for a meal.
Can't follow written signs, write name, add or subtract.
May accuse spouse of hiding things, infidelity, or childish behavior.
May undress at inappropriate times or in wrong place.
Forgets when last meal was eaten, may gradually lose interest in food.
Third/terminal stage 1 - 3 years
Symptoms:
Can't recognize family or self in mirror.
Loses weight even with good diet.
Little capacity for self care. Can't communicate with words.
May put anything in mouth or touch anything.
Can't control bowels or bladder
May have seizures, experience difficulty with swallowing, skin
infections.
Examples:
Looks in mirror and talks to own image.
Needs total care with bathing, dressing, eating and toileting
May groan, scream or make grunting noises.
Sleeps more, becomes comatose, eventually dies.