If dementia occurs in an individual over 65years of age, it is usually because of Alzheimer’s disease. There are diagnostic measures to identify this disease. Making the diagnosis is not very difficult in this case as there is a particular pattern in which the disease progresses.
The initial presentation of the disease is by forgetfulness. The person tends to forget recent events, names of people who are associated with him/ her, numbers etc. Most of the time, this is attributed to age related changes ( if the person is an elderly) or stress if it happens in a younger person. Measures are advised to avoid stress so as to see whether there is a relief of the symptoms. In Alzheimer’s disease, there would never be a remission of the symptoms, but the memory loss only worsens. The initial stage of the disease is termed as predementia.
Once there is onset of the disease, the signs and symptoms only worsen. The patient becomes generally withdrawn, often irritable or aggressive, agitated when he can’t remember things, may not be able to find the location of his own house, starts wandering off, seems lost, may seem not able to remember words or phrases when speaking, writing abilities also might be impaired. There are often instances where elderly people are found wandered off a long distance from their homes, and then cannot remember anything related to their families (names, phone numbers etc). This level of the Alzheimer’s disease is called early dementia. The patient is still able to remember the incidents related to his childhood, may recognize people from early life, might be able to undertake activities of daily living under supervision and lead a life at home.
The disease then progresses to a stage where the patient might not recognize his own family, may not be able to speak or write properly, gets agitated or irritable more often, the distant memories which was retained till this stage also seems lost, control of body movements like urinary or fecal continence might be lost, may not be able to maintain the activities of daily living. This is moderate dementia.
The end stage of Alzheimer’s disease is advanced dementia when the patient is very terminal with all the bodily functions gone. Feeding has to be done by another person, other activities of daily living are also done by another person, and the patient is often bedridden and deteriorated. At this stage, infections or other diseases often set in and death results mostly because of the secondary illnesses.
Though a patient with predementia or early dementia may stay at home and requires only supervision, the patient with moderate or advanced dementia needs constant professional care. At the initial stage, measures like keeping a tag with the details of the patient and contact numbers of the family may be helpful. At advanced stage, relatives might consider transfer to a home care facility where skilled care is available.