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The Alzheimer’s timeline: What to expect as the disease progresses

Right now, there are more than 310,000 Australians living with Alzheimer’s disease and this number is only set to rise as our population ages, according to Dementia Australia. 

While even a healthy person’s brain usually shrinks as they get older, some people are thought to be more severely impacted by a naturally occurring protein called amyloid. In people with Alzheimer’s, amyloid clumps together and acts as a trigger that causes another protein called tau to spread through the brain.

Tau impacts the way nerve cells function and ultimately changes the way the brain sends and receives signals to the rest of the body. As tau continues to build up in the brain, a person’s cognitive functions decrease.

The early stages of Alzheimer’s disease

Alzheimer’s is a progressive disease with symptoms appearing gradually – so gradually that people with the condition may not notice the changes to their cognitive abilities.

Their loved ones, however, often notice their memory is poorer than before, because this is the most common symptom that arises in the early stages of the disease: people forgetting things that they have previously remembered easily.  

However, Associate Professor Michael Woodward, Director of Aged Care Research and the Memory Clinic at Austin Health, says not remembering the name of someone you met the previous day or forgetting a family member’s birthday is not a dire warning that you are developing Alzheimer’s disease.

“It’s got to be consistent in areas we would normally remember,” he explains. “So, if you look at the film Still Alice, she forgets the word ‘lexicon’, which is an important word for her profession because she was a linguist.

“Those sorts of changes that are core to our knowledge and function are probably much more important than forgetting who won the Academy Award 40 years ago or who was the Prime Minister.”

Plus, there are other signs that a person has Alzheimer’s that often become apparent around the same time as memory changes occur, including changes in behaviour. An uncharacteristic unwillingness to try new things, or an unusual loss of interest in hobbies and activities should raise a red flag, Dementia Australia says.

People with early-stage Alzheimer’s may start to repeat themselves when speaking or lose their train of thought, or they could have difficulty carrying out previously easy, everyday tasks such as shopping or cooking.

The intermediate stages of Alzheimer’s

Memory loss becomes more severe as the disease progresses, and Assoc Prof Woodward says a person with moderate Alzheimer’s could start to forget simple tasks such as turning off the stove or the sprinkler, or how to pay a bill online.

“We might head off on a short journey and can no longer work out how we got there, forget where our car is, or we might completely forget an important daily function,” he explains.

In addition, Dementia Australia say an unusual disinterest in appearance or personal hygiene or not being able to choose appropriate clothing for a specific occasion is common in people with moderate Alzheimer’s. 

Irritability is also common as simple tasks become more difficult, with some people becoming frustrated and even angry when they can’t do something they previously found straightforward.

The advanced stages of Alzheimer’s

By the time the disease is in its advanced stages, people with Alzheimer’s are likely to need support, either at home or in a residential care facility, to complete ordinary daily tasks such as showering or eating.

Their memory is also likely to have further declined, with events from their early lives  forgotten and people they have met difficult to recall, Dementia Australia says. They may also have difficulty understanding what certain objects around the home are and what they are used for. 

As confusion increases, so too can aggression as people living with Alzheimer’s experience the pain of losing their independence because they increasingly rely on family members or carers for support. 

“We might become more cranky, more disinhibited, paranoid, delusional or even depressed,” Assoc Prof Woodward explains.

Coping with Alzheimer’s disease

Managing the symptoms of Alzheimer’s can be physically and mentally challenging for the person living with Alzheimer’s and his or her carers, particularly as the condition progresses and the person feels angry, confused and depressed by the changes.

Assoc Prof Woodward says it’s important that the carer maintains a calm composure when speaking to or assisting a loved one with Alzheimer’s disease to not upset them further. Focusing on the things the person can’t do and can’t remember will likely worsen the situation, he adds.

“Rather than confronting the person and saying ‘what are you talking about, surely you remember that!’, just say something like ‘yeah, I know that it’s really important to you to do this, or remember that fact, but the doctor says you’ve got the early stages of Alzheimer’s and you will have these changes, but that’s okay, I understand there’s much more to do’,” Assoc Prof Woodward explains.

Carers should prioritise taking time out to rest and recuperate, he notes, because spending time away from a loved one with Alzheimer’s is essential to maintaining a positive frame of mind.

“I would recommend getting support from family and friends, so that they have some time out – I’d recommend four to six hours of respite per week – where they’ve got some time on their own,” Assoc Prof Woodward explains.

He also suggests making use of the Dementia Australia’s excellent resources and even undertaking the living with dementia course which is offered by the organisation. The six-week educational course is available for both people with Alzheimer’s and the person caring for them and provides teaching on various topics, from the symptoms and drug treatments for Alzheimer’s disease to how to communicate more effectively and plan for the future.