How does Alzheimer’s disease typically progress?

DEAR DOCTOR K:

My mother has Alzheimer’s disease. What should I expect in the coming years?

DEAR READER:

It’s impossible to predict exactly how Alzheimer’s disease will affect someone. Symptoms of the disease, and how quickly they progress, can vary widely from person to person. In some people, for reasons we don’t understand, the disease progresses very slowly.

However rapidly Alzheimer’s disease progresses, it generally unfolds in five stages:

  • Stage 1. Memory problems begin. The person may misplace valuable objects. Their performance at work or in social situations begins to suffer. They may have more trouble expressing their thoughts. Personality changes also begin. A person may become withdrawn, apathetic, moody, depressed, irritable or anxious.
  • Stage 2. Memory problems are more obvious. It may be difficult for someone with Alzheimer’s to follow conversations. The person may have difficulty recalling current events or even bits of information from their own life. Depression often becomes prominent. Reasoning and judgment skills are impaired.
  • Stage 3. Memory can fluctuate daily or even hourly. People sometimes forget major events in their lives. Often they are unaware of the date or the time of year. Their conversations may become disjointed and veer off track. You may see episodes of paranoia or anger. Stressful situations can trigger shouting, cursing or hitting. At this stage, people with Alzheimer’s can still manage many basic activities of daily living. But they can no longer live independently.
  • Stage 4. In this stage, you’ll see dramatic changes. Language skills drop sharply. Memory impairment becomes profound. A person remembers only bits and pieces of his or her past. People become less withdrawn, but they often develop behavior and emotional problems, including delusions and hallucinations. Sleep disturbances and wandering are also common. By this stage, the person will likely require help to bathe, toilet, dress and eat.
  • Stage 5. This stage has been called “the long goodbye.” There seems to be very little left of the person’s “self.” Motor skills decline until the person can no longer walk, sit up, chew and swallow food, or control bladder and bowel movements. As the brain shuts down, the person becomes unresponsive, lapses into a coma and finally dies.

I am sorry to paint such a bleak picture, but unfortunately today we have no way of preventing or treating this terrible disease. However, there is reason to hope that the picture will become brighter in the future. In the past 20 years, scientists have begun to unravel what goes wrong with the chemistry of the brain in Alzheimer’s. I am cautiously optimistic that this knowledge will lead to true breakthroughs.

But like the pace of the disease itself, the pace of our growing knowledge is hard to predict. It may take decades, but I think medical research will make major advances. I know that gives little comfort to people who must deal with this terrible illness today.

(This column ran originally in October 2014.)