World Alzheimer’s Month is September - Why It’s Important to Spread Awareness

It is always good to encourage patients and their families to ask questions of their medical care providers and to share information about symptoms and concerns. In the case of a dementia diagnosis, it is imperative that families understand there are many types of dementia. The dementia that most people have heard of is Alzheimer’s disease. Alzheimer’s, just one of 10 dementia classifications, is the most prevalent of the dementias. Diagnosis numbers for Alzheimer’s continue to grow at an aggressive rate. Mayo Clinic reports an estimated 6.5 million Americans aged 65 and older are living with Alzheimer's in 2023. Of the about 55 million people worldwide with dementia, 60% to 70% are estimated to have Alzheimer's disease¹.

Understanding the type of dementia that a loved one is challenged with is key to ensuring that the proper care plan and treatments are in place. While significant research is ongoing, and new therapies are being developed, dementia is currently not curable. However, proper treatment can help those living with the disease, and their caregivers, to cope with symptoms and improve quality of life.

With Alzheimer's, the symptoms depend on the stage of the disease and cause a gradual decline in memory, thinking and reasoning skills. The disease results from the progressive loss of brain cells and therefore progresses slowly in three stages: early, middle, and late². Since Alzheimer’s affects people differently, each person may progress through the stages differently. Changes in the brain begin years before any symptoms occur. This period can last for years and is referred to as preclinical Alzheimer's disease. It’s important to note that it may be difficult to place a person in a specific stage as stages may overlap. Also, note that since individuals with Alzheimer's experience symptoms differently, the stages outlined below should only be used as a general guide².

Early-stage (mild)
In the early stage, a person may function independently. They may be able to tackle tasks such as driving, working, and partaking in social activities. Despite this, the person may feel as if they are having memory lapses, such as forgetting familiar words or locating everyday objects. Symptoms may not be widely obvious at this stage, but family and friends may notice, and a doctor would be able to identify symptoms using certain diagnostic tools. A few common difficulties include coming up with the correct word, losing or misplacing a valuable object, or experiencing increased trouble with planning or
organizing.

Middle-stage (moderate)
The middle-stage is typically the longest stage and can last for many years. The individual will require a higher level of care as the disease progresses. During the middle stage, symptoms are more apparent. He or she may confuse words, get frustrated or angry, and act in unexpected ways, such as refusing to bathe. They may experience confusion about where they are or what day it is. Damage to nerve cells in the brain can make it challenging for the individual to express thoughts and complete routine tasks without assistance. In the middle stage, he or she can still participate in daily activities with assistance. It’s important to identify what the person can still do or find ways to simplify tasks. During this stage, caregivers may want to consider an adult day center so they can have some temporary assistance while the individual with Alzheimer’s continues to receive care in a safe environment.

Late-stage (severe)
In the last stage, symptoms are severe, and individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but it becomes difficult to communicate abstract ideas like levels of pain. As memory and cognitive skills continue to decline, significant personality changes may occur, and individuals need extensive care. The Alzheimer’s patient may require 24-hour assistance with daily personal care and can become susceptible to infections, especially pneumonia. Even though the individual may not be able to initiate engagement as much during the late stage, they can still benefit from interaction in ways that are appropriate, like listening to music of their liking or getting reassurance through gentle touch. At this stage, caregivers may want to utilize support services, such as hospice care, which offer comfort at the end of life.

As Alzheimer’s disease progresses and neurocognitive impairment becomes more severe, the risk of falls significantly increases³. While falls may seem like a physical issue, aspects of cognitive function are major influences that contribute to increased falls. Some of the most
common causes of falls are outlined below³:

• Severity of the disease: Typically, Alzheimer's patients in the later stages are more likely to experience frequent falls than those in the earlier stages.
• Gait changes and balance: Changes in gait and poor balance contribute to difficulty walking and balancing, which can ultimately lead to falls.
• Changes in visual perception: A person with Alzheimer's can misinterpret what he or she sees which can cause them to misjudge steps, trip over objects, slip, and fall. Some individuals experience loss of sight, while others may struggle with visualizing and interpreting their environment.
• Confusion and delirium: Impairment of memory and cognitive decline can lead to confusion and delirium in many patients. This confused thinking and reduced awareness of the environment can cause patients to become irritable, anxious, or restless. A diagnosis of delirium increases fall risk by up to six times.
• Side effects from medications: Many patients are on several medications to treat several conditions. Some medications can increase the risk of falls, including benzodiazepines, antipsychotics, anticonvulsants, antidepressants, opioid analgesics, anticholinergics, and antihypertensives. Antihypertensive medications (those that work to lower blood pressure), for example, can cause dizziness.

World Alzheimer’s Month is September with the goal of raising awareness of the disorder and providing platforms to discuss what is new in medical breakthroughs for the disease. New therapies including stem cell therapy⁴, new medications, and prevention methods are evolving and becoming available to patients. It is important for families to receive the right patient diagnosis, and to have informed discussions with their care team. There are many ways to get involved to help spread awareness⁵ .

The Greater Maryland Alzheimer’s Association is hosting six (6) individual walks throughout the greater Maryland region: Aberdeen, Annapolis, Ellicott City, Frederick, Hunt Valley, and Salisbury. Consider joining or donating to the CarePatrol of Baltimore team as we walk together to end Alzheimer’s on Saturday, October 28th in Hunt Valley (our team sign up page is here:
http://act.alz.org/goto/CarePatrolForgetMeKnots.

References:
¹ Mayo Clinic https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-
causes/syc-20350447
² Alzheimer’s Association https://www.alz.org/alzheimers-dementia/stages
³ Altoida https://altoida.com/blog/the-correlation-between-alzheimers-and-frequent-falls/
⁴ DVC Stem https://www.dvcstem.com/post/stem-cell-therapy-for-
alzheimers?msclkid=b860436b99431e9c39da27918c1708e8
⁵ Alzheimer’s Association https://www.alz.org/about/awareness-initiatives