Stages
Introduction
Stage 1: No impairment
Stage 2: Very mild cognitive decline
Stage 3: Mild cognitive decline
Stage 4: Moderate cognitive decline
Stage 5: Moderately severe cognitive decline
Stage 6: Severe cognitive decline
Stage 7: Very severe cognitive decline
Introduction
Alzheimer's disease gets worse over time. Experts have developed "stages" to describe how a person's abilities change from normal function through advanced Alzheimer's.
It is important to keep in mind that stages are general guides, and symptoms vary greatly. Not everyone will experience the same symptoms or progress at the same rate.
This seven-stage framework is based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine's Silberstein Aging and Dementia Research Center.
Stage 1: No impairment
(normal function)
Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.
Stage 2: Very mild cognitive decline
(may be normal age-related changes or earliest signs of Alzheimer's disease)
Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.
Stage 3: Mild cognitive decline
Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms.
Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:
- Word- or name-finding problems noticeable to family or close associates
- Decreased ability to remember names when introduced to new people
- Performance issues in social or work settings noticeable to family, friends or co-workers
- Reading a passage and retaining little material
- Losing or misplacing a valuable object
- Decline in ability to plan or organize
Stage 4: Moderate cognitive decline
(mild or early-stage Alzheimer's disease)
At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:
- Decreased knowledge of recent occasions or current events
- Impaired ability to perform challenging mental arithmetic – for example, to count backward from 100 by 7s
- Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests or paying bills and managing finances
- Reduced memory of personal history
- The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations
Stage 5: Moderately severe cognitive decline
(moderate or midstage Alzheimer's disease)
Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:
- Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated
- Become confused about where they are or about the date, day of the week or season
- Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
- Need help choosing proper clothing for the season or the occasion
- Usually retain substantial knowledge about themselves and know their own names and the names of their spouses or children
- Usually require no assistance with eating or using the toilet
Stage 6: Severe cognitive decline
(moderately severe or midstage Alzheimer's disease)
Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:
- Lose most awareness of recent experiences and events as well as of their surroundings
- Recollect their personal histories imperfectly, although they generally recall their own names
- Occasionally forget the name of their spouses or primary caregivers but generally can distinguish familiar from unfamiliar faces
- Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
- Experience disruption of their normal sleep/waking cycles
- Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)
- Have increasing episodes of urinary or fecal incontinence
- Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that a caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
- Tend to wander and become lost
Stage 7: Very severe cognitive decline
(severe or late-stage Alzheimer's disease)
This is the final stage of the disease when 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.
Individuals at this stage need help with much of their daily care, including eating or using the toilet. They may also lose their capacity to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing is impaired.
Next: Asians and Pacific Islanders and Alzheimer's
簡介
第 1 階段：無損傷
第 2 階段：極輕微的認知能力衰退
第 3 階段：輕微認知能力衰退
第 4 階段：中度認知能力衰退
第 5 階段：稍嚴重的認知能力衰退
第 6 階段：嚴重認知能力衰退
第 7 階段：極嚴重的認知能力衰退
簡介
阿滋海默症會隨時間而惡化。專家已詳細說明了用於說明人們的能力如何從正常功能發展到晚期阿滋海默症的「階段」。
請瞭解這些階段為一般指引，各症狀有很大的差異，這一點非常重要。並非每個人都會出現相同症狀或者以相同速度發展。
這種分七個階段的架構是紐約大學醫學院 Silberstein 老化與失智症研究中心臨床主任 Barry Reisberg 提出的。
第 1 階段：無損傷
（功能正常）
未受損傷的人沒有出現記憶問題，並且在醫患溝通過程中醫療保健專業人員也看不出明顯的症狀。
第 2 階段：極輕微的認知能力衰退
（可能是與年齡相關的正常變化，或者是阿滋海默症的最早期徵兆）
個人可能感覺到他們的記憶力下降，尤其是忘記熟悉的詞語或名字，或者鑰匙，眼鏡或其他日常物品的位置。但這些問題在進行醫學檢查過程中不明顯，朋友，家人或同事幾乎看不出這些問題。
第 3 階段：輕微認知能力衰退
在具有這些症狀的一些（但並非全部）人中可診斷出早期階段的阿滋海默症。朋友，家人或同事開始注意到他們的這些症狀。記憶或注意力的問題可在臨床試驗中加以測量，或者在詳細的醫患溝通過程中加以辨別。常見困難包括：
- 家人或關係密切的同事能夠注意到患者的忘記詞語或名字的問題
- 在介紹給初次見面的人時記住對方姓名的能力減退
- 家人，朋友或同事能夠注意到患者的在社交或工作環境中的表現發生問題
- 閱讀一篇文章後幾乎記不住其中的內容
- 將貴重的物品遺失或放錯位置
- 計劃或組織的能力下降
第 4 階段：中度認知能力衰退
（輕微或早期阿滋海默症）
在此階段中，仔細的醫患溝通，一個詳盡的病情面談可發現以下方面明顯的改變：
- 不太知道最近發生的事
- 進行具有挑戰性的心算的能力下降 – 例如從 100 開始每隔 7 個數目進行倒數
- 執行複雜工作的能力下降，例如行銷，為請客作計劃和準備晚餐或支付帳單，以及管理財務
- 對個人往事的記憶力下降
- 患者變得比較沉默寡言和孤僻，尤其是在社交場合或需要腦筋急轉彎的情況下
第 5 階段：稍嚴重的認知能力衰退
（中度或中期阿滋海默症）
記憶力出現較大減退，並且認知功能下降。需要一些協助來進行日常活動。在該階段，人們可能：
- 在看醫生時無法回憶一些重要細節，例如他們目前的地址，電話號碼，或者他們畢業的大學或中學名稱
- 分不清他們所在的位置，或者日期，星期幾或季節
- 難以進行難度不大的心算；例如從 40 開始每隔 4 個數進行倒數，或者從 20 開始每隔 2 個數進行倒數
- 在選擇適合季節或場合的衣服時需要協助
- 通常大體上瞭解自己，並且知道自己的姓名以及他們配偶或子女的姓名
- 在吃飯或上廁所時通常需要協助
第 6 階段：嚴重認知能力衰退
（稍嚴重或中期阿滋海默症）
記憶力不斷下降，可能出現重大個性變化，受影響的人在進行習慣的日常活動時需要大量協助。在該階段，人們可能：
- 幾乎記不起最近的經歷和活動，以及他們周圍的情況
- 儘管他們一般可回想起自己的姓名，但不能完全回憶起他們的個人往事
- 偶爾會忘記他們配偶或主要照護者的姓名，但一般能夠辨別熟悉和不熟悉的面孔
- 需要協助正確穿衣服；在無監督的情況下，可能會犯錯誤，例如將睡衣套在白天穿的衣服上，或將鞋子穿錯腳
- 他們的睡眠/覺醒週期變得不規律
- 需要協助處理上廁所的細節（沖馬桶，無法正確的擦拭和丟棄衛生紙）
- 大小便失禁的情況增加
- 出現重大個性變化和行為症狀，包括多疑和錯覺(例如，認為照護者是騙子)；幻覺（看到或聽到並不真正存在的事情)；或者強迫的重複行為，例如扭絞雙手或撕衛生紙
- 往往會走失和迷路
第 7 階段：極嚴重的認知能力衰退
（嚴重或晚期阿滋海默症）
這是該疾病的最後階段，此時患者會喪失回應環境，進行對話的能力，最後無法控制行動。他們可能只會說單詞或片語。
處於該階段的患者需要別人照顧他們的日常生活，包括吃飯或上廁所。他們還可能失去微笑，在無支撐的情況下坐下以及抬頭的能力。反射作用變得異常。肌肉變得僵硬。吞咽能力下降。
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