Question:
My mother (age 97...yes she is 97 to be 98 in July) has had dementia for thelast several years, and now the doctor feels it is alzheimers. She has hadsome myoclonic seizures (periodic jerking of her legs or arms) which she isnow taking medication for. She appears to be in stage 3, but that's only aguess. She is not talking much, and has trouble swallowing. She is alsosleeping a lot (goes into a deep sleep). Can anyone tell me about thisstage? How long do most people live once they reach the point of havingdifficulty in swallowing. She still recognizes me (her daughter) and knowsmy name. At present, she is in the hospital and we are looking for anursing home for her to go to. Any help and information ????

Answer: Stages of Alzheimers

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints ofmemory deficit. No memory deficit evident on clinical interviews.

Level 2Very mild cognitive decline (forgetfulness or normal older adult).Subjective complaints of memory deficit, most frequently in thefollowing area:(a) forgetting where one has placed familiar objects;(b) forgetting names on formerly knew well. No objective evidence ofmemory deficit on clinical interview.

Level 3Mild cognitive decline (early confusional or Early AD). Earliestclear-cut deficits. Manifestations in more than one of the followingareas:(a) patient may have gotten lost when traveling to an unfamiliarlocation;(b) co-workers become aware of patient's relatively low performance;(c) word and name finding deficit becomes evident to intimates;(d) patient may read a passage of a book and retain relatively littlematerial;(e) patient may demonstrate decreased facility in remembering namesupon introduction to new people;(f) patient may have lost or misplaced an object of value;(g) concentration deficit may be evident on clinical testing.

Level 4 Deficit manifest in followingareas:(a) decreased knowledge of current and recent events; (b) may exhibitsome deficit in memory of one's personal history;(c) concentration deficit elicited on serial subtractions; (d)decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:(a) orientation to time and person;(b) recognition of familiar persons and faces;(c) ability to travel to familiar locations. Inability to performcomplex tasks. Denial is dominant defense mechanism. Flattening ofaffect and withdrawal from challenging situations occur.

Level 5Moderately severe cognitive decline (Early Dementia or moderate AD).Patient can no longer survive without some assistance. Patient isunable during interview to recall a major relevant aspect of theircurrent lives, e.g., an address or telephone number of many years, thenames of close family members (such as grandchildren), the name of thehigh school or college from which they graduated. Frequently somedisorientation to time (date, day of week, season, etc.) or to place.An educated person may have difficulty counting back from 40 by 4s orfrom 20 by 2s.

Level 6Severe cognitive decline (Middle Dementia or Moderately Severe AD).May occasionally forget the name of the spouse upon whom they areentirely dependent for survival. Will be largely unaware of all recentevents and experiences in their lives. Retain some knowledge of theirpast lives but this is very sketchy. Generally unaware of theirsurroundings, the year, the season, etc.

Level 7Very severe cognitive decline (Late Dementia or Severe AD). All verbalabilities are lost. Frequently there is no speech at all - onlygrunting. Generalized and cortical neurologic signs andsymptoms are frequently present.

7a - Speech ability limited to about a half-dozen intelligible words7b - Intelligible vocabulary limited to a single word7c - Ambulatory ability lost7d - Ability to sit up lost7e - Ability to smile lost7f - Ability to hold up head lost