Category: Dealing with Dementias

Does she have a dementia?

Every day, we all take part in activities that we do routinely, often without much thought or planning. We complete work tasks, take part in hobbies and social events, cook and clean, and care for ourselves.

When an individual is not able to independently and reliability complete “activities of daily living” (ADLs) he or she may be showing signs of Alzheimer’s Disease or another dementia (cognitive impairment).

Having temporary trouble with an activity of daily living may not be alarming, but when an individual has persistent difficulties with one or more ADL, it is recommended that they consult with a physician for a thorough examination.

What are “Activities of Daily Living”?

Activities of Daily Living (ADLs) are tasks that we carry out routinely every day. They include

• Eating
• Hygiene: bathing, washing, brushing teeth, and grooming)
• Dressing: selecting and putting on clothing
• Using the toilet and maintaining continence
• Movement: walking and getting into and out of bed and chairs

There are also Instrumental Activities of Daily Living (IADLs), which are more complex tasks that have an impact on whether an individual can function independently. For example,

• Communication: using phone, email or other tools to communicate as needed
• Transportation: driving or using appropriate public/private transportation
• Shopping: buying food, clothing, medications, and other necessities
• Food preparation: making appropriate food choices, preparing and storing foods safely, and following recipes
• Medications: organizing and taking medications appropriately
• Home maintenance: completing tasks related to safety, cleanliness, and proper functioning of the home and appliances
• Finances: making sound financial decisions, keeping accurate financial records, and understanding one’s financial resources

 

The American Elder Care Research Organization provides its definitions of ADLs and IADLs, along with a checklist for informal use, at ADLs & IADLs.

Another article, by social worker Esther Heerema for VeryWell.com, provides information about the reasons for changes in ADLs and some tips for caregivers at ADLs – Causes and Tips.

When Did He Get Alzheimer’s Disease? A Continuous Journey

We probably all know that we can’t date the start of Alzheimer’s Disease. Instead, we notice changes over time.

• Hal’s memory is not working well. He is asking the same question several times in a row or he drives to the neighborhood supermarket, but doesn’t remember what he went there to buy.
• Susana, a sweet and passive woman for most of her life, seems grumpy and snaps at her family members.
• Bella has bruises on her body, but doesn’t remember falling.

Alzheimer’s Disease develops gradually. In fact, it may begin to develop long before the symptoms are noticed by the patient or people around him.

We won’t know when the disease started, but it is helpful to know how the disease develops over time.

Most descriptions of Alzheimer’s Disease include three stages, starting with noticeable symptoms. The following list includes two additional stages . . . stages before symptoms interfere with daily living.

Before noticeable symptoms:

1. Prior to Symptoms: The brain may undergo changes for many years, but there are no noticeable, significant symptoms of the disease.
2. Mild Cognitive Impairment (MCI): People who have MCI experience some memory and thinking changes but are capable of independently carrying out daily activities. About 38% of people with MCI go on to develop Alzheimer’s Disease.

After noticeable symptoms:

1. Early (or Mild) Stage Alzheimer’s Disease: People with an Alzheimer’s Disease diagnosis experience changes in memory, language and personality that make some tasks difficult for them. The changes are noticeable and interfere to some extent with carrying out activities of daily living.
2. Middle (or Moderate) Stage Alzheimer’s Disease: In this stage, the person with a diagnosis needs significant amounts of help with activities of daily living, but can communicate some and carry out some activities without help.
3. Late (or Severe) Stage Alzheimer’s Disease: Typically, in this stage, the person with a diagnosis needs help with all activities of daily living. Communication and memory are severely restricted.

Alzheimer’s Disease is a progressive disease. It is often described as a “continuum,” which reminds us of a smooth, steady progression of changes. However, this is not always the case.

• The changes caused by Alzheimer’s Disease and the timing of those changes vary from person to person.
• The disease does not always progress in a continuous, smooth path. There are times when some changes seem to be noticed “suddenly” or “acutely.”
• A person’s ability to remember, communicate, and engage in activities may be stronger some days than other days.

 

For more about the progress of Alzheimer’s Disease, you might see the Alzheimer’s Association’s Stages of Alzheimer’s.