Symptoms & Strategies for Mid Stage
As the disease progresses, you will find some of your loved one's symptoms are getting more profound, and there will also be new ones to deal with.
- Increasingly severe memory issues. A person with moderate Alzheimer's will have great difficulty remembering things that have just happened. Their short-term memory is mostly gone, but often they can still have conversations and enjoy your company. This stage is where you will most likely find the 15-minute loop, wherein you can have a perfectly normal conversation together for about 15 minutes before the Alzheimer's sufferer begins the conversation over again. This can be a perfectly enjoyable activity! As long as you both are focused on enjoying the visit, it's okay to go along with the loop.
In addition, someone with moderate progression of the disease will have trouble remembering what things are for, for example that shoes go on your feet, that forks are for eating, that undergarments go under shirts or pants, etc.
- Concentration problems. Repetition is one form of concentration problem that most Alzheimer's patients experience. It might be a word, phrase or action that's being repeated, and while it might drive you crazy, remember that it is usually harmless. Your loved one is probably either bored or feeling apprehensive. Give him an activity, such as sorting clothes in a suitcase, or change the subject completely to help distract him.
- Anxiety, Depression, and Paranoia. Depression often occurs in Alzheimer's patients when they aren't able to do the things they used to be able to do. Make sure your loved one, while being cared for, still has a sense of purpose and value. Let her help wash the vegetables as you prepare dinner or clean some plastic plates (even if the plates were purchased just for this activity!). Or help him to sort something – nuts and bolts of different sizes, laundry, crayons of different colors, etc. Your loved one needs to feel useful.
Anxiety and paranoia can be extremely difficult for families to face, especially when it's directed at them. If your loved one accuses your son or a family friend of stealing, remember that in their mind, this person is a stranger. Practice calming techniques, such as massages or speaking in a soft tone of voice.
- Wandering. This is one of the most dangerous symptoms of Alzheimer's disease. See our page on wandering to find ways to discourage this risky activity. Contact the Alzheimer's Association for more information on their Safe Return program, which is a 24-hour program that helps return your loved one to you, and in addition alerts hospitals to any allergies or special health needs. Check out that program at www.alz.org or call (888)572-8566 to enroll.
- Aggressive behavior. There is really no aggressive “stage” of this disease. Some people with the disease become aggressive to varying degrees, but others do not at all. People become aggressive when their fight-or-flight response is being activated because they are feeling threatened in some way, or are afraid. Check out our Ask Jo section to find lots of ways to calm your loved one and avoid confrontational behavior right from the start. If your loved one is becoming too much for you to handle or if he is excessively aggressive, then it is imperative that you find a safe place for him in an Alzheimer's-specific care facility. Don't risk harm to your loved one, yourself or your family in order to keep him at home.
- Delusions. Your loved one is losing their memory from the present, backward. They may say they want to go home, and may not remember who you are. But remember, they are now living in a different place in time. When you hear, “I want to go home,” you should not feel guilty if they're not in the last place they lived anymore. What “home” is at this point might be a childhood home, or they may even be referring to the feeling they had when they were held by their parents. If you're the child of an Alzheimer's-afflicted person and they don't remember you, they are probably existing in a time in their life before you were born. Your role as a child has changed to caregiver, and there's nothing wrong with experiencing grief over that. Don't be afraid to cry in front of your loved one, because you might find he or she wants to comfort and console you. Just because they don't remember that you're their child doesn't mean you can share hugs, laughter, tears, and the love you always have.
- Help with activities of daily living (ADLs). By this time your loved one will probably need help with many ADLs, whether you or another caregiver is assisting them. These include bathing, going to the bathroom, preparing and eating food, dressing and undressing, and walking or moving between the bed and a chair. This is where many caregivers begin to feel exasperated, because there are simply so many little things, which we usually take for granted, that now need to be addressed.
Whether you already have another caregiver helping you or not, you'll probably want to raise the level of help you're receiving at this time. You may need to hire an additional caregiver, round-the-clock care for your loved one at home, or help them transition to a facility, you will surely need more help in order to keep you from getting burned-out, sick, or injured. Especially by this stage in the disease, make sure that you are not allowing yourself to rationalize that since your loved one may not have all of these symptoms, that there is not a process taking place that will require assistance – from you, from your doctor, and from alternate caregivers. However, just because you are being honest with yourself about the toll this disease is taking on your precious loved one, doesn't mean that you can't feel a huge amount of joy and laughter from your time together. See our activities (link) page for some great ideas on things you and your loved one can do together.