Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease)
Okay, this is where things get pretty obvious and serious. This is when the going gets rough for the caregiver and the frustration gets huge for most Alzheimer's patients. This is where a great deal of the agitation occurs. People are aware that they aren't functioning normally, and it understandably makes them angry. They often take it out on the person or people they feel safest with – their spouse and/or their adult children. Those that are their caregivers.
The Alzheimer's afflicted person will have major memory gaps, and people at this stage often need some help with daily living. This, my friends, is where I would have to stop blaming my right-brained thinking and if I were to have these problems, I likely would have to concede that I had dementia, probably of the Alzheimer's type.
People in this stage are often unable to recall their current address or phone number. They may not remember where they graduated from school, can become confused not only about the date (not too hard to do) but the season, as well. They have trouble with easier arithmetic such as counting backward from 20 by 2s. They often need help choosing appropriate clothing for the occasion or even for the season.
The Alzheimer's Association says that in stage 5, people usually retain "substantial knowledge about themselves," such as their own names and those of their children. They also, generally, do not need help eating or using the toilet.
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease)
This stage is where really significant personality changes can emerge. That sweet person you used to know suddenly is combative, volatile and possibly violent at times. The Alzheimer's Association says that at this stage, people lose "most awareness of recent experiences…as well as their surroundings."
People in this stage can be very inventive, when trying to outwit the caregiver. They are also prone to wandering, so keeping them safe can be a challenge. They've been known to find ways to unlock several locks on doors and to enable a supposedly disabled car. They are not dumb, folks. This isn't about intelligence.
Caregivers have been known to remove and hide car batteries. People sometimes get alarms installed that are meant to let you know if someone is breaking in, but they get them so they know if their Alzheimer's afflicted loved one is breaking out.
During this wandering prone stage, an Alzheimer's afflicted person must be watched carefully, as an unfortunate number of them have, literally, been stranded out in the cold. There are alarms and ID bracelets and other forms of protection on the market that can help keep track of, or find, someone who is wandering.
Stage 6 is also a phase where, according to the National Alzheimer's Association, "(People) lose most awareness of recent experiences and events as well as of their surroundings."
They often don't remember their own histories and can forget the names of people they love (though they usually recognize faces). They need help dressing and toileting. This, too, is the stage where the sleep cycle is greatly disturbed for this person (to say nothing of the caregiver's sleep cycle).
Late day/early evening confusion, often called "sundowning," where the person is agitated and confused is thought to have to do with light and/or activity changes that trigger the Alzheimer's patient's need to do something important, but they don't know what (perhaps it's time to "go home from work?"). Whatever the cause, this is a difficult time of day for many caregivers and dementia patients.
Stage 6 is also the phase where the caregiver will witness more paranoia or suspicions ("they are trying to steal my dentures"). Hallucinations are not at all uncommon, and compulsive behaviors such as picking, tissue shredding, scratching and hand-wringing can occur.
This is often the phase where the person with Alzheimer's may need to be moved to a secure environment where they are safe and the caregiver can get some relief from the 24/7 job of caregiver (often that occurs earlier).
Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)
This phase, before death, is the sad time when speech is often unrecognizable, there is general incontinence, eating is difficult (or food refused – in any form) and swallowing can be impaired. They usually need assistance and support walking and even sitting.
This stage was one that I found particularly hard for caregivers to tolerate, in that many become frantic when the Alzheimer's patient wouldn't eat. We, as healthy humans, get hungry. We think they must be starving. However, as the body prepares to die, it often does not want food. The organs are shutting down.
I've shared, throughout all the phases, many a tearful session with caregiving friends. From Stage 3 on, this disease is a mind-bender to deal with. Each stage puts new demands on the caregiver.
Education can help. Contact the National Alzheimer's Association or the Alzheimer's Foundation of America. The adjustment to the final stage, which will bring death, is one where hospice can support the caregiver, as well. Don't go through this alone. Caring for someone with Alzheimer's takes a super-human effort. This is a disease where community support can make all the difference. Get help for your loved one. Get help for yourself.