A Family Caregiver’s Guide to Mild-Stage Alzheimer’s Disease
(Can be used for understanding other types of dementia as well)
Understanding Mild-Stage Alzheimer’s Disease (FAST Stage 4)
While each person’s journey through Alzheimer’s is unique, most people experience some common symptoms in a similar progression. Understanding these common Alzheimer’s symptoms can be helpful in terms of helping your loved one cope with the changes on a day-to-day basis and helping you plan for caregiving needs.
In mild-stage illness, while the individual is still able to be mostly independent and social (even driving may continue to be safe), the changes in the brain continue and are slowly creating more dysfunction or inability to do things the patient would have easily done in the past.
In this progressive illness, the changes from the early-stage illness are continuing to worsen, and new issues will start to arise.
The changes of this stage are typically obvious to the family caregiver or in fact anyone interacting with the patient.
For caregivers, the exact way to respond to this stage is complicated by the variable effect this stage has on the patient’s level of awareness. Some patients will retain complete insight into the ongoing changes. For these patients, they can be at risk for depression, anxiety, anger or an unsettled mix of emotions. For other patients, they are unable to “see” their deficits and may therefore resist anyone attempting or offering to help. If they don’t see a need, why would they need help? Finding a path forward as a family caregiver is challenging in this stage.
Let’s start by reviewing some of the common “mild-stage” symptoms and steps every family caregiver should take at this stage. Individuals with mild-stage Alzheimer’s disease will have significant decline in function overall. Typically, there will be difficulty in the more complicated activities of daily life in this stage, but keep in mind not everyone will experience all Alzheimer’s symptoms of each stage.
Symptoms in Mild-Stage Alzheimer’s Disease
Memory Loss Symptoms
Remembering names when introduced to new people.
Forgetting material that was just read/Processing what was said by others and understanding what has been read.
Losing or misplacing a valuable object.
Recalling recent events such as appointments or conversations.
Communication-Related Symptoms:
Coming up with the right word or name.
Expressing thoughts and feelings due to difficulty finding the right word or difficulty writing letters or emails.
Executive Function/Multi-tasking/Planning/ Concentration
Having difficulty performing tasks in social or work settings.
Experiencing increased trouble with planning or organizing shopping trips, dinner parties, trips.
Making decisions and judgments, especially with limited time such as in response to an emergency.
Handling tasks such as balancing a checkbook or taking medications as prescribed.
Concentration may be reduced.
Emotional Symptoms
Behavior and mood changes including loss of interest in favorite activities and socializing, new onset of or increase in feelings of anxiety and depression.
Being a Family Caregiver for a Loved One in Mild-Stage Alzheimer’s Disease
For caregivers, the exact way to respond to this stage is complicated by the variable effect this stage has on the patient’s level of awareness. Some patients will retain complete insight into the ongoing changes. For these patients, they can be at risk for depression, anxiety, anger or an unsettled mix of emotions. For other patients, they are unable to “see” their deficits and may therefore resist anyone attempting or offering to help. If they don’t see a need, why would they need help? Finding a path forward as a family caregiver is challenging in this stage.
Helping Your Loved One in the Mild-stage of Alzheimer’s Disease
For Loved ones who retain complete or partial insight into their illness and its decline, the family plays a vital role in maintaining as much quality of life as possible amid this serious challenge.
Steps you will want to consider:
Risk for Depression / Anxiety:
Keep in mind the very real possibility that your Loved one is at risk for developing major depression or generalized anxiety. If you have any concerns about their mood, start by having them seen by their primary care provider to ensure thorough evaluation is completed. If they are found to have one of these conditions, there are treatment strategies that should be considered.
Usual care for these emotional diseases often includes both medication and counseling, and for someone in mild-stage Alzheimer’s these should be offered as well. While the intellectual changes may limit the potential for counseling to help, it can help some patients, and should be considered. Medications can be helpful to some patients and should be considered as well. Be certain to ask the provider to avoid medications that may add excessive sedation that may further worsen cognitive ability.
Strategies to Stay Social:
One aspect of Alzheimer’s disease that can have a significant impact on your loved one is the change in social circles and activities. Often due to a combination of the slowly worsening cognitive changes and emotional changes, involvement in social settings can become more difficult for patients to manage. Even well-known places or activities can become a potential source of embarrassment or a trigger for increased anxiety if your loved one’s memory is fading. For example, if your loved one has gone to church every week for many years, it can be upsetting if they can no longer remember the names of long-time friends.
In other situations, it is friends or even family members that withdraw after a diagnosis such as Alzheimer’s disease. Some people find it difficult to face seeing the changes in your loved one or they are unsure how they should behave, so they simply avoid you. Clearly that is a regrettable reality, but many caregivers find they instead find some meaningful and helpful relationships from new friendships with people who are more able to handle the situation or are in a caregiving situation themselves.
Acknowledge your loved one’s feelings and assure them you will continue to be alongside them as you adjust to this new normal.
You will need to take the lead and think through whether it is possible to continue an old hobby with modification or if you need to seek out alternatives. Keep things going as long as possible but ONLY if your loved one is obviously enjoying it. Any sign of anxiety should be taken as a signal to start looking for other options.
Be open to the possibilities of what your loved one may enjoy now. Since the illness changes their mind there are some beautiful examples where new interests emerge. The best example is that some Alzheimer’s patients become more artistic. So even if your loved one was a strictly “stick-figure artist”, for example, you might consider giving “paint-by-number” kits a try!
Reach out for support for both yourself and your loved one. The more you reach out to others and get support, the more you will be able to cope with Alzheimer’s symptoms while continuing to enrich and find meaning in your life.
Your Role as Advocate for Your Loved One:
In the mild stage of illness, continue to encourage your loved one to stay involved in discussions about day-to-day issues as much as possible. Of course, as the disease progresses there will come a time that they will no longer be able to participate in complex deliberations or decision making. Your advocacy will start to take on a greater role in this stage.
