As Alzheimer's disease begins to affect the cerebral cortex, memory loss continues and impairment of other cognitive abilities emerges. This stage is referred to as "mild Alzheimer's disease." The clinical diagnosis is usually made during this stage.
Signs of mild Alzheimer's disease include the following:
Confusion about the location of familiar places (getting lost begins to occur)
Taking longer to accomplish normal daily tasks
Trouble handling money and paying bills
Compromised judgment, often leading to bad decisions
Loss of spontaneity and sense of initiative
Mood and personality changes; increased anxiety
Patients with mild Alzheimer's disease usually have somewhat less obvious executive, language, and/or visuospatial dysfunction. In atypical presentations, dysfunction in cognitive domains other than memory may be most apparent. In later stages, many patients develop extrapyramidal dysfunction, including akathisia, parkinsonism, dystonia, bradykinesia, tremor, and tardive dyskinesia.
In late-stage/severe Alzheimer's disease, plaques and tangles are widespread throughout the brain, and areas of the brain have atrophied further. Patients with severe Alzheimer's disease cannot recognize family and loved ones and have extreme difficulty communicating in any way. These patients are completely dependent on others for care. All sense of self seems to vanish.
Other symptoms of late-stage disease include the following:
Seizures, skin infections, difficulty with swallowing
Groaning, moaning, grunting
Lack of bladder and bowel control
The National Institutes of Health-Alzheimer's Disease and Related Disorders Association criteria for the diagnosis of Alzheimer's disease require the finding of slowly progressive memory loss of insidious onset in a fully conscious patient. Alzheimer's disease cannot be diagnosed in patients with clouded consciousness or delirium. Toxic metabolic conditions and brain neoplasms must also be excluded as potential causes of the patient's dementia.
Learn more about the presentation of Alzheimer's disease.
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