Patterns of progression in Alzheimer’s disease, Part 3

One of the questions I am frequently asked by families and staff caring for people with Alzheimer's disease is how to better understand the patterns of progression during the slow deterioration of the brain. This blog entry is a continuation of excerpts from my book, Alzheimer's Basic Caregiving - an ABC Guide, as guidance on that topic. To order the book, click here.

Early stage patterns in communication

In the early stages, people often have word-finding difficulties.  It's the sort of thing that happens to all of us when we say, It's on the tip of my tongue, but we simply can't come up with the word we want.  Sometimes we forget a name or lose our train of thought as we're speaking.  Those things tend to happen more often when we are stressed and literally "have a lot on our minds." 

Similar to this are malapropisms.  Casey Stengel one day addressed his team by saying, Now all you fellows line up alphabetically by height.  What was the real message?  Who knows?  Confusing responses are given by people with Alzheimer's disease regularly and can be more upsetting when they realize others expect answers that they can't give.  Barb, on the videotape Inside Looking Out, describes how when she tried to explain something and couldn't come up with a word, the woman she was speaking with gave her an impatient motioning gesture, meaning, Well, come on; out with it! Barb said she was devastated by that gesture.  People with AD are often filled with self-doubt; they don't need their confidence further undermined by our impatience.  But the fact that Barb could recount the story shows that people in the early stages of AD are often highly competent in articulating their feelings and carrying on normal conversations.

In this early stage (which can last for years), they are most often "tongue-tied" because we ask them questions related to short-term memory that were never recorded in their brains. They are stymied by seemingly simple questions like, What did you have for lunch?

or What did you watch on TV last night?

Next up: Middle stage changes in AD