Risk Factors and Stages of Alzheimer’s Disease

Risk Factors and Stages of Alzheimer’s Disease

The information in this post is from the Alzheimer’s Prevention and Intervention Specialist Certificate Program: Course 1: Exercise Prescription for Alzheimer’s Prevention and Intervention.
Authored by Dharma Singh Khalsa M.D., Founding President/Medical Director of Alzheimer’s Research and Prevention Foundation.

There is a growing body of research on modifiable risk factors for dementia. However, modern medicine still hasn’t discovered all the answers in this field. Therefore, prevention supports available evidence targeting risk factors for vascular disease such as diabetes, hypertension, obesity, smoking, hyperlipidemia, and physical inactivity. (Dementia: A World Health Priority 2016) Many of these risk factors can be controlled effectively by making healthy lifestyle choices to aid in the prevention of Alzheimer’s disease.

Most experts believe that Alzheimer’s disease, similar to other common chronic diseases, develops as a result of multiple factors instead of a single cause. They also support the idea that some risk factors can be controlled by making smart lifestyle choices.

Physical exercise on a regular basis is a valuable habit to help decrease the risk of Alzheimer’s and vascular dementia. Exercise may benefit the brain cells directly by improving both oxygen and blood flow to the brain. An evidence-based and medically approved exercise program is recommended as part of an overall wellness plan. (Prevention and Risk of Alzheimer’s and Dementia 2016)

There are a number of risk factors that may lead to cognitive decline.
(Adapted from Alzheimer’s Risk Factors 2016 and 2016 Alzheimer’s Disease Facts and Figures 2016)

  • Age
  • Family History
  • Genetic Predisposition
  • Stroke
  • Depression
  • Head/Brain Injury
  • Lack of Adequate Sleep
  • Cardiovascular Disease and Risk Factors.
    • Smoking
    • Diabetes
    • Hypertension (high blood pressure)
    • High cholesterol
    • Physical inactivity
    • Obesity

Exercise is an important part of treatment. Research shows that it may help slow the progression of disease. Be patient and creative when working with clients who have Alzheimer’s disease. Have an understanding of the disease progression, be vigilant in identifying physical decline, and overall, adjust their exercise program to maintain safety. The seven stage model that is commonly accepted and used to stage the progression of Alzheimer’s is provided below. 

When working with clients, it is helpful to understand the stage of progression (often identified by disease symptoms) they are experiencing. This will give you ideas and guidelines for how to most effectively communicate and motivate the client in order to produce results. Different strategies may be required for communication, programming, and expectations during different stages of disease progression.

For more information on risk factors, risk factor reduction, stages of progression, and The 4 Pillars of Alzheimer’s Prevention™, see the FLS course Introduction to Alzheimer’s Disease. Or visit the Alzheimer’s Research and Prevention Foundation Website at www.alzheimersprevention.org.

Seven Stage Alzheimer’s Disease Progression Model for Help with Expectations during Disease Progression.
(Alzheimer’s Disease: Symptoms, Stages, Diagnosis and Coping 2016) 
(Reprinted with permission from HelpGuide.org)

Stage 1:
Subjective Cognitive Decline (SCD). No impairment. Memory and cognitive abilities appear normal, but individual complains of memory difficulties.

Stage 2: 
Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel, especially as about half of all people over 65 begin noticing problems in concentration and word recall.

Stage 3: 
Early Confusional/Mild Cognitive Impairment. While subtle difficulties begin to impact function, the person may consciously or subconsciously try to cover up his or her problems. Difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur. Duration: 2 to 7 years.

Stage 4: 
Late Confusional/Mild Alzheimer’s. Problems handling finances result from mathematical challenges. Recent events and conversations are increasingly forgotten, although most people in this stage still know themselves and their family. Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping. Often withdraw from social situations, become defensive, and deny problems. Accurate diagnosis of Alzheimer’s disease is possible at this stage. Lasts roughly 2 years.

Stage 5: 
Early Dementia/Moderate Alzheimer’s disease. Decline is more severe and requires assistance. No longer able to manage independently or recall personal history details and contact information. Frequently disoriented regarding place and or time. People in this stage experience a severe decline in numerical abilities and judgment skills, which can leave them vulnerable to scams and at risk from safety issues. Basic daily living tasks like eating and dressing require increased supervision. Duration: an average of 1.5 years.

Stage 6: 
Middle Dementia/Moderately Severe Alzheimer’s disease. Total lack of awareness of present events and inability to accurately remember the past. People in this stage progressively lose the ability to take care of daily living activities like dressing, toileting, and eating but are still able to respond to nonverbal stimuli, and communicate pleasure and pain via behavior. Agitation and hallucinations often show up in the late afternoon or evening. Dramatic personality changes such as wandering or suspicion of family members are common. Many can’t remember close family members, but know they are familiar. Lasts approximately 2.5 years.

Stage 7: 
Late or Severe Dementia and Failure to Thrive. In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Total support around the clock is needed for all functions of daily living and care. Duration is impacted by quality of care and average length is 1 to 2.5 years.

References:

7 Essential Guidelines for Exercise for Diabetics

7 Essential Guidelines for Exercise for Diabetics

November is Diabetes Awareness Month!
The information in this course is from “Exercise, Diabetes, and Metabolic Syndrome,” a continuing education course offered by NAFC.  

There are several precautions a client can take to not only prevent hypoglycemia, but to also have a safe exercise experience. Use these Guidelines to help your client avoid complications during exercise.

  1. Inject insulin in a part of the body that will not actively be used for exercise. The abdomen is recommended.
  2. Check blood glucose levels before, during and after exercise the first couple of exercise sessions and/or if trying a new activity.
    • Activity type, intensity, and duration may affect glucose levels.
    • Typically, 1 hour of exercise = an additional 15 grams of carbohydrates either before or after exercise.
  3. During exercise, a quick source of carbohydrates (that does not also contain fat) should be readily available such as orange juice or hard candy.
  4. Be aware of a delayed post-exercise hypoglycemia in those who take insulin.
    • Metabolism may remain elevated for several hours post-exercise especially during the night.
    • Check glucose at bedtime and again a couple hours after (~1-2AM) especially on a day of increased activity.
  5. Adequate fluids before during and after exercise are recommended.
  6. Wear proper shoes with polyester or blend socks as well as inspecting feet after exercise to practice good foot care.
  7. Carry medical identification.

References: