Alzheimer’s disease continuously degenerate the general function of the brain cells causing massive neurologic disruption and brain malfunctions. The signs and symptoms of Alzheimer’s disease can be divided using the four phases of dementia comprising of (a) pre-dementia, (b) early dementia or middle stage, (c) moderate dementia or late stage and (d) advanced dementia or terminal stage (Roach, 2000 p. 204). During the stage of pre-dementia, the common symptoms identified are (a) forgetfulness and (b) uncertainties.
According to Papanicolau, Billingsley-Marshall and Blum (2006), the pre-dementia stage usually has a slow progression and can take up an average of three to five years before proceeding to the next stage (p. 106). Memory and cognitive deficiencies are usually mild during this stage, while emotional impairments are almost undetectable. However, the patient in this stage may already experience problematic concepts in relationships, principles, meanings and abstract reasoning (Roach, 2000 p. 204).
In the second stage – early dementia, the distinguishing symptoms is the patient’s occasional to frequent disoriented behaviors and instances of confusion (Roach, 2000 p. 204). During the progress of the disease, the most commonly affected functions are memory and thought, which are significant elements of emotional processing (Balch, 2006 p. 193). According to Silverstein, Flaherty and Tobin (2006), the patient already requires supervision since most of them cannot anymore perform their daily tasks without supervision (p.
19). During this phase, the patient is still capable of independent activities, appropriate decision-making and expressions of appropriate emotions (Roach, 2000 p. 204). However, the patient may already manifest feelings of anxiety, hallucinations, panic and other psychiatric aggressive behaviors (Silverstein, Flaherty and Tobin, 2006 p. 19). In the third stage of dementia, the actual manifestations of demented behaviors become more evident.
According to Balch (2006), as Alzheimer’s disease becomes severe, memory loss, emotional disorientation and remaining intellectual functions dramatically decline as well as a result of the brain degeneration (p. 196). Common manifestations of the disease include disorientation from reality, dysphagia, unpredictable and aggressive behavior, unable to recall appropriate events in the past, and development of hallucinations and delusions (Balch, 2006 p. 193).
The stage of moderate dementia or late stage comprises an even greater cognitive loss leading to problematic memory and emotional function. According to Roach (2000), the patient at this stage may manifest significant emotion disorientations and respond inappropriately in any given event (p. 204). The study of Hargrave, Maddock and Stone (2002) suggest that Alzheimer patients are capable of perceiving emotion stimuli but cannot appropriately reply with the correct emotion due to the impairment caused by the disease.
Lastly, in the terminal phase of dementia, the patient becomes mute, loses the capacities to function both mentally and physically, total impairment of memory and, most importantly, unable to respond or perceive emotional stimuli presented in any form of environment (Roach, 200 p. 204). In this stage, the patient become incontinent and unable to perform any self-care activities; hence, the patient becomes totally dependent for care and basic needs.