By the Middle Stage, it is obvious that "something is wrong" and that a medical
evaluation is necessary. Sometimes the person with Alzheimers Disease may be unaware
of the decline. Even the person who is aware of changes become less aware as time passes.
The unpredictability of the decline and changing ability of the person to function from
day to day can increase caregiver stress.Symptoms become more
severe in the Middle Stage and often include:
- Poor Short-Term Memory: After completing a meal, the elder may ask,
"When do we eat?:"
- Disorientation to Person, Place or Time: A person in this stage may
not know the name or relationship of a close relative or think that the current time is 10
to 30 years ago;
- Inability to Perform Skilled Movements: The person may be unable to
use eating utensils, tie shoelaces or operate the washer or stove;
- Language Difficulties: It may take more effort to express ideas or
needs with major word-finding problems; sentences may not make sense; speech may be slow;
- Social Withdrawal: The elder may feel uncomfortable or awkward in new
places or with groups of people, be socially dependent on caregivers and feel depressed;
- More Spontaneity, Fewer Inhibitions: There may be inappropriate
comments to friends, questions to strangers or an attempt to undress in a public place;
- Agitation: An elder may exhibit anger or anxiety if unable to express
needs or when faced with confusing situations. Frustration may lead to verbal or physical
outbursts, such as yelling or throwing furniture;
- Restlessness, Fidgeting, Pacing or Aimless Wandering: The person may
feel restless in a chair and unable to sit for any length of time. S/he may wander around
the house or pace the hallway;
- Sleepiness: The person may be slow-moving and sleepy. S/he may sleep
10 hours at night and nap during the day. The person may even nap while sitting during a
meal;
- Severe Sleep Disturbances: Some people sleep 14 to 16 hours a day.
Others sleep only two to four hours each night with or without daytime naps. Some mix up
the day/night cycle;
- Need for Assistance: Supervision and assistance with activities of
daily living must be available, although it may not be needed constantly. For example,
help may be needed with parts of dressing or just getting started at the task;
- Sundowning: As the sun goes down, the confusion increases;
- Hallucinations or Delusions: There may be evidence of hallucinations
or delusions toward the end of the day, in the middle of the night or with some people at
any time. The experience may be unpleasant or frightening;
- Changes in Eating Habits: The person may experience erratic eating,
weight loss or gain, for example.
Communication
At this stage, recall and word recognition decrease and attention
span is shortened. A person with Alzheimers Disease may change the subject often.
You may need to repeat the same question or sentence many times and in different ways
before its understood.
Tips and Techniques
- Give stimulation that can be sensed emotionally, like music and
touch;
- Present objects with the quality of moderate novelty. Things that are
familiar enough so that they do not frighten or confuse, but unusual enough so that they
interest;
- Give touch in a systematic way. Stimulate the persons forehead,
cheeks, ears, neck, shoulders, back, forearms, hands, feet and lower legs through small
circular stroking movements. Use skin lotion to protect the skin;
- Stimulate smell with bread, wood, soft soap, fur, camphor, yarn,
etc.;
- Comb the persons hair and give him or her the opportunity to
look in the mirror;
- Stimulate taste buds;
- Elicit listening behavior and maintain attention by touching;
- If the person speaks only in single words, then you should speak in
single words. However, note that the person may be able to understand better than he/she
can talk;
Behavioral Problems
As the disease progresses, behavioral problems may become more
frequent and severe. Some people in the Middle Stage become very paranoid and suspicious,
accusing their caregivers of stealing things or being unfaithful. Some people have sleep
disturbances and begin to wander from home. More detailed articles on Behavior Problems
are available in the Alzheimers & Dementia Care Channel and the "Coping
With Alzheimers Disease" Learning Resource Guide.
Website Resources
- Alzheimer's & Dementia Care Channel
- Skill Builders for Activities of Daily Living
Articles
- The Early Stage of Alzheimer's Disease
- Managing Behavior
Problems
- Helping
Your Elder Adjust to a Residential Facility
- Using
Validation Therapy to Manage Difficult Behaviors
- Locks and Wandering (Part 1 of 3)
- Alarms: Precautions for
Wandering (Part 2 of 3)
- Deterrents and
Diversions: Precautions for Wandering (Part 3 of 3
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