Abnormal Psychology

Cognitive Disorders 705

The Progression of Alzheimer’s Disease

The onset of Alzheimer’s disease is gradual, with symptoms becoming more severe

over time. Often, the early signs of dementia of the Alzheimer’s type involve diffi -

culty remembering recent events or newly learned information. In fact, in the early

stages of Alzheimer’s, the memory problems may be diagnosed as amnestic disorder

(Petersen & O’Brien, 2006); it is only as the disease progresses that other cognitive

dysfunctions emerge.

Within a few years of onset, symptoms may include aphasia, apraxia, and ag-

nosia. Spatial abilities may deteriorate markedly. Patients may also become irritable

and their personality may change, and such changes may become more pronounced

as cognitive functioning declines. In the fi nal stage of the disease, motor problems

arise, creating diffi culties with walking, talking, and self-care. Generally, these pa-

tients die about 8–10 years after the fi rst symptoms emerge. Table 15.10 describes

normal functioning with aging and the fi ve stages of the disorder’s progression in

more detail.

In some cases, people with dementia also exhibit behavioral disturbances, such

as agitation or wandering about, which arise because of the cognitive defi cits—they

get lost or, like Ms. McGowin, they can’t remember their destination. DSM-IV-TR

Level of Cognitive Impairment Clinical Phase Clinical Characteristics Diagnosis

1 = No Cognitive Decline Normal No subjective complaints of memory defi cit. No memory defi cit

evident on clinical interview.

Normal

2 = Very Mild Cognitive Decline Forgetfulness Subjective complaints of memory defi cits. No objective defi cits in

employment or social situations. Appropriate concern with respect

to symptomatology.

Normal aged

3 = Mild Cognitive Decline Early confusional Earliest clear-cut defi cits. Decreased performance in demanding

employment and social settings. Objective evidence of memory

defi cit obtained only with an intensive interview. Mild to moderate

anxiety accompanies symptoms. When introduced to new people,

has increased diffi culty remembering their names. Word-fi nding

problems noticeable to other people. Loses objects.

Compatible with incipient

Alzheimer’s disease

4 = Moderate Cognitive Decline Late confusional Clear-cut defi cit on careful clinical interview. Inability to perform

complex tasks. Although patient has signifi cant memory problems,

denies them or blames others for problems. Flattening of affect and

withdrawal from challenging situations occur. Inability to perform

complex tasks such as paying bills.

Mild Alzheimer’s disease

5 = Moderately Severe Cognitive

Decline

Early dementia Patients can no longer survive without some assistance. Patients

are unable during interview to recall a major relevant aspect of

their current lives. Persons at this stage retain knowledge of many

major facts regarding themselves and others. They invariably know

their own names and generally know their spouses and children’s

names. They require no assistance with toileting or eating, but may

have some diffi culty choosing the proper clothing to wear.

Moderate Alzheimer’s

disease

6 = Severe Cognitive Decline Middle dementia May occasionally forget the name of the spouse upon whom they

are entirely dependent for survival. Will be largely unaware of all

recent events and experiences in their lives. Will require some

assistance with activities of daily living. Personality and emotional

changes occur, such as suspiciousness; may develop psychotic

symptoms, wander, and become lost.

Moderately severe

Alzheimer’s disease

7 = Very Severe Cognitive

Decline

Late dementia All verbal abilities are lost. Frequently there is no speech at all—

only grunting. Incontinent of urine; requires assistance toileting

and feeding. Loses basic psychomotor skills (e.g., ability to walk).

Severe Alzheimer’s disease

Source: Adapted from Reisberg et al., 1982, Table 12.1.

Table 15.10 • Normal Functioning and the Five Stages of Dementia of the Alzheimer’s Type