My mother started to become depressed two years ago. At first, the doctors thought it was merely depression. Later on, she started to forget more and more things.

About one year ago, she accused the maid of stealing her things. Lately, she has started to accuse me of the same thing. I am very hurt and upset. What is happening to my mother?

It certainly sounds like your mother is having Alzheimer’s disease.

Alzheimer’s disease is a neurological condition that progressively destroys memory and other mental functions.

Most people do not know what to expect, and many family members are confused, and even hurt, by what is happening to their loved ones. Often, the symptoms of Alzheimer’s are mistaken for other diseases, or even natural ageing.

There are some researchers who have classified Alzheimer’s disease into seven stages.

Although researchers have discovered a defect in a key cell-signaling pathway they say contributes to both overproduction of toxic protein in the brains of Alzheimer’s disease patients, as well as loss of communication between neurons, there’s still no cure. Photo: TNS

What are the seven stages?

• Stage 1 – Normal or disease-free.

• Stage 2 – Forgetfulness caused by normal ageing

It has been estimated that more than 50% of people above 50 years of age cannot recall names as well as they used to, misplace their things, and have difficulty focusing and finding the correct word to describe something.

There is recent evidence to suggest that people who have this type of forgetfulness decline at a rate faster than people who don’t have it.

• Stage 3 – Mild cognitive impairment

Relatives and friends tend to notice this stage first. Here, the patient repeats questions a lot. If the patient is still working, the work quality may decline. They cannot master new skills or plan parties like they used to. They may become anxious.

This stage normally lasts for two to four years.

That was when I started to notice my mother’s deterioration. What are the next two stages?

Stage 4 is mild Alzheimer’s disease. Here, the person finds it difficult to manage the complex activities of daily life, like finances, shopping, preparing meals, or even ordering food from a menu in a restaurant.

They cannot recall recent things, like a holiday they went on, or even the correct date or month.

They can still survive independently in community settings, but may not be able to pay bills and the rent. Someone has to do this for them.

They may seem to be less emotionally responsive and more withdrawn. They realise what is happening to them, but dare not participate in conversations for fear of other people finding out.

This stage often lasts two years.

Stage 5 is moderate Alzheimer’s disease. Here, the person cannot survive independently anymore. They can’t select or change their own clothes. They are angry and suspicious.

Long-term memory starts to go, e.g. occasionally not being able to recall which school they went to.

The pattern of memory recall varies. There are good days and bad days. This stage lasts for about 1.5 years.

My mother seems to have manifestations of several stages. What are the final two stages?

Stage 6 is moderately severe Alzheimer’s disease. Here, the person cannot perform the activities of daily life, such as putting on clothes correctly.

As the disease progresses, the person cannot bathe on his/her own, and ultimately, becomes incontinent.

The person now mixes up names of family members. He or she may display violent behaviour, and develop a fear of being alone.

This stage lasts for about 2.5 years.

Stage 7 is severe Alzheimer’s disease. The person mutters unintelligible words. They can’t walk properly anymore and must be assisted. They might only be able to sit with support.

This stage lasts around one year. Rigidity of limbs becomes pronounced in the very last months, and the joints may become contracted.

Most die due to aspiration pneumonia.

What can I, as a caregiver, do?

There is no cure for Alzheimer’s. However, there are some drugs that may retard or manage symptoms.

As family, you have to understand Alzheimer’s and what to expect in the different stages.

It is far more stressful than caring for someone with a physical impairment, like cancer.

As a result, many caregivers often suffer from depression.

But you are not alone. You can form your own support network among family and friends, and the online community.

Take time to enjoy the things you like. Pamper yourself.

Understand that it’s the disease that is transforming your loved one, and not them, and don’t take their verbal abuse personally.

Discuss the past with the person. If you need help for care, you may consider hiring a maid, nurse or putting the person into a nursing home.


Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.