In most cases, Alzheimer's dementia begins with a memory disorder (amnesic syndrome), particularly short-term memory, and progresses later with a series of symptoms.
The course of the disease has been divided into four stages: initial phase, intermediate stage, stage severe stage, final stage. It must be said, however, that a significant proportion of cases does not respect this trend.
One of the first symptoms is the so-called anomie: the inability to find the right word to express a concept. Patients present difficulties in learning and remembering new information and, more and more evident, in carrying out daily activities, such as finding their way back home (the elderly ends up getting lost in the vicinity of the house or while going to the supermarket) or remember where they put things. Relatives usually notice these strange "blackouts", even if in the initial stage the subject can still maintain good social relations and acceptable professional performances.
Some patients may react to memory loss with irritability and hostility. Slowly the memory for the remote events vanishes and the loss of the mental schemes of the "automatic" gestures (apraxia) becomes evident, which involves the inability to dress, to shave, to engage the reverse gear. If the disease affects the dominant cerebral hemisphere, which in the right-handed is the left, disturbances occur in the production and comprehension of language (aphasia). Depending on the area of the brain involved, the speech can be rich in words but poor in content (fluent aphasia), or characterized by a poor and stunted language (non-fluent aphasia).
Other typical language disorders of the patient with Alzheimer's are the misuse of assonant words (table for cabbage) or non-assonant (spoon fork), which is called paraphasy; or the repetition of the same word (echolalia) or the same sentence (palilalia). par Patients end up completely losing the sense of time and space, or the ability to identify sensory stimuli (agnosia), even those related to domestic environments: to the point that they are no longer able to find their own bedroom or the bathroom. They are people without environmental and social references. Dramatic is the inability to recognize the face of the loved one (prosopagnosia).
At this point, the subject is no longer able to perform the simplest activities of daily life. Endless Alzheimer's affects almost all brain functions: memory, behavior, abstract thinking, personality, judgment, movement and coordination. "Cognitive deficits - we read in the definition of dementia of DSM IV, the most recent classification of mental disorders - are such as to significantly reduce the social and occupational function of the subjects". They become incontinent, ie they generally lose control of the bladder and intestine. The ability to walk can be long preserved (even if they risk falling or incurring accidents), but eventually even the motor skills are degraded.
In addition to walking alone, patients with severe Alzheimer's may no longer be able to eat or swallow normally, so malnutrition, bed sores, and potentially lethal fluid aspiration pneumonias occur. At this stage, admission to long-term care facilities becomes almost inevitable. From the time of diagnosis to the death of the patient (which usually occurs as a result of infections), it is estimated that the course of the disease is about ten years. These are years of suffering both for the patient - who at first may be aware of the progressive failure of his mental functions - and for his family.
Many studies have shown that there is a preclinical phase of dementia characterized by the presence of certain deficits of cognitive functions (of memory, fluency of language, reasoning) that can herald the incipient disease and which can be seen from 1 to 3 years before clinical beginning of the same. For example, some researchers have discovered linguistic skill measures - which they referred to as "density of ideas" and "grammatical complexity" - and applied them to autobiographies written by a group of nuns at the age of 22. "These women - says Carlo Caltagirone, neurologist of the University of Rome Tor Vergata - were examined 58 years later by cognitive tests and after their death they were evaluated by the neuropathologist. The researchers found that low-density ideas and low grammatical complexity in youth were associated with low cognitive performance tests in adulthood. Furthermore, among the 14 deceased sisters, the evaluation performed at the autopsy table confirmed the presence of Alzheimer's disease in all those with low density of ideas at a young age, while no signs of Alzheimer's were found in any of those with high density of ideas ".
(source: Pharmacy thirty-three).