AD - Stages

Question 1

Stage I: Early Stage

Answer 1

(1-3 years)

• Forgetfulness & mild memory deficit
• Difficulty w/ novel or complex tasks
• Apathy & social withdrawal, lack of spontaneity
• Repeating same thing over & over again
• Emotional lability, moodiness, hypochondriasis
• Time disorientation
• ↓ judgment, problem solving, abstract thinking
• May display catastrophic reactions to stressful events

Question 2

Stage II: Moderate Stage

Answer 2

(3-10 yrs)

Moderate to severe objective memory deficit
Disorientation to time & place
Restless & wanders aimlessly, sundowning, paranoia, hallucinations, sleep pattern disturbances, ↓ impulse control
Personality & behavioral changes
Language disturbance, visuoconstructive difficulty & apraxia
Inability to learn new things
Requires supervision

Question 3

What stage requires supervision

Answer 3

Starts at stage 2

b/c of wandering

Question 4

What is sundowning and what stage

Answer 4

Starts as stage 2

as the sun goes down people tend to wander and get confused more

Question 5

What is visuoconstructive difficulty and what stage does it start?

Answer 5

(AD) Starts as stage 2

Trouble coordinating fine motor skills and where they are in space.

To test this you would have them draw that shape on the mini mental

Question 6

Stage III: Late Stage

Answer 6

(8-10 yrs) - will need full time aid

• Intellectual functions virtually untestable
• Verbal communication severely limited
• Incapable of self-care
• Physical impairment
• Difficulty swallowing
• Weight loss
• Incontinence of B/B
• Inability to recognize family members
• Return of primitive reflexes
• Gegenhalten tone

Question 7

What does return of primitive reflexes mean and what stage would this happen

Answer 7

Reversal of encephalization process of childhood, whereby primitive reflexes fade as higher cortical areas take control over lower subcortical centers
In AD, positive release from higher control ➡ re-emergence of primitive reflexes

Question 8

Three examples of returning of primitive reflexes

Answer 8

Primitive oral responses (sucking)

Palmomental reflex-abnormal contraction of the chin

Myerson’s Sign – glabellar tap reflex (poor prognostic sign)- keep bliking

Question 9

What is the Palmomental reflex

Answer 9

abnormal contraction of the chin

AD

Question 10

What is the Myerson’s Sign

Answer 10

glabellar tap reflex (poor prognostic sign)- keep bliking

Question 11

What is gegenhalten tone

Answer 11

happens in the Stage III: Late Stage

Generalized muscular rigidity
Can be mistaken for spasticity or cogwheel rigidity
Characterized by what seems almost like volitional resistance to passive movement
Only other place this is found is in the womb with fetuses – comes back along with the return of primitive reflexes

Question 12

Why do you have to be aware of gegenhalten tone when working with an individual with late stage AD

Answer 12

If you put your hands on them they will resist you.

you might think spasticity or rigidity but they do not they are just resisting your pressure

NOTE: do not put hands on their back during tx to avoid retropulsion

Question 13

Stage IV: Terminal Stage

Answer 13

Loss of all abilities – speech, motor, perceptual
Unaware of environment
Mute
Abulic
Bedridden
Joint contractures
Pathological reflexes
Myoclonus
Loss of “self”

Question 14

What is abulic

Answer 14

lack of motivation and willpower