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The Stages of Alzheimer ’s Disease – Greensboro, NC

Joseph Coupal - Monday, January 30, 2017

Spring Arbor assisted living in Greensboro, NCAfter we find out that a loved one has Alzheimer's disease (AD) or any other disease, it is only natural to explore the subject with some research. What can we expect and when can we expect it?

The national Alzheimer's Association (AA) has developed a very useful tool, or "staging system," to use as a frame of reference when coping with AD. But people are not programmed to follow these stages in a direct line. No matter how much we would like to "know" what stage someone is in, we cannot. With that in mind, let's look at the stages to better understand the progression of this disease.

Stage 1: No Impairment
Research now reveals that AD begins years, if not decades, before we have a clue that anything is wrong with ourselves or our loved ones. Genetic research and much more sophisticated technology will no doubt make this an important and focused area of study as we march into the future. But, for now, most of us will never know if we are in the beginning stages of the disease. Unfortunately, doctors can only diagnose probable AD due to the fact that a definitive diagnosis is only made through the post-mortem examination of brain tissue.

Stage 2: Very Mild Cognitive Decline
This stage may be indicative of normal age-related decline or the very earliest signs of Alzheimer's disease. At this time, you or your loved one may have a sneaking suspicion that something questionable is on the horizon. A little more forgetfulness could be due to natural aging. But what about increased irritability when that forgetfulness occurs? Maybe we should chat with a doctor. Still, we are not likely to get the satisfaction of a definite yes or no either way. We will most likely hear something to the effect that it is just normal aging and perhaps we should do more crossword puzzles or take a class to learn a new skill. And eat more chocolate. Chocolate has antioxidants in it that are good for the brain.

Stage 3: Mild Cognitive Decline
This is a tricky point in the disease. Early-stage AD can be diagnosed in "some, but not all," individuals with the symptoms recognizable to family and others close to the person having problems. These symptoms include difficulty with words and names and a decreased ability to remember names of newly introduced people. Unusual performance issues at work or in social settings, reduced retention of recently read material, losing or misplacing items, and a decline in the ability to plan and organize are strong indicators of a deeper issue. This is especially true if all or a few of these symptoms are occurring simultaneously.

We can chat with a doctor and even request the cognitive tests at this point, but will they be conclusive? This is still a point where a diagnosis could be a tough call. If someone is very concerned, he or she should see a team of physicians uniquely qualified to diagnose dementia because this a point where some medications can help maintain better brain function longer into the disease. If we brush off worries too long and then decide to go for help, we may have lost valuable time. Still, this is not the time to panic. Schedule a general physical and perhaps see a qualified neuropsychologist that has experience with diagnosing dementia.

Stage 4: Moderate Cognitive Decline
This point in the progression is considered to be mild or early-stage AD and by now there are clear-cut indications of the condition that a careful medical examination can detect. This includes an obvious decrease in knowledge of recent events, both personal and concerning the local community or world. There would be a decrease in the performance of the standard test where they ask someone to count backward from 75 by sevens. Less scary, perhaps, is testing the person's capacity to perform tasks such as planning dinner for several people or balancing a checkbook.

Again, remember that it is important to know how well the person performed similar tasks at an earlier time. Some people do not do well with numbers or do not exhibit high levels of reading comprehension, but that doesn't mean dementia is present. They are looking for changes in these abilities. They conduct many different kinds of tests to account for the fact that some people struggle with certain things like math or organizational skills. These are consistent characteristics that have been with us all of our lives and do not indicate an illness or neurodegenerative condition.

Stage 5: Moderately Severe Cognitive Decline
Also known as moderate or mid-stage AD, this is where things become pretty obvious and serious. This is when the going gets rough for the caregiver and frustrations mount for most patients. A great deal of agitation occurs. People are aware that they are not functioning normally, and it understandably makes them angry and possibly even more confused. They often take it out on the person or people they feel safest with, such as their spouse or their adult children; those that are their caregivers.

The afflicted person will have major memory gaps, and people at this stage often need some help with activities of daily living (ADLs).

People in this stage are often unable to recall their current address or telephone number. They may not remember where they graduated from school and can become confused about the date and even the current season. They have trouble with easier arithmetic such as counting backward from 20 by twos. They often need help choosing appropriate clothing for activities, occasions, and the season.

Although memory and daily function may be somewhat impaired in stage 5, people usually retain "substantial knowledge about themselves," such as their own names and those of their children. They also, generally, do not need help eating or using the toilet.

Stage 6: Severe Cognitive Decline
This moderately severe mid-stage is where really significant personality changes can emerge. That sweet person you used to know is suddenly combative, volatile and possibly violent at times. At this stage, people lose "most awareness of recent experiences… as well as their surroundings."

Individuals in this stage can be very inventive when trying to outwit their caregiver. They are also prone to wandering, so keeping them safe can be a constant challenge. Patients may find ways to undo several locks on doors and enable a supposedly disabled car. Caregivers have been known to remove and hide car batteries to prevent this. Family members sometimes install an alarm system that is meant to alert homeowners if someone is breaking in, but use it to keep track of whether their loved one is trying to break out. During this wandering-prone stage, the patient must be watched carefully.

Stage 6 is also a phase where, "(People) lose most awareness of recent experiences and events as well as of their surroundings."

They often do not remember their own histories and can forget the names of people they love (although they usually recognize faces). They need help dressing and toileting. This, too, is the stage where the sleep cycle is greatly disturbed for this person. Unfortunately, this means that the caregiver's sleep habits suffer as well.

Late day or early evening confusion called "sundowning" can trigger additional agitation and confusion. This phenomenon is thought to have to do with changes in lighting and/or activity changes that trigger the patient's need to do something important, but they don't know what. For example, they may have the impulse to go home from work or begin cooking dinner. Whatever the cause, this is a difficult time of day for many caregivers and dementia patients.

This is also the phase where the caregiver will witness increased paranoid or suspicious behavior. Hallucinations are not at all uncommon, and compulsive behaviors such as picking at skin or nails, tissue shredding, scratching and hand-wringing can occur.

At this point the patient may need to be moved to a secure environment where they are both stimulated and safe. This minimizes or completely eliminates the dangers associate with wandering and provides the caregiver with some needed relief from their 24/7 responsibilities.

Stage 7: Very Severe Cognitive Decline
This severe late stage of AD is the sad time when the patient's speech is often unrecognizable, there is general incontinence, eating is difficult or refused, and swallowing can be impaired. They usually need assistance and support with walking and even sitting. Falls can be a dangerous complication at this stage.

Families often become frantic when their loved ones refuse to eat. We get hungry. We think they must be starving and are compelled to try to provide comfort and sustenance through food. However, as the body prepares to die, it often does not want food. The organs are shutting down.

Patients also become increasingly weak and susceptible to bacterial infections such as pneumonia or urinary tract infections (UTIs). The adjustment to the final stage, which will bring death, is one where hospice can support the caregiver and family members, as well.

From stage 3 on, this disease is a mind-bender to deal with. Each stage puts new demands and strains on both family and professional caregivers. Education can help immensely throughout this process, so it is important for family members to conduct research in order to be as prepared as possible. Going through this alone should not be an option. Caring for someone with AD takes a super-human effort. This is a disease where community support can make all the difference. Be sure to get help for your loved one and get help for yourself.

For more information on caring for a loved one with Alzheimer’s Disease, contact Spring Arbor.


The 10 signs of Alzheimer’s Disease Are… - Richmond, VA

Joseph Coupal - Thursday, January 26, 2017

Spring Arbor, Memory Care, Richmond, VAForget what day it is? Lost your keys? Can’t think of the word? Could be typical, related to age – or not.

Alzheimer’s is a progressive disease with no cure. The biggest risk factor is age, and since women tend to live longer than men, it occurs in more women.

Before seeing a doctor – choose one with experience with diagnosing Alzheimer’s – the spouse or family members should keep a log of specific symptoms that have occurred. Also, bring all medication to the appointment and a list of current and previous health problems.

The 10 signs of Alzheimer’s Disease are:

  1. Memory changes that disrupt daily life, like not remembering phone numbers or addresses.
  2. Challenges in planning or solving problems.
  3. Difficulty completing familiar tasks, such as setting the table or following a well-used recipe.
  4. Confusion with time or place.
  5. Trouble with visual images and spatial relationships, interpreting a sequence of instructions.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgment, like giving money to charities or to anybody who asks.
  9. Withdrawal from work or social activities, because they realize something is wrong.
  10. Changes in mood and personality, often becoming more bitter, just not like themselves.

For more information on Alzheimer’s Care, contact Spring Arbor.

The Daily Courier

Signs of Alzheimer’s Disease and Demetia – Greensboro, NC

Joseph Coupal - Thursday, January 19, 2017

Spring Arbor, Greensboro, NCHow do you know if your parent has Alzheimer's disease (AD) or dementia? If dad continually forgets where he puts his keys, or mom seems to get easily confused these days, does it mean they have a progressive neurodegerative disease? Not necessarily. Only a doctor can diagnose the condition. Every person experiences different symptoms with different severity, but there are some main warning signs you can look for.

Early Indicators of Alzheimer's Disease and Dementia:

Forgetfulness and Memory Loss

The most common symptom of most types of dementia is memory loss. However, just because Dad cannot remember where he put his shoes or calls the grandkids by the wrong names does not mean he has Alzheimer's. We all forget the details of a conversation from time to time, but early onset of this disease can cause a person to forget entire conversations that took place only moments ago. AD usually affects short-term memory first, meaning the person forgets information that they recently learned. They have trouble remembering important dates and events and they ask for the same information over and over again. They may even lose the ability to recognize their family members.

Lack of Concentration and Increased Confusion

Getting confused about times and places is a common indicator. Your mom or dad may have difficulty concentrating and take much longer to do things than they did before. Individuals may forget where they are or how they got there. They might have difficulty understanding that an event happened in the past or will be occurring in the future, versus something that is happening in the present. They can lose track of the seasons and the general passage of time.

Losing Things

A person with AD may begin to put things in increasingly unusual places. Car and house keys tend to elude everyone from time to time, but finding lost keys in the freezer could indicate a more serious problem. They may lose things and be unable to use the simple method of retracing their steps to find the items. This situation can even escalate into accusations of theft when they cannot find a personal belonging that they have unknowingly misplaced. This can lead to paranoia, and they may react by placing their things in even more unusual "hiding spots" to foil the perceived thief.

Difficulty Doing Familiar Tasks

This condition also affects the ability to do normal, everyday tasks. People may have trouble remembering how to drive, cook a favorite recipe, or play a familiar game. They may start relying more on a spouse or family member to do things for them that they once enjoyed doing themselves. Symptoms can affect one's abilities related to vision as well, such as depth perception, judging distance and seeing colors. This can lead to an increase in perceived clumsiness, accidents and other uncharacteristic mishaps.

Language and Speaking Problems

AD affects how sufferers create and process language. They typically have trouble recalling the right words in conversation or while writing. For example, they say "what-cha-ma-call-it" instead of eyeglasses, or call a watch a "hand-clock." This confusion can cause them to stop abruptly in the middle of sentences or conversations as well.

Problems with Simple Math

People in the early stages may have difficulty working with numbers, including simple math problems they have done their entire lives. They may struggle when balancing their checkbook or performing simple addition and subtraction calculations.

Poor Judgment

Look for changes in their decision-making abilities, rational thought processing and judgment skills. A person who has made poor or risky decisions all of their life probably does not have a medical condition causing these behaviors. But dementia could be the culprit in a situation where a once logical decision maker who carefully weighed all the options and made informed decisions suddenly begins exhibiting poor judgment.

Personality Changes and Mood Swings

Individuals might exhibit changes in personality and sudden mood swings. They could become fearful, suspicious, depressed or anxious. A once confident person might become tentative and shy. They may be easily upset at home and in new or public places where they are out of their comfort zone.

Changes in Grooming and Personal Hygiene

Sudden or steadily declining attention to personal care, such as infrequent bathing, wearing the same clothes over and over again, and not their brushing teeth, can point to this disease. If a person kept their home immaculate all their life but suddenly stops cleaning and allows clutter to accumulate, it could be a cause for concern.

Withdrawing from Friends and Family

Finally, withdrawal from social opportunities and activities they once enjoyed can be a red flag. Affected individuals tend to dodge situations where they have to be around others in order to avoid drawing attention to their memory lapses or communication difficulties. They are typically embarrassed by their inability to converse or perform tasks as they once did. Depression related to this change in abilities can also cause withdrawal from social situations.

Doctors will only diagnose dementia only if two or more brain functions, such as memory and language skills, are significantly impaired without loss of consciousness. If you think someone you love may have Alzheimer's disease, contact your doctor immediately.

For information on memory care, contact Spring Arbor.


Weighing the Options for Assisted Living, Part II - Greensboro, NC

Joseph Coupal - Friday, January 13, 2017

Spring Arbor, assisted living in Greensboro, NCAssisted living residences are aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when needed. Assisted living facilities are a great choice for those who can’t live on their own, but do not need nursing care.

If assisted living sounds like the right choice for your loved one, we offered the first steps to beginning your search in an earlier blog post. Here are the rest of the steps to help begin your search:

Plan to Visit

First, it is imperative that you involve your loved one in the choices about his or her care. Take them with you on the tours of each facility and let them handle as much of the talking and decision-making as possible.

Second, take these questions, along with the residence-specific questions that arose while reviewing the mailed materials, with you. As you and your loved one meet with staff and take a tour, pay attention to how you feel and your surroundings. Spend time with the staff and residents. Ask them what they like and dislike about the place. Make a second, unannounced visit on a weekend or in the evening. You may find out important information by dropping by unannounced.

Signing the Contract

After reviewing all the materials, visiting each prospective residence, and getting all questions answered, singing a contract is the final, and most important, step. This is the legal document that states what arrangements are agreed to, regardless of anything promised verbally or in marketing materials. The more specific the contract, the greater your loved one’s legal protection. Compare information in the sales brochure with that in the contract, paying close attention to fees, level of care, health care services and discharge policies. Benefits that a residence promotes in a brochure should also appear in the contract.


  • Make sure you understand what the contract says. Get any and all questions you have answered before signing.
  • Ask that any information not included about care, rights, costs and services be added — and don’t sign a contract until you see these additions have been made (a residence can promise anything in a brochure, but it is only bound legally by what is in the signed contract).
  • Never sign on the day you visit.
  • Before making a decision about a residence, take the contract home and review it with family members.
  • Consider reviewing the contract with a financial adviser and a lawyer.

The Cost of Assisted Care

Assisted living can be costly. About four out of five people pay for it out of pocket. Medicare does not cover assisted living. While more states are starting to cover some services under Medicaid or other government programs, public payment is not common in the assisted living industry. State Medicaid agencies can provide information about eligibility and covered services. Before you seriously consider assisted living as an option for your loved one, decide whether you and your loved one can afford it long-term. Keep in mind that the cost will rise over time because of standard cost-of-living increases. Also, expect monthly price hikes for extra services as needs change.

Promotional materials for these residences commonly present fee information in general terms, so it’s crucial that a contract detail all of your payment obligations. Consider running the contract by a lawyer before signing.

For more information, contact Spring Arbor.


Weighing the Options for Assisted Living - Greensboro, NC

Joseph Coupal - Monday, January 09, 2017

Spring Arbor assisted living, Greensboro, NCAssisted living residences are aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when needed. A combination of housing, meals, personal care and support, social activities, 24-hour supervision and, in some residences, health-related services is usually provided. Assisted living facilities are a great choice for those who can’t live on their own, but do not need nursing care. As needs change, these facilities offer different levels of care at different costs – and some are even associated with nursing facilities should your loved one eventually need full-time nursing care.

There is no standard for assisted living residences, which vary in size, appearance, cost, and services offered. Some residences provide only meals, basic housekeeping, and help with the activities of daily living (ADLs) such as bathing, dressing, and grooming. Others go beyond these services and furnish transportation and certain health services. Facilities range from small homes with just a few residents to high-rise apartment-style buildings with hundreds of residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.

If assisted living sounds like the right choice for your loved one, here are some steps to help begin your search:

Finding Facilities

Start by making a list of residences to visit. The following resources can help:

  • The state or local Area Agency on Aging (AAA).
  • The long-term care ombudsman’s office .
  • The state licensing agency.
  • Friends and neighbors.
  • Retirement guides.
  • The Assisted Living Federation of America (ALFA), which provides lists of its member residences by each state. These are mostly for-profit residences. The lists do not include all residences in each state.
  • The American Association of Homes and Services for the Aging (AAHSA), which provides lists of member residences by state. These are not-for-profit.
  • The Eldercare Locator helps you find the closest Area Agency on Aging (AAA) office and the state long-term care ombudsman’s office.

Keep in mind that assisted living residences are not defined or regulated by the federal government. Each state decides how they’re licensed. Be sure to find out from the AAA or state health department how the state where you are searching handles this. Make sure all the residences on your list are appropriately licensed—if one of them isn’t, cross it off and move on.

Check, too, with the state licensing agency and ombudsman’s office to see if there have been complaints filed against the facilities on the list. Don’t assume that a state license ensures quality care.

Next: Make the Call

Call each potential residence and ask for a general overview of their facilities. Remember that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.

If you’re still interested after the call, ask that more information be mailed to you or your loved one, including:

  • Brochures.
  • A price list.
  • A map or floor plan.
  • A copy of the residents’ rights and rules.

Copies of all the documents that will need to be signed before admittance, including, most important, the contract (sometimes referred to as residency, occupancy, or admission agreements).

Once you receive these materials, review them carefully with your loved one and write down all the questions that come to mind. Strike any residences from your list that don’t meet your criteria.

In our next blog post, see information about planning the visit, signing the contract and other general tips.

For more information, contact Spring Arbor.


Signs Your Parent Needs Help - Richmond, VA

Joseph Coupal - Friday, January 06, 2017

Spring Arbor Assisted Living, Richmond, VAKnowing when to begin discussions about needing assistance for aging parents is not always as simple as one might think. Maybe you've noticed unopened mail is piling up. Or parents who had been meticulous about their appearance are now wearing wrinkled clothes. When you bring up these observations, their instant response is, "Everything is fine, there's no need to worry."

Admitting they need help would mean they can no longer take care of themselves, and no one wants to lose their independence. Denial is the unrealistic hope that a problem is not really happening and will go away by itself. Admitting they need help and accepting assistance is not easy for people as they age. It represents a loss of independence. Denial plays a major role and signs get ignored.

The burden often falls on the family to recognize the signs that an aging parent might need help with daily living tasks. This may mean it may be time that your loved one move to assisted living. If they're not willing to admit it, how do you know if your elderly parent needs help? Look for the red flags listed below.

Signs Your Parent Needs Help

  • Spoiled food that doesn't get thrown away
  • Missing important appointments
  • Unexplained bruising
  • Difficulty getting up from a seated position
  • Difficulty with walking, balance and mobility
  • Uncertainty and confusion when performing once-familiar tasks
  • Forgetfulness
  • Unpleasant body odor
  • Infrequent showering or bathing
  • A strong smell of urine in the house
  • Noticeable decline in grooming habits and personal care
  • Dirty house, extreme clutter and dirty laundry piling up
  • Stacks of unopened mail or an overflowing mailbox
  • Late payment notices, bounced checks and calls from bill collectors
  • Poor diet or weight loss
  • Loss of interest in hobbies and activities
  • Changes in mood or extreme mood swings
  • Forgetting to take medications, or taking incorrect dosages
  • Unexplained dents and scratches on a car

Once the problem is realized, the family must decide if assisted living is the best option.

When and How to Start the Conversation

If you've noticed the warning signs, the time to start talking with senior parents is sooner rather than later. Do not wait until after a crisis has occurred. But how do you bring up sensitive subjects related to aging? Use conversation starters that might help overcome the awkwardness.

Discuss what you've observed and ask your parents what they think is going on. If your parents acknowledge the situation, ask what they think would be good solutions. If your parents do not recognize a problem, or shrug it off, use concrete examples to support your concerns.

Remember, you are having a conversation with an adult, not talking to a child. Patronizing speech or baby talk will only put older adults on the defensive and convey disrespect. Put yourself in your their shoes and think of how you would want to be addressed in this situation.

For more information on assisted living, contact Spring Arbor.

Aging Care