The Alzheimer's Solution, page 7
The latest lifestyle research supports our comprehensive approach to brain health. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), published in 2015, participants who adhered to a diet with a greater focus on plant-based foods, exercised regularly, engaged in cognitively challenging activities, and addressed metabolic and vascular risk factors like diabetes, hypertension, and high cholesterol had a significantly higher score in overall cognitive performance than participants who received standard medical care. This was the first large clinical trial to prove that we can prevent cognitive decline using a comprehensive protocol, even in individuals at a high risk of developing Alzheimer’s. Interventions like this are not only essential for long-term cognitive health but also possible for each and every one of us.
A Plan for Success
Through all these endeavors, and through working together, we’ve completely reenvisioned our approach to Alzheimer’s. We are now conducting the most comprehensive research to date that explores lifestyle risk factors and the development of neurodegenerative disease. Our lifestyle program at Loma Linda University is one of the most sophisticated in the world—we have the most advanced imaging techniques, the latest biomarker and neuropsychological tests, and a behavioral intervention protocol more thorough and personalized than anything ever developed. Ayesha has become a recognized expert in nutrition, stress management, and restorative sleep, while Dean specializes in exercise, optimizing the brain’s infinite power through cognitive and social activities, and bringing these habits into both the home and community.
The following aspects of a healthy lifestyle form the heart of our unique NEURO Plan:
Nutrition: A whole-food, plant-based diet low in sugar, salt, and processed foods.
Exercise: An active lifestyle that incorporates movement every hour—not just a stop at the gym after an otherwise sedentary day.
Unwind: Stress management in the form of meditation, yoga, mindful breathing exercises, time spent in nature, and the support of strong communities.
Restore: Seven to eight hours of regular, detoxifying sleep through intensive sleep hygiene, treatment for sleep disorders, and management of medications and foods that adversely affect sleep.
Optimize: Multimodal activities (like music) that challenge and engage many of the brain’s capacities, as well as meaningful social interaction.
Using these five factors, we create highly personalized lifestyle plans—as we’ll teach you to do in the upcoming chapters—instituting one or two changes at a time based on your individual resources and capacity for change. As you’ll soon see, the comprehensive nature of our approach brings about a nearly foolproof process of personalized, incremental change.
How to Use This Book
Before you start implementing the NEURO Plan in your own life, we want to share with you some of the fundamental principles of lifestyle change that we’ve found are incredible tools for achieving success with our protocol.
Whole Body Synergy: Brain health can only be achieved through whole body health. When you address vascular risk factors like high blood pressure, high cholesterol, and microvascular disease, you protect not only your heart and kidneys but also your brain. When you work to achieve metabolic and hormonal balance to prevent diabetes, nutrient deficiencies, and immune disorders, you also decrease the risk of cognitive decline. Health is synergistic: anything that’s good for the rest of the body is good for the brain, and vice versa. As you’ll learn throughout Section Two, knowing your personal health risks is essential to protecting and optimizing your brain.
Personalization Is Key: A personalized program is the future of Alzheimer’s treatment. We are moving toward precision medicine, an emerging specialty for disease treatment and prevention that takes into account the interplay between genes, environment, chronic wear-and-tear, protective factors, and lifestyle for each individual. Alzheimer’s prevention based on these individual differences, an approach exemplified in the NEURO Plan, will be the standard of care in the future. As you read through Section Two, keep looking for ways to personalize this program based on your unique needs. Use the upcoming information in the Seven Stages on the Road to Dementia section and The Alzheimer’s Solution Risk Assessment to determine where best to begin.
Keep Yourself Accountable: Lifestyle change requires focus and effort; it can only work if it’s constant and intensive and results in habit formation. We work closely with patients in our clinic, keeping them accountable through personal messaging, monthly evaluations, and comprehensive workups every three months. You can do all this on your own by using the tools and techniques we offer in Section Two. Making your progress visible—on a whiteboard in your living room, for instance—can help keep you focused and motivated.
Find a Community: The most effective way to prevent Alzheimer’s is by paying close attention to the way you and the people around you live. What do you eat together? How do you stay physically active together? How do you encourage a healthy lifestyle together? As you begin the NEURO Plan, we recommend that you enlist the support of your family and friends. They will help you achieve success and also learn how to protect themselves against cognitive decline in the process. Faith communities, community centers, volunteer groups, and online groups are also wonderful sources of support. We know one woman who didn’t have family or friends to help her. Instead, she decided to start a healthy aging group at her church. She was so successful at developing a supportive community that we were able to implement her plan in dozens of other churches. If you’re unable to find or start a community, there are countless communities online, including our own, which you can find at TeamSherzai.com.
In our years of research and clinical work, perhaps the most profound thing we’ve realized is this: the pursuit of cognitive health is about so much more than just avoiding Alzheimer’s. Getting old doesn’t have to be about mental decline. The brain can actually expand as we get older, giving us the capacity to see the world more complexly, to truly understand ourselves and the people around us. Aging can be a beautiful, fascinating process. In fact, studies have shown that when elderly individuals are in good health, they report greater happiness and contentment than any other age group.
Our goal is to reclaim the concept of wisdom. We want everyone to approach their later years with curiosity instead of fear. We want to use lifestyle not just as a shield against neurodegenerative disease but as a way of living better for longer. Our patients, and our own lives, have shown us that all this is possible. The Alzheimer’s Solution will teach you how.
The Seven Stages on the Road to Dementia
Alois Alzheimer observed in his now famous patient some of the classic symptoms of advanced Alzheimer’s: paranoia, outbursts, confusion, withdrawal. But what are the first signs of the disease? In the great majority of cases, the earliest symptom of Alzheimer’s is difficulty with short-term memory (though in some variants of Alzheimer’s, the earliest symptoms are predominantly visuospatial, language oriented, or behavioral). Over time the disease progresses into mood swings, disorientation, difficulty with language, and the inability to carry out basic activities like bathing, putting on clothes, and in later stages even walking and swallowing. By definition, a person has developed dementia when he or she has difficulty with one or more daily activities such as driving, taking medication, making phone calls, cooking, and finances.
THE SEVEN STAGES ON THE ROAD TO DEMENTIA
Physical manifestations of the changes in the brain from Stage 1 through Stage 7.
STAGE 1: PRECLINICAL
Can last 20 or more years
–Appears normal with occasional forgetfulness
STAGE 2: MILD DECLINE
Can last 20 years
–Occasional forgetfulness; others may notice
–Can still do daily activities
STAGE 3: MILD COGNITIVE IMPAIRMENT
Lasts 1 to 3 years
–Forgetfulness noticed by others
–May be anxious; difficulty at work
–Can still do daily activities
STAGE 4: MILD TO MODERATE DEMENTIA
Lasts 2 to 3 years
–A formal diagnosis is often made
–Difficulty with driving
–Anxious, aggressive, or withdrawn
–May have difficulty with finances
STAGE 5: MODERATE TO SEVERE DEMENTIA
Lasts 1½ to 2 years
–Now has difficulty with finances
–Unable to drive
–Anxious, aggressive, or withdrawn
–Confusion pronounced; often forgets address and numbers
–Hygiene is now often affected
STAGE 6: SEVERE DEMENTIA
Lasts 2 to 2½ years
–Unable to do any daily activities
–Professional care is needed
–Personality changes (aggression or silence)
–Sometimes doesn’t recognize close family
–Completely bound to one caregiver
–Sleep cycles severely affected
STAGE 7: THE FINAL STAGE OF DEMENTIA
Lasts 1 to 2 years
–Now needs help with all daily activities
–May become unresponsive
–Often refuses to eat
–Difficulty walking
–Little or no language
–Often loses control of urine and bowel movements
–Often experiences less anxiety
The common denominator of all stages of dementia is anxiety. Even people in the early stages experience significant anxiety because they fear further decline. Anxiety often diminishes in the final stage, perhaps an indication of declining awareness of one’s condition, or even one’s self. Some researchers believe that psychological changes in midlife like increased anxiety, stubbornness, sadness, and aggression can also be early indicators of cognitive decline. Oftentimes these conditions are diagnosed as neuropsychiatric disorders, while the root cause may be brain changes associated with early neurodegenerative and neurovascular pathology.
Though the development and speed of the disease are unique to each individual, dementia generally progresses through the following seven stages. Changing the course of your health requires understanding where you fall on this spectrum. Before taking the Risk Assessment at the end of this chapter, we recommend you review the stages of dementia, as we’ll refer to them throughout Section Two and the NEURO Plan.
Stage 1: Preclinical
A person in this stage has no impairment, no memory disorder or cognitive deficits, though amyloid plaques and tau tangles may be accumulating in the brain (Alzheimer’s and other dementias begin to form years—and often decades—before they manifest). There may also be inflammation, vascular changes, and atrophy in certain parts of the brain, but not enough to cause symptoms.
This stage can last twenty years or longer. Preclinical individuals experience significant benefits from all aspects of the NEURO Plan. Proper nutrition will slow down the inflammatory, oxidative, and vascular damage that may have already started. Exercise will help regrow neuronal connections and increase blood flow to the brain. Both nutrition and exercise will reduce insulin resistance. Stress reduction allows the brain to heal itself, and sleep is the brain’s ultimate detox. Optimizing cognitive activities will also restore and further reinforce connections.
Stage 2: Mild Decline
Some mild memory changes begin to emerge in Stage 2. A person can still do everything they’ve always done. Their finances, driving, and work responsibilities are not yet affected, and family members haven’t noticed any changes.
This early stage can also last up to twenty years before symptoms worsen. Individuals with mild decline will experience the same benefits from the NEURO Plan as preclinical patients. Many individuals at this stage are able to reverse their symptoms if lifestyle change is implemented early on.
Stage 3: Mild Cognitive Impairment (MCI)
A person’s friends and family may begin to notice changes in memory and thinking in this stage. The individual may actually be in denial and claim he or she is only experiencing mild short-term memory problems. People with mild cognitive impairment experience more forgetfulness, lose things more often, and struggle to perform tasks they could easily do before. When neurologists conduct a cognitive exam, they notice some changes as well. Word finding, planning and organizing, and visuospatial skills tend to present difficulties.
There are two types of MCI: amnestic MCI disproportionately affects short-term memory (which is processed in the hippocampus) compared to long-term memory (which is more diffusely stored in the brain and thus more resilient in earlier stages), and is closely associated with Alzheimer’s disease; multidomain MCI simultaneously affects several cognitive domains (specialized aspects of cognition that control language, attention, executive function, behavior, and other cognitive functions) and is associated with vascular dementia. It is thought that each year about 10 to 15 percent of patients with MCI convert to dementia, and that ultimately up to 50 percent will convert to dementia. It’s entirely possible to reverse course at this stage, even for the 50 percent of people who would have otherwise proceeded to dementia.
On average, this stage lasts between one and three years. Individuals with mild cognitive impairment will experience all the benefits from the NEURO Plan as patients in Stages 1 and 2.
Stage 4: Mild to Moderate Dementia
Patients now have more difficulty with cognition and memory. They forget some of their life histories and are unable to remember what they did over the last week. Short-term recall is significantly affected. In a neurologist’s office, a person at this stage will fail to recall a list of five words. Often they’re more tense when driving (avoiding the highway is common), and they’ve made some mistakes with their finances. At this stage, by definition, a person is having difficulty with one or more daily activities like managing finances, cooking, or taking medication on their own. A formal Alzheimer’s diagnosis is most often made during Stage 4. Many of these patients withdraw, either consciously or unconsciously, because of how they’re struggling with memory and managing conversations. This stage is especially dangerous because most patients are still in denial and want to maintain control of their daily lives.
Stage 4 lasts an average of two to three years. Patients with mild to moderate dementia will also benefit from all aspects of the NEURO Plan. Stress management is especially important for reducing anxiety, which is present in some form in all individuals at this stage. Restorative sleep is also very helpful for these patients as sleep patterns may start to change dramatically. By far the most important factor during Stage 4 is social activity: if patients aren’t actively engaged with the people around them, their rate of decline will increase.
Stage 5: Moderate to Severe Dementia
Patients at this stage need assistance. Confusion is now pronounced, with an increasing inability to recall details like phone numbers and addresses. Hygiene begins to be affected as well: patients need to be reminded to shower, brush their teeth, and use the toilet. Sometimes anxiety in this stage can manifest as frustration and anger.
Stage 5 often lasts one and a half to two years. Just as in Stage 4, anxiety reduction is extremely important for these patients. They also benefit from cognitive and social activities that can help them maintain and strengthen neuronal connections. Regular exercise is crucial. Beginning with Stage 5 and throughout the remainder of the disease, Alzheimer’s patients have three times the risk of falls and hip fractures. There is evidence that maintaining muscle strength and balance through exercise significantly reduces the chance of injury, and interestingly, even increases cognitive health.
Stage 6: Severe Dementia
Professional care is needed in Stage 6. Patients are confused, unaware of their environments, and also experience major personality changes—sometimes aggression emerges, other times a person completely withdraws. People in this stage may not recognize close family members. There’s often one very close family member, usually a spouse or child, that the patient depends on for a sense of security. If this person leaves the room, the patient instantly grows anxious. In this way, the Stage 6 patient is completely bound to the caregiver. Other times, however, patients suffer from Capgras syndrome, where they believe that a familiar person is an imposter. Sleep cycles are also severely affected. Wandering can occur during this stage if the right safeguards are not instituted ahead of time (bracelets, identification, locked doors).
This stage lasts roughly two to two and a half years. Patients with severe dementia can still benefit from a diet low in sugar and saturated fats, though they will need someone to oversee their dietary plan. A simple walking routine, or exercise in the home, is an excellent way of slowing down the disease process, which usually accelerates at this stage due to general frailty. Because the sleep-wake cycle is often erratic in patients with severe dementia, sleep hygiene techniques can be especially helpful. Stress management can also help reduce anxiety, though at this stage the focus should be on creating a familiar and relaxing environment (rather than on meditation or yoga).
Stage 7: The Final Stage of Dementia
The patient’s appetite is poor, and he or she has problems swallowing, difficulty walking, and little to no language—though there can be flashes of lucidity that are often connected to a patient’s strongest memories and associations (more on this in the “Optimize” chapter). Thankfully, many patients at this stage experience less anxiety and aggression, which seems to be an indication of diminished consciousness, the awareness of one’s self in an environment. Patients at this stage require assistance with all activities of daily living.
The final stage of the disease can last anywhere between one and two years. Anxiety reduction and functional sleep patterns still help patients in Stage 7. Even in the final years of Alzheimer’s, patients benefit greatly from social interaction in a familiar environment.
A Plan for Success
Through all these endeavors, and through working together, we’ve completely reenvisioned our approach to Alzheimer’s. We are now conducting the most comprehensive research to date that explores lifestyle risk factors and the development of neurodegenerative disease. Our lifestyle program at Loma Linda University is one of the most sophisticated in the world—we have the most advanced imaging techniques, the latest biomarker and neuropsychological tests, and a behavioral intervention protocol more thorough and personalized than anything ever developed. Ayesha has become a recognized expert in nutrition, stress management, and restorative sleep, while Dean specializes in exercise, optimizing the brain’s infinite power through cognitive and social activities, and bringing these habits into both the home and community.
The following aspects of a healthy lifestyle form the heart of our unique NEURO Plan:
Nutrition: A whole-food, plant-based diet low in sugar, salt, and processed foods.
Exercise: An active lifestyle that incorporates movement every hour—not just a stop at the gym after an otherwise sedentary day.
Unwind: Stress management in the form of meditation, yoga, mindful breathing exercises, time spent in nature, and the support of strong communities.
Restore: Seven to eight hours of regular, detoxifying sleep through intensive sleep hygiene, treatment for sleep disorders, and management of medications and foods that adversely affect sleep.
Optimize: Multimodal activities (like music) that challenge and engage many of the brain’s capacities, as well as meaningful social interaction.
Using these five factors, we create highly personalized lifestyle plans—as we’ll teach you to do in the upcoming chapters—instituting one or two changes at a time based on your individual resources and capacity for change. As you’ll soon see, the comprehensive nature of our approach brings about a nearly foolproof process of personalized, incremental change.
How to Use This Book
Before you start implementing the NEURO Plan in your own life, we want to share with you some of the fundamental principles of lifestyle change that we’ve found are incredible tools for achieving success with our protocol.
Whole Body Synergy: Brain health can only be achieved through whole body health. When you address vascular risk factors like high blood pressure, high cholesterol, and microvascular disease, you protect not only your heart and kidneys but also your brain. When you work to achieve metabolic and hormonal balance to prevent diabetes, nutrient deficiencies, and immune disorders, you also decrease the risk of cognitive decline. Health is synergistic: anything that’s good for the rest of the body is good for the brain, and vice versa. As you’ll learn throughout Section Two, knowing your personal health risks is essential to protecting and optimizing your brain.
Personalization Is Key: A personalized program is the future of Alzheimer’s treatment. We are moving toward precision medicine, an emerging specialty for disease treatment and prevention that takes into account the interplay between genes, environment, chronic wear-and-tear, protective factors, and lifestyle for each individual. Alzheimer’s prevention based on these individual differences, an approach exemplified in the NEURO Plan, will be the standard of care in the future. As you read through Section Two, keep looking for ways to personalize this program based on your unique needs. Use the upcoming information in the Seven Stages on the Road to Dementia section and The Alzheimer’s Solution Risk Assessment to determine where best to begin.
Keep Yourself Accountable: Lifestyle change requires focus and effort; it can only work if it’s constant and intensive and results in habit formation. We work closely with patients in our clinic, keeping them accountable through personal messaging, monthly evaluations, and comprehensive workups every three months. You can do all this on your own by using the tools and techniques we offer in Section Two. Making your progress visible—on a whiteboard in your living room, for instance—can help keep you focused and motivated.
Find a Community: The most effective way to prevent Alzheimer’s is by paying close attention to the way you and the people around you live. What do you eat together? How do you stay physically active together? How do you encourage a healthy lifestyle together? As you begin the NEURO Plan, we recommend that you enlist the support of your family and friends. They will help you achieve success and also learn how to protect themselves against cognitive decline in the process. Faith communities, community centers, volunteer groups, and online groups are also wonderful sources of support. We know one woman who didn’t have family or friends to help her. Instead, she decided to start a healthy aging group at her church. She was so successful at developing a supportive community that we were able to implement her plan in dozens of other churches. If you’re unable to find or start a community, there are countless communities online, including our own, which you can find at TeamSherzai.com.
In our years of research and clinical work, perhaps the most profound thing we’ve realized is this: the pursuit of cognitive health is about so much more than just avoiding Alzheimer’s. Getting old doesn’t have to be about mental decline. The brain can actually expand as we get older, giving us the capacity to see the world more complexly, to truly understand ourselves and the people around us. Aging can be a beautiful, fascinating process. In fact, studies have shown that when elderly individuals are in good health, they report greater happiness and contentment than any other age group.
Our goal is to reclaim the concept of wisdom. We want everyone to approach their later years with curiosity instead of fear. We want to use lifestyle not just as a shield against neurodegenerative disease but as a way of living better for longer. Our patients, and our own lives, have shown us that all this is possible. The Alzheimer’s Solution will teach you how.
The Seven Stages on the Road to Dementia
Alois Alzheimer observed in his now famous patient some of the classic symptoms of advanced Alzheimer’s: paranoia, outbursts, confusion, withdrawal. But what are the first signs of the disease? In the great majority of cases, the earliest symptom of Alzheimer’s is difficulty with short-term memory (though in some variants of Alzheimer’s, the earliest symptoms are predominantly visuospatial, language oriented, or behavioral). Over time the disease progresses into mood swings, disorientation, difficulty with language, and the inability to carry out basic activities like bathing, putting on clothes, and in later stages even walking and swallowing. By definition, a person has developed dementia when he or she has difficulty with one or more daily activities such as driving, taking medication, making phone calls, cooking, and finances.
THE SEVEN STAGES ON THE ROAD TO DEMENTIA
Physical manifestations of the changes in the brain from Stage 1 through Stage 7.
STAGE 1: PRECLINICAL
Can last 20 or more years
–Appears normal with occasional forgetfulness
STAGE 2: MILD DECLINE
Can last 20 years
–Occasional forgetfulness; others may notice
–Can still do daily activities
STAGE 3: MILD COGNITIVE IMPAIRMENT
Lasts 1 to 3 years
–Forgetfulness noticed by others
–May be anxious; difficulty at work
–Can still do daily activities
STAGE 4: MILD TO MODERATE DEMENTIA
Lasts 2 to 3 years
–A formal diagnosis is often made
–Difficulty with driving
–Anxious, aggressive, or withdrawn
–May have difficulty with finances
STAGE 5: MODERATE TO SEVERE DEMENTIA
Lasts 1½ to 2 years
–Now has difficulty with finances
–Unable to drive
–Anxious, aggressive, or withdrawn
–Confusion pronounced; often forgets address and numbers
–Hygiene is now often affected
STAGE 6: SEVERE DEMENTIA
Lasts 2 to 2½ years
–Unable to do any daily activities
–Professional care is needed
–Personality changes (aggression or silence)
–Sometimes doesn’t recognize close family
–Completely bound to one caregiver
–Sleep cycles severely affected
STAGE 7: THE FINAL STAGE OF DEMENTIA
Lasts 1 to 2 years
–Now needs help with all daily activities
–May become unresponsive
–Often refuses to eat
–Difficulty walking
–Little or no language
–Often loses control of urine and bowel movements
–Often experiences less anxiety
The common denominator of all stages of dementia is anxiety. Even people in the early stages experience significant anxiety because they fear further decline. Anxiety often diminishes in the final stage, perhaps an indication of declining awareness of one’s condition, or even one’s self. Some researchers believe that psychological changes in midlife like increased anxiety, stubbornness, sadness, and aggression can also be early indicators of cognitive decline. Oftentimes these conditions are diagnosed as neuropsychiatric disorders, while the root cause may be brain changes associated with early neurodegenerative and neurovascular pathology.
Though the development and speed of the disease are unique to each individual, dementia generally progresses through the following seven stages. Changing the course of your health requires understanding where you fall on this spectrum. Before taking the Risk Assessment at the end of this chapter, we recommend you review the stages of dementia, as we’ll refer to them throughout Section Two and the NEURO Plan.
Stage 1: Preclinical
A person in this stage has no impairment, no memory disorder or cognitive deficits, though amyloid plaques and tau tangles may be accumulating in the brain (Alzheimer’s and other dementias begin to form years—and often decades—before they manifest). There may also be inflammation, vascular changes, and atrophy in certain parts of the brain, but not enough to cause symptoms.
This stage can last twenty years or longer. Preclinical individuals experience significant benefits from all aspects of the NEURO Plan. Proper nutrition will slow down the inflammatory, oxidative, and vascular damage that may have already started. Exercise will help regrow neuronal connections and increase blood flow to the brain. Both nutrition and exercise will reduce insulin resistance. Stress reduction allows the brain to heal itself, and sleep is the brain’s ultimate detox. Optimizing cognitive activities will also restore and further reinforce connections.
Stage 2: Mild Decline
Some mild memory changes begin to emerge in Stage 2. A person can still do everything they’ve always done. Their finances, driving, and work responsibilities are not yet affected, and family members haven’t noticed any changes.
This early stage can also last up to twenty years before symptoms worsen. Individuals with mild decline will experience the same benefits from the NEURO Plan as preclinical patients. Many individuals at this stage are able to reverse their symptoms if lifestyle change is implemented early on.
Stage 3: Mild Cognitive Impairment (MCI)
A person’s friends and family may begin to notice changes in memory and thinking in this stage. The individual may actually be in denial and claim he or she is only experiencing mild short-term memory problems. People with mild cognitive impairment experience more forgetfulness, lose things more often, and struggle to perform tasks they could easily do before. When neurologists conduct a cognitive exam, they notice some changes as well. Word finding, planning and organizing, and visuospatial skills tend to present difficulties.
There are two types of MCI: amnestic MCI disproportionately affects short-term memory (which is processed in the hippocampus) compared to long-term memory (which is more diffusely stored in the brain and thus more resilient in earlier stages), and is closely associated with Alzheimer’s disease; multidomain MCI simultaneously affects several cognitive domains (specialized aspects of cognition that control language, attention, executive function, behavior, and other cognitive functions) and is associated with vascular dementia. It is thought that each year about 10 to 15 percent of patients with MCI convert to dementia, and that ultimately up to 50 percent will convert to dementia. It’s entirely possible to reverse course at this stage, even for the 50 percent of people who would have otherwise proceeded to dementia.
On average, this stage lasts between one and three years. Individuals with mild cognitive impairment will experience all the benefits from the NEURO Plan as patients in Stages 1 and 2.
Stage 4: Mild to Moderate Dementia
Patients now have more difficulty with cognition and memory. They forget some of their life histories and are unable to remember what they did over the last week. Short-term recall is significantly affected. In a neurologist’s office, a person at this stage will fail to recall a list of five words. Often they’re more tense when driving (avoiding the highway is common), and they’ve made some mistakes with their finances. At this stage, by definition, a person is having difficulty with one or more daily activities like managing finances, cooking, or taking medication on their own. A formal Alzheimer’s diagnosis is most often made during Stage 4. Many of these patients withdraw, either consciously or unconsciously, because of how they’re struggling with memory and managing conversations. This stage is especially dangerous because most patients are still in denial and want to maintain control of their daily lives.
Stage 4 lasts an average of two to three years. Patients with mild to moderate dementia will also benefit from all aspects of the NEURO Plan. Stress management is especially important for reducing anxiety, which is present in some form in all individuals at this stage. Restorative sleep is also very helpful for these patients as sleep patterns may start to change dramatically. By far the most important factor during Stage 4 is social activity: if patients aren’t actively engaged with the people around them, their rate of decline will increase.
Stage 5: Moderate to Severe Dementia
Patients at this stage need assistance. Confusion is now pronounced, with an increasing inability to recall details like phone numbers and addresses. Hygiene begins to be affected as well: patients need to be reminded to shower, brush their teeth, and use the toilet. Sometimes anxiety in this stage can manifest as frustration and anger.
Stage 5 often lasts one and a half to two years. Just as in Stage 4, anxiety reduction is extremely important for these patients. They also benefit from cognitive and social activities that can help them maintain and strengthen neuronal connections. Regular exercise is crucial. Beginning with Stage 5 and throughout the remainder of the disease, Alzheimer’s patients have three times the risk of falls and hip fractures. There is evidence that maintaining muscle strength and balance through exercise significantly reduces the chance of injury, and interestingly, even increases cognitive health.
Stage 6: Severe Dementia
Professional care is needed in Stage 6. Patients are confused, unaware of their environments, and also experience major personality changes—sometimes aggression emerges, other times a person completely withdraws. People in this stage may not recognize close family members. There’s often one very close family member, usually a spouse or child, that the patient depends on for a sense of security. If this person leaves the room, the patient instantly grows anxious. In this way, the Stage 6 patient is completely bound to the caregiver. Other times, however, patients suffer from Capgras syndrome, where they believe that a familiar person is an imposter. Sleep cycles are also severely affected. Wandering can occur during this stage if the right safeguards are not instituted ahead of time (bracelets, identification, locked doors).
This stage lasts roughly two to two and a half years. Patients with severe dementia can still benefit from a diet low in sugar and saturated fats, though they will need someone to oversee their dietary plan. A simple walking routine, or exercise in the home, is an excellent way of slowing down the disease process, which usually accelerates at this stage due to general frailty. Because the sleep-wake cycle is often erratic in patients with severe dementia, sleep hygiene techniques can be especially helpful. Stress management can also help reduce anxiety, though at this stage the focus should be on creating a familiar and relaxing environment (rather than on meditation or yoga).
Stage 7: The Final Stage of Dementia
The patient’s appetite is poor, and he or she has problems swallowing, difficulty walking, and little to no language—though there can be flashes of lucidity that are often connected to a patient’s strongest memories and associations (more on this in the “Optimize” chapter). Thankfully, many patients at this stage experience less anxiety and aggression, which seems to be an indication of diminished consciousness, the awareness of one’s self in an environment. Patients at this stage require assistance with all activities of daily living.
The final stage of the disease can last anywhere between one and two years. Anxiety reduction and functional sleep patterns still help patients in Stage 7. Even in the final years of Alzheimer’s, patients benefit greatly from social interaction in a familiar environment.
