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The History of Dementia
The Four A’s of Alzheimer’s
Brain Changes
Understanding Behavior
Caregiver Burden Scale
The Four A’s of Alzheimer’s
Persons with any of the dementias will exhibit certain, classic features or behaviors which are caused by the disease. As the brain becomes damaged during the disease process, different lobes of the brain are affected and in some cases destroyed. Each lobe of the brain is responsible for various bodily functions or memories. We call these changes the Four A’s of Alzheimer’s. Your physician may use these terms when working with your loved one and it is helpful to know and understand them as we partner in care.

Amnesia – the inability to use or retain memory, including short term and long term memory.

The person may constantly repeat questions such as “Where am I?” and “Who are you?” and “When are we going to eat?” or accuse the caregiver of stealing or being an imposter. This process occurs from damage to the Frontal lobes. These lobes store memory, personality, cognition, impulse control, speech, attention, rational thought, imagination and judgment.

This is usually the first area of change noticed by families and the “A” which has most likely caused verbal or physical abuse. This is usually when families are accused of stealing. The attacks on family members occur because the person doesn’t remember new information, like where she put her purse, but you are there, so you must have stolen her purse!

Agnosia -- the inability to recognize or use common objects or people.

The person may become lost in a familiar place because he/she doesn’t recognize the items that alert us to our surroundings. He/she may confuse a fork with a spoon, a toothbrush with a hairbrush or toothpaste with denture cream. Eventually the ability to recognize objects is lost completely. The person may also confuse a son with a husband or a father or an uncle, or a daughter may be confused with a mother or an aunt or a grandmother. This process is associated with increased damage to the Frontal lobes, the Occipital lobes (visual association, distance and depth perception) and the Temporal lobes (language, hearing and smell).

Aphasia – the inability to use or understand language.

The person will use the wrong word, or complete a story with phrases from another story, or provide a lengthy description of an item because he/she cannot find the right word. He/she may call family members by the wrong name, which increases the family’s anxiety and concern. This word finding difficulty will increase until all language use is lost. This is associated with damage to the Temporal lobes and the Frontal lobes.

Apraxia – the inability to use or coordinate purposeful muscle movement or coordination.

In the early stages the person may reach for an item and miss it. He/she may have difficulty catching a ball or clapping his/her hands. The floor may appear to be moving to this person and balance becomes affected, increasing the risk for falls and injury. Falls are not a sign of poor care, they are an indicator that the disease is progressing.

In time, this loss of ability to move affects the Activities of Daily Living (sleeping, ambulating, toileting, grooming, hygiene, dressing and eating). In the end stage, the person is not able to properly chew or swallow food, increasing the risk of choking or aspiration. This is linked to damage to Parietal lobes (pain, touch, temperature and pressure, sensory perception) and the Cortex (skilled movement) and the Occipital lobes.

Copyright by Tam Cummings, Geriatric Care Consulting LLC, used with permission
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