The five “A’s” of Alzheimer’s disease refer to the five common cognitive disabilities in all types of dementia — amnesia, aphasia, apraxia, agnosia and anomia.
Amnesia refers to memory loss and is often most noticeable when people with Alzheimer’s begin having difficulty with short-term memory, which later progresses to a decline in a long-term memory. As memory loss progresses, challenges in communication occur. Affected people cannot retain information, such as numerous instructions, so caregivers should speak in short, simple sentences while talking at a much slower pace.
Aphasia refers to impaired communication. The affected person has problems understanding what is being said and problems expressing thoughts with words. They are unable to find the right words or say them correctly. It also may affect the ability to read and write. In the later stages of Alzheimer’s, speech may become impossible to understand, and it may be difficult to determine how much of what the caregiver says is being comprehended. Nonverbal communication becomes important. Smiling, reassurance and touch therapy are all ways to communicate as aphasia progresses in the later stages. In the vast majority of those with Alzheimer’s disease, memory loss (amnesia) is more prominent than language impairment (aphasia).
Apraxia is a loss in voluntary motor skills. The affected person forgets how to do common movements and activities. The brain and the muscles required to carry out a task aren’t communicating, so they lose the ability to perform activities of daily living, like bathing, dressing, walking and eating. Because of these changes, there is a high risk of falls. Keeping the affected person as active as possible may help delay the physical changes in apraxia.
Agnosia is the loss of the ability to recognize objects, faces, voices or places. Not only does the affected person lose the ability to name the object — they may make up a word — but also the ability to describe its use. Caregivers should use gestures, such as pointing to objects the person might need, such as a comb, brush, fork or spoon.
Anomia is when messaging in the brain misfires and the affected person has difficulty with finding the right word. The person knows what item they need and what it does but cannot find the correct word. Again, gestures might help as might questions with two or three choices, such as “Would you like cereal or eggs for breakfast?”