RAG Files/Alzheimer's Disease - Signs and Symptoms - Middle Stage.txt

Middle stage
Progressive deterioration eventually hinders independence, with subjects being unable to perform most common activities of daily living.[32] Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions (paraphasias). Reading and writing skills are also progressively lost.[32][36] Complex motor sequences become less coordinated as time passes and Alzheimer's disease progresses, so the risk of falling increases.[32] During this phase, memory problems worsen, and the person may fail to recognise close relatives.[32] Long-term memory, which was previously intact, becomes impaired.[32]

Behavioral and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and emotional lability, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.[32] Sundowning can also appear.[37] Approximately 30% of people with Alzheimer's disease develop illusionary misidentifications and other delusional symptoms.[32] Subjects also lose insight of their disease process and limitations (anosognosia).[32] Urinary incontinence can develop.[32] These symptoms create stress for relatives and caregivers, which can be reduced by moving the person from home care to other long-term care facilities.[32][38]