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Stages of Alzheimer’s Disease and What to Expect

Elderly woman with Alzheimer's.
Alzheimer’s is a progressive disease, meaning symptoms will gradually change and become more severe.

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October 28, 2011

First blanking on a grandchild’s name, then accusing a son or daughter of stealing personal belongings, to eventually not recognizing close family members—this is the heart-breaking long goodbye, also known as Alzheimer’s disease. One of the scariest parts of Alzheimer’s can be the unknown of how it will affect your loved one day to day, month to month and year to year.

Alzheimer’s is a progressive disease, meaning symptoms will gradually change and become more severe. While these changes affect everyone in different ways and at different paces, it does follow patterns that enable you to understand the affected person’s level of cognitive impairment and plan accordingly for the additional care that will be needed along the way.

The phases of Alzheimer’s are typically grouped into three main stages:

  • Mild (early)
  • Moderate (middle)
  • Severe (late)

The following information, gathered from, the Alzheimer’s Association and Dr. Barry Reisberg’s Global Deterioration Scale, describes each stage in more detail.



  • Repeating questions or comments without realizing it, often within the same conversation
  • Misplacing objects or storing them in an unusual spot
  • Difficulty comprehending, retaining and recalling new information (yet memories from long ago are vivid and easily recalled)
  • “Good” days where your loved one seems completely normal and “bad” days when his or her cognitive impairment seems more pronounced and interferes with daily life
  • Avoiding regular activities that have become more difficult in order to minimize embarrassment and frustration. Mood changes may accompany these frustrations

Care Considerations:

  • For the most part, those in the early stages of Alzheimer’s can remain independent in carrying out their normal activities of daily living
  • It will become increasingly helpful or necessary to provide assistance with complex tasks like managing finances, keeping track of appointments, following a recipe and going to unfamiliar places. Whether it’s you, another family member, a neighbor or a hired companion who stops by several times a week, it’s important to have a support system in place
  • If incidents of getting lost, locking the keys in the car or house, or forgetting to turn off the oven become more prevalent or hazardous to the safety of your loved one and others, it’s time to re-evaluate the level of care



  • Greater difficulty with social situations and communicating appropriately
  • Decreased sense of time
  • Increased irritability due to frustrations from declining abilities
  • Withdrawal from daily activities that have become too difficult to handle
  • More frequent and prolonged memory lapses
  • Periods of disorientation, regardless of familiarity with environment
  • Difficulty reasoning and making good judgments
  • Changes in behavior that may including wandering; rummaging; delusions or hallucinations; expressions of anger aggression, or anxiety; shouting; and disrupted sleeping and eating patterns
  • Care Considerations:

    • Daily support is needed during this stage of Alzheimer’s, whether from family members or trained professional caregivers
    • External memory cues and verbal prompting should accompany every activity
    • Maintain a daily routine and minimize change as much as possible
    • Allow extra time to perform tasks
    • If violent or aggressive behaviors become frequent, incontinence becomes an issue, or you see a decrease in mobility, talk to your loved one’s doctor. It may be time for a more advanced level of care



    • Difficulty or complete inability to recognize familiar people, including close family members and even self
    • A lot of time spent sleeping
    • Nonsense speech including babbling or making strange noises
    • Loss of motor skills and sense of touch
    • Cognitive abilities similar to those of a 2 to 5 year old

    Care Considerations:

    • Someone entering late stage Alzheimer’s will require personal care assistance to bathe and use the toilet or manage incontinence
    • 24/7 care is needed as the person becomes completely dependent on others
    • Safety and fall-prevention measures must be taken to accommodate decline in mobility
    • May become more susceptible to other illnesses
    • Even though the person with Alzheimer’s may not seem to remember, recognize or respond to anything, he or she can still feel personal touch and loving attention
    • Depending on the severity of symptoms and behaviors, skilled nursing, palliative or hospice care may be needed

    No matter which stage your loved one falls into, it’s important to focus on what he or she CAN do rather than which abilities have declined. Helping a loved one through such devastating changes puts a lot of stress on you as the caregiver to continue providing the best care possible. But whether or not it seems as though your loved one with Alzheimer’s or dementia can understand and appreciate your efforts, know that he or she will always be able to feel your love.

    The more you know, the better your loved one's care will be. Free online training and expert tips at

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    Thoughts and stories from others
    1. April 8, 2017 at 7:20 pm | Posted by caroline kirkham

      my Ronnie looks so sad ,I am very unhappy ...I love him so much. met him when I was 14years old he was my first and only boyfriend. got married at 17yrs old I am now 67years old.and still love him the same if not more after all these years.dont know what to do and I feel so so guilty that he is in a nursing home . x


    2. April 8, 2017 at 7:13 pm | Posted by caroline kirkham

      husband has alzheimers/vascular dementia .


    3. April 8, 2017 at 6:05 pm | Posted by Dawn

      I'm not trying to be ugly but I wonder if the folks that say things like keep your loved one awake during the day, etc.., have ever taken care of an Alzheimers patient full time before. It's definitely easier than done. My ma-in-law stays up all night, and that's after taking pills for sleep, and then wants to sleep during the day. I can't make her stay awake if I tried! It is exhausting!


    4. November 3, 2016 at 9:42 pm | Posted by cindy harshaw

      If you parent or parents were a veteran the VA can help alot try contracting your nearest va. They have help my husband and I alot.


      • March 2, 2017 at 10:17 pm | Posted by K Phelps

        Unfortunately that isn't true for our local VA in Danville IL. The don't have a place for my father because he doesn't have rank or a "connection" as the dr said. My dads risked his life and served his country but in the end it's about who you are and who you know.


        • March 7, 2017 at 11:33 pm | Posted by Connie

          I agree! My husband is 82 and served in Navy and now has Lewey Body and gets very little help from VA he only had 10% service related disability and he needs 70% to get help!


    5. October 28, 2016 at 12:24 pm | Posted by dianna

      Has she seen a neurologist and is she on any medications? There are lots of medications that can control some of the issues you are having like the wandering all night. That can help your Sister and you to get some rest. Sounds like it is time for a walker if you can get her to use one. Try to get one with a seat that she can down on when she gets tired. The repetitive things she does is the Alzheimers disease, not your Mom. She probably doesn't even realize she is doing it. Staying clean and dry and bathing can sometimes be hard. Depends etc are so hot to wear but she needs to have something on all the time if she cannot get to the bathroom in time and lots of great wipes to clean her with. If she has a UTI her doctor needs to check her and treat in. She may just not remember to go to the bathroom or just can't seem to get their in time or have complete bladder loss. It is important to get those medical check ups and see what stage she is truly in and how to maintain or go from here. The unknown is very fearful, I know. I overlooked a lot of things in the beginning thinking she was just playing with me until my brain could accept that this is reality, she for real could not go from the kitchen to her chair in the living area and remember what she had just done. She forgot she just ate. I will be in prayer for you & your sister. Behavior and mood changes happen a lot without proper dx and medication. Some Alzheimers folks get mean and ugly but they don't know what they are ding. It is not them. It is the disease. Mom is still Mom. Just keep loving on her.


    6. October 28, 2016 at 9:32 am | Posted by Emily

      My dad didn't tell us about his diagnosis until we had to start taking our parents to the doctor. I am so sad that he didn't tell us because maybe we could have planned a little bit better for this. I am terrified because my mom has Mild Cognitive and my dad has Dementia. I don't know what our future will hold, sometimes I feel we are not going to make it through this, like I feel at any minute I am going to drown. My brother comes down during the weekdays to check on them, and I come on the weekends. We have been doing this for awhile now and I feel guilty because I really do miss my weekends. Today I just feel really sad and tired and scared.


    7. August 2, 2016 at 6:21 pm | Posted by Diane Bruers

      My mother did walk again but she was heading into the moderate stage at that time.


    8. August 2, 2016 at 4:56 pm | Posted by Peggy Vickers

      I have been told by Drs. after an MRI that I have the beginnings of dementia.My memory is getting worse,I can't remember names, etc. My car had to go because of the problem. Just sick about them finding this but thought It is better than altimers . Can you share any information that will help me get through this time? I have been told by some that what I have is not so bad & I could get over this. Do you think this is true.? I am a 81 year old widow lady. If you can send me any information that would help me understand dementia I would surely appreciate it. Right now I am looking at nursing homes since I live alone.Thank you. Peggy Vickers


      • August 20, 2016 at 9:38 am | Posted by Janelle

        Hi Peggy, I hope you have found the help you need. My Mum was widowed in January 2016 aged 77 and we think she has dementia so I have been learning what I can. You have so many resources online if you are still comfortable using a computer. I highly recommend Christine Bryden who has been living with dementia for 20 years now and is a great advocate. She was involved in starting up this group and has written 4 books of her own.


    9. July 24, 2016 at 5:19 pm | Posted by Lisa

      In late stage do they ever walk again after breaking a hip?


      • October 28, 2016 at 12:14 pm | Posted by dianna

        My Mother was never able to walk again after a broken hip, she could not follow directions for physical therapy and had other issues also. The trauma of the fall pushed her Alzheimers disease into high gear. it made her very fearful and she could not get beyond it. We even gave her some time off and then retried P.T. again but after lying in bed for 6 weeks immobilized because she could not have a hip repair done she was too stiff and scared to try anything. She has now been in a nursing care home facility for 3 years. She is bed bound and wheel chair bound but still laughs and goes to activities, plays bingo and feeds herself with some assistance from family or the staff. We try to focus on what she can do and not what she can't. We play her music and sing with her. We take her out of the facility at least once a month for a haircut and a meal out with our immediate family at a quiet place where she can have us all around her. We just love on her and encourage her everyday. It is hard for us to watch her sometimes struggle with not knowing where she is and who we are, etc. but we do the best we can for her, she will always be Mama no matter what happens.


        • November 9, 2016 at 12:45 pm | Posted by Janis Stevenson

          My Mother also broke her hip and has not been able to regain her "footing". She was in rehab for 5 weeks with no success whatsoever. She became aggressive and hit people, refused to cooperate, etc. Our biggest problem is she does not remember she cannot walk and tries to stand up (alot) and repeatedly falls. We have placed her in a Memory Care facility now, that is wonderful, but it won't slow the progress of the Alzheimer's. Every time we have moved her, such as from home to hospital, hospital to rehab, rehab back to the ER (4 times for falls), Rehab to Memory Care, it does incredible damage to her mind. You can actually see the downhill trajectory each time. We were told when we moved her into the Memory Care facility that it was not a good idea to move her anywhere for any reason other than an emergency. Watch your Mother closely for signs that the outings may be stressing her mind. Enjoy her sweetness.


    10. July 7, 2016 at 3:57 pm | Posted by Joyce Hamelin

      What a tough situation! In terms of the bladder incontinence, it sounds like a paper-panty, like Depends or a heavy pad like Poise would be in order at this time. This will prevent the urine from flowing to the carpet. Also, it's good to check in with the GP to see if there might be a medical problem with the bladder, like an infection, sometimes people urinate much more if they have an infection. Making sure she does not drink beverages a few hours before bed, so that she can fully empty her bladder and this makes it less likely she will get up or wake up to pee in the night. A toileting routine can also help. Take your mother (by the hand or by verbal encouragement) to the bathroom every few hours and make it a part of her daily routine. If she empties her bladder frequently, then it's less likely she'll have accidents. Also, if you (or your sister) take her, she can go directly in the toilet vs. a "potty chair" and then there will not be a full pot for her to carry around and spill. Otherwise, if you go with her, then as soon as she is finished, empty the chamber pot right away. Then, if she does go to take it out, it will be empty and less accidents will happen. You are on the right track to try and keep her awake as much as possible during the day. Are there activities she used to really enjoy? Cards, walks, dancing, arts/crafts, etc. engaging her in activities she enjoys will help her to want to more fully participate. If she is falling, you might need a walker or a cane. Not sure where you live, but the Geriatric Assessment Outreach Team might be appropriate to assess where your mother is at in terms of her cognition (memory); the falls, urinary incontinence, medication review, etc. If you are in West End Ottawa, call: 613-721-0041 and you can refer your mum and/or have her GP refer her. if you are in the East End of Ottawa, call 613-562-6362. This is an in-home medical assessment and it is covered by OHIP. The assessor can help with other ideas, refer on to appropriate support services in the community; as well, if determined appropriate at the assessment refer your mother to specialized geriatric services. you can call to consult to see if this would be something helpful to your mother, you and your sister. Blessings, Joyce


    11. July 5, 2016 at 1:43 am | Posted by Rita Wilson

      Mom had dementia and hid from us for many years. We found out later that she'd drive to town and forget where she was going. Not sure what stage mom is but she wants to prowl around all night and wants to sleep all day. It's hard because my sis lives with her and works so she's exhausted. I go during the day. Mom was walking around tonight looking for quarters and folding and refolding her blanket. She pees all the time and on the carpet. We have to watch her cause she will get her potty chair container and carry it around the house spilling it. Mom has fallen like3 times in the last month but has been lucky enough not to break anything. She still eats really good but had lost 12 pounds in 2 weeks which concerned us. I try to keep her awake as much as possible during the day but she gets mad and curses (something she rarely did). Any suggestions?


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