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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. September 4, 2017 at 10:29 pm | Posted by Gail N.

      My husband believes our house is full of bugs. He has them under his skin and is trying to dig them out. Seems all I can do is up his meds, again. Is this common with LBD? He is always asking where everyone went, no one is ever here. All I can say is "it's just you and me."


    2. July 27, 2017 at 8:20 am | Posted by chris

      Oh, honey, I feel for you. I have taken care of my mother with dementia for 5 yrs now. sad to say, I am glad my father passed 5 yrs ago as he was ill also with heart disease and diabetes and to take care of two would have been impossible. I have 11 siblings, none of which help except my bipolar schizophrenic brother who cannot drive and who is currently not helping because he's mad about 'whatever'. I am the daughter who works, has a fulltime caregiver in my home every day, takes my mother to all appointments, shopping while lifting a wheelchair in and out of the care with each stop. I can't go out to dinner with friends, take a walk, etc. I put her on the porch while I mow the lawn so she won't fall while I'm outside. I am so exhausted, emotionally worn out and resentful that I am the only one to step up while my siblings live their lives as they choose. i pray that God will take her so i can get back to my life....


      • October 15, 2017 at 4:45 pm | Posted by Kennedy

        Chris,I just wanted to send you strength. I'm in same situation as you and very resentful and angry towards my siblings as well. They don't help, live there lives as they please and are insensative enough or clueless to let me know about ALL the trips they go on, from Spain, to vacationing on private homes on a lake, to Ohio art festival, and on and it goes - how nice for them. I have quit my job to caretaker my parents and now have no health insurance, no social life, finances are a burden as I am a widow. I can't do anything for myself to get away, while my siblings selfishly and convienantly live there lives and offer no help. I told my sister to take them for summer as she doesn't work and her husband is a VP - she wouldn't do it. I ask myself daily, how long does one sacrifice my own life and pay costs for there parents to point of great unhappiness. I pray and pray like you that God will take them in their sleep, so I can live a life of my own and find joy for myself. Both have dementia. Peace to you dear one.


    3. July 13, 2017 at 8:22 pm | Posted by Gwen Wingard

      My husband has had alzheimer's disease for about 10 years. The last year, he doesn't want to shave, doesn't want to shower. He will wear the same clothes for a month if I didn't slip and get them when he's asleep. He doesn't want to do anything anymore. We had to move to be closer to our children and he hates it. He gets mad at me, curses me (something he has never done). He is like a different person. He recently started sleeping about 20 hours a day. It doesn't want to eat or drink anything. He just wants to sleep all the time. I'm his only caregiver and I just wondered if there is anything I can do to help draw him out. He is just starting this sleeping thing a couple of weeks ago. I don't know if it's a permanent thing or not. I really don't know what to do or if I need to do anything. Any word from anybody would help. He at times, talked babble, makes no sense at all. I know there is no "normal" to this disease but I just wondered if this is a characteristic of it. If anybody has had the same experience, please let me know. Thanks.


      • July 25, 2017 at 5:08 pm | Posted by Home Instead

        Hi Gwen, thanks for sharing your caregiving experience with us. A resource you might find helpful is the website In particular, the Dementia Support Network section has many different tips related to sleep behaviors: You may also find the Daily Companion app helpful for tips from experts and other caregivers: Check with your husband's doctor if you have concerns about the development of new symptoms or behaviors. Your local Alzheimer's Association chapter may also be able to provide helpful support, as well as your local Home Instead Senior Care office if you're considering professional in-home Alzheimer's and dementia care services: Finally, a great place to chat with other caregivers about their experiences is the Remember for Alzheimer's Facebook page: Big hugs to you and wishing you strength on this difficult caregiving journey!


    4. June 1, 2017 at 12:40 am | Posted by Marlene

      My 92 yr. old mom has had Alzheimer's for around 13 or more years now. It started out very slow in 2004 where she would forget a lot of everyday things, then in 2006 she needed to use a walker or drive a scooter to get around. In 2008 she became permanently wheelchair bound after many falls and 2 hip surgeries. I've lived with her and my dad, who is 86, my disabled brother (who has bipolar-schizophrenia), since 2004. My younger sister who moved in 5 years ago, also has mental and emotional problems but she does help around the house and with my mom. My brother does what he can but has to be repeatedly told how to do things because of his disability. I feel that I have aged 25 years instead of 13 because of the stress of dealing with my mom, who is in the end stages now and totally incontinent, and my brother and sister who need constant reminders of everyday tasks. My father has had quad bypass open heart surgery and is on end stage kidney dialysis. I have to cook for them their special food (mom also has diabetes type 2 and my brother just diagnosed with it), because of my dad's heart and kidney problems I sometimes need to make 2 separate types of meals. I was taking care of my mom day and night until I was injured (she is 165 lbs) helping lift her and my leg tore a ligament. I see her slowly deteriorating daily and just about a month ago she stopped swallowing her food. She does fine with breakfast but lunch and dinner she needs to drink glucerna or have her food ground up to a thick liquid. Today she started falling asleep at breakfast and wanted to sleep all day. We just put her to bed and she wouldn't let us change her diaper. She wants to sleep so we did not argue with her. She doesn't make sense when she talks at times but reacts to touch and love and stimuli (my older sister gives her facials to clean her skin). I rub lotion on her arms, legs, neck and face and she sometimes says it hurts...even though I am very gentle. It is getting scarier every day. She smiles only occasionally now whereas she loved to joke around and laugh. I fear she will not make it to Christmas this year but hope the sleep thing is just today. Anyone who takes care of parents and/or siblings/family members with Alzheimer's or dementia knows that it is a debilitating and draining disease on not just the person with the disease, but the entire family involved, so you are not alone. Living with them and having hardly any time for myself makes me feel hopeless and exhausted. I thank God that my dad still has his cognitive senses or this would be a very different scenario. I commend anyone dealing with this horrible disease and hope they find a cure soon.


      • July 22, 2017 at 6:17 pm | Posted by Amy

        Hi Marlene,Your determination is admirable, but remember to care for yourself, too; that's a lot for you, perhaps it's time to find professional assistance? Our mother has Alzheimer's and there's four of us, all doing what we can, but still very tiring and energy draining. Your mother is fortunate to have a daughter such as you.


    5. 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


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

      husband has alzheimers/vascular dementia .


    7. 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!


      • June 25, 2017 at 8:19 am | Posted by Cissi

        I understand your dilemma. My mother ( 3 yrs) and husband (6 yrs) with Alzheimer's. It's easy to say to yourself and for others say, keep them awake, do this, do that. I feed, change, give meds, and shower them. I try to stimulate their senses and keep them involved. But sometimes they're in shut down mode and there you have it. I pray for the next day to be better. I'm proud that they will walk around a little and some days they seem their selves. They have no sores and are not in pain. That is my biggest goal for them. For me, I'm happy all though tired sometimes, having them home.


      • August 18, 2017 at 8:28 pm | Posted by Mandy Ford

        I totally agree with you I've been taking care of my granny with middle stage Alzheimer's for 2 years. About 4 months ago she started staying up later and later. Now she's up half the night and would sleep till 2 in the afternoon if I let her but she's a diabetic and has to eat and take her medicine. I get her up at noon everyday and after getting dressed eating she's in her recliner fast asleep. I'll tell her granny you just got up try and stay awake so you can sleep tonight. But she forgets it within a minute or less. I'll have her get up and walk and try to keep her awake but that don't last long. So I've learned to deal with it and let her sleep when she wants plus it makes my life so much easier. I don't think they know about the aggression and how mean they can be also. With isn't them it's the disease.


    8. 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!


          • June 17, 2017 at 11:51 am | Posted by Dottie

            So my husband has been diagnosed as well with Lew Body dementia with Parkinsonism. It took us 10 years to get the diagnosis. This morning he didn't know his own name. Can not toliet himself at all,eats with spoon, could go on and on.. But am wondering if any one can tell me in their own experience how much longer he may have. I know all are different. I have been through the VA and applies for some Benifits.. Having said that he must still be alive when they reach their decision, and will expedite if he is terminal. HOWEVER no doctor etc. will use the "T" word for fear of legal issues.he was in Vietnam so that is hopefull eligibility for help. He does have heart falling. So that was listed as well.oh gosh sorry this sounds more like rant. Tough day... I did use the A.MVet to help me out with paper work hope this helps. Is there a chance you can challenge the decisions?


            • July 27, 2017 at 11:32 pm | Posted by S. Moore

              Houst on office has a Consumer Affairs that offers help in challenging decisions.

    9. 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.


    10. 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.


    11. 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.


    12. 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.


      • April 24, 2017 at 1:12 am | Posted by Ash

        Hi Peggy, I truly believe you can slow down the process by exercising and eating a plant based diet. do not loose hope. I am praying for you.:)


    13. 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.


    14. 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


    15. 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?


      • June 1, 2017 at 12:47 am | Posted by Marlene

        Sounds like your mom is in need of adult diapers and maybe be assesed by a neurologist to see if they can refer some help to you and your family on how to care for her. She may also need a nurse to check on her daily. My mom has a nurse come daily to bathe, clean, dress her and give her breakfast every day. My brother and I clean and change her diaper at night. She may not like the diaper idea at first but it will save you and her much stress and headaches.


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