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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 Caring.com, the Alzheimer’s Association and Dr. Barry Reisberg’s Global Deterioration Scale, describes each stage in more detail.

Mild

Characteristics:

  • 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

Moderate

Characteristics:

  • 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

    Severe

    Characteristics:

    • 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 HelpforAlzheimersFamilies.com

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    Thoughts and stories from others
    1. March 29, 2014 at 6:30 pm | Posted by Sheryl

      I have been taking care of my mom for the last 2 years. She is in the late stages, incontinent doesn't know us and is basically lost. Imagine just being lost. Every second on every day. Mom has fallen twice in the last 5 days. First time I called an ambulance because I panicked because of the blood. They didin't admit her because there was really no reason too. The second time my husband and I just helped her up and she seemed fine. It is horrifying to watch someone die every day because that's what it seems like. I can't believe that we can put a dog or cat out of it;'s misery but not a loved one....

      Reply

    2. March 20, 2014 at 12:05 pm | Posted by Jenny

      I have a friend who's grandma raised her since she was about 8 years old due to her mother abandoning her and her two sisters. Last summer, my friend's aunt came through and got temporary guardianship of the gma, evicted my friend, and put her on a no contact list. At that time, to our knowledge, she had not been diagnosed with Alzheimer's. My friend had taken her to the doctor and the doctor said no memory loss. Then, an affidavit showed up for 5 days later from the same doctor that said dementia and the doctor's office gave it to the aunt who used it to get her gma. Now, she has been diagnosed. The courts finally ruled 2 weeks ago that my friend could go see her gma with the Guardian Ad Litem present. So, she went and saw her. The gma had no recollection of myself, husband, or kids who were over there EVERY DAY and she thought my friend was trying to kill her which she would NEVER hurt her gma. Gma said she had nothing nice to say to her grandma and didn't want to see her. It broke all of our hearts especially her. That's really going to hurt my friend's contested guardianship case, but aside from that what stage does this seem like it is? Is that normal to think someone that would never hurt you was there to kill you after not seeing them for 9 months? Also, 2 weeks prior to the visit, another friend called the assisted living home to talk to the gma and the gma said she wanted to talk to her grand daughter and she didn't know why she was there. Then, 2 weeks later she thought the grand daughter was going to kill her and one night they almost had to sedate her because she thought her grand daughter would kill her so the nurses told her she had been arrested and that helped the grandma sleep. Aren't the nurses just adding to gma being afraid by lieing like that instead of letting her know that no one is out to kill her? Is this normal? I just told my 3 boys that gma loves them because the gma they knew did love them:( Please help my understanding.

      Reply

    3. January 30, 2014 at 8:41 am | Posted by Melissa Williams

      If you are like me, I read every book about this subject and many made a person feel guilty if you put your loved one in a nursing home. My dad became more than my Mother and I could handle at home. We had him going to an adult day care while I was at work and then someone to stay with him and my Mother until I was off work and available to help her. We did this until it wore both my Mother and myself down and Daddy was not a happy camper either. We admitted him to a nursing home (for people with memory problems) and he is so much happier. He is able to wander all over the facility (they can't open outside doors) doesn't feel caged in and they are able to help him bath, dress and take care of his needs much easier than we were. Now when we visit it is to see him and not "Do Things" for him..Of course there are things that we don't like, but it is things that bother us, not him. He may not get a shave as often as we would like, or he may have mismatched clothes on, but this is stuff that isn't important to him, so we try to let it go. Good Luck and whatever you choose to do, remember it is what is best for your family, no one can tell you what you need to do, they are not the one who is living your life.

      Reply

      • February 13, 2014 at 8:37 pm | Posted by Kathy Hawksford

        Thank you for sharing your experience with the nursing home. My mother's long-time companion is now at a nursing home. I now listen to her complain about how the care is at the nursing home (he's not dressed in "his" clothes, the nursing home has him drugged, the care at the nursing home costs too much, on and on). After listening to my mother's diatribe today, I googled the stages of the disease and found this website and your experience with your father. I was grateful to read how you and your mother's attitude toward things at the nursing home. I'm going to try to get this across to my mother. Wish me luck!

        Reply

    4. January 24, 2014 at 12:51 am | Posted by dylan

      My grandpa is entering the severe stage. He was in mild for about 3 and half years. The moderate for 2 years in the past 2 to 3 months it has jumped from moderate to severe from day to day. For the last two weeks it has been complete severe. Luckily he is a very happy go lucky person with Alzheimer's. He talks alot of non sense and makes up stories. His long term memory has always been good till recently. And now my most major issue is that me and my fiance live with him to take care of him, he is sure that she is his wife and that I am trying to take her from him. He literally gets mad if we even act the least bit close to each other around him. It scares her pretty bad. He tries to go in the bathroom while she is in the shower and has walked in our bedroom more than once with her dressing. Now we have locks so it can't happen again. Some days he's fine with her but other's it's worse. We don't want to put him anywhere but if it gets any worse I don't see another way. We have him on Lexapro, Namenda and Syriquil. Without those he would already be gone. Anyone have any suggestions on what to do or say when he starts acting like she is his wife or gf? Thanks for any advice.

      Reply

      • March 10, 2014 at 2:11 pm | Posted by S Davis

        I'm sorry you and your fiancé are having this troubling situation with your dad but glad he's a happy go lucky person - that makes caregiving a bit easier. Try to redirect your father when he thinks your fiancé is his wife, say something like, please tell me about your wife or ask your fiancé to ask your dad about his wife. It probably won't do any good trying to correct him. I found support groups very beneficial. Good luck and God bless.

        Reply

    5. January 19, 2014 at 7:18 am | Posted by Stephanie

      I am interested in the "Severe" stage and how to know if it's best to keep my mom "OUT" of the rest home or accept she need to be in one? Thank you and GOD BLESS!

      Reply

      • January 24, 2014 at 1:01 am | Posted by dylan

        If you can safely keep her and take care of her I would. But that's just me personally. Only reason I say that is my fiance works in health care both assisted living and also has in nursing homes. Their is not enough workers in the places to provide complete around the clock care for your mom. Just an example: where she works now it is her and 2 other co workers for 79 residents. And like she told me they can't watch and keep up with everyone at all times. Not to mention the mean and rude ones that could care less how long someone lies around in their own urine. If you can't take care of her and are to the point she needs to go somewhere. I would only put her in one that has a lock down unit. Cause even though they can't always be by her side at leastcshe can't get out and do anything to harm herself. Good Luck.

        Reply

    6. June 16, 2013 at 8:04 pm | Posted by Louise

      My husband refuses to wear Depends and is confused about where to urinate so does it just about anywhere; also this happens sometimes with defecating. He gets very angry with me when I try to get him to wear a product, and screams at me and calls me names and orders me to get out. Does anyone have a good idea for protecting wood floors against this urination, or ways to cajole a very stubborn and unduly prideful person to wear protection? Of course, there's no reasoning with him and I also can get very angry with him and these "battles" take so much out of me.

      Reply

      • March 10, 2014 at 2:16 pm | Posted by S Davis

        I empathize with you and for your husband. Any chance your husband would listen to his doctor if the doctor told him that he/she is writing him a prescription? Sometimes a person will listen to the doctor's advice. Good luck.

        Reply

    7. November 10, 2012 at 1:31 am | Posted by Ellen Olson

      I am particularly interested in information/personal histories of persons in the "Severe" stage as that is where my husband is now. Thanks.

      Reply

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