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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. May 16, 2016 at 5:29 am | Posted by Rachel C

      It could be. My grandmother would forget things, like giving companies checks and such. My mother had full access to her account, she handled the finances. My grandmother called her, accusing her of writing herself checks, not remembering she had written them herself. She is close with my mother, really close, but the Alzhiemers causes these types of reactions. Is she also forgetful, or tells stories multiple times in a row? If so, I would say she has it. And I am sorry if that is the case. I am now a 24/7 caregiver to my grandmother, and it is not easy. Being a caregiver isn't the only option, but it was the best one for my grandmother.


    2. May 1, 2016 at 11:51 pm | Posted by jackie

      Need advice. My mother in law has been having some issues for the last 8 months. She was unfortunately scammed , someone told her she won a sweepstakes for a million dollars. She has sent them money. After 8 months she is still waiting on her money. We have all tried to convince her that she hasn't. She has had total meltdowns toward her daughters (she is very close to ). She called them liars etc...We are in touch with alzheimer's organization, does this sound like alzheimer's? ,


    3. February 27, 2016 at 1:24 pm | Posted by Elayne Webb

      husband with dementia sleeps 15 hours a day no food all those hours.


    4. January 31, 2016 at 2:56 pm | Posted by Gail N.

      My husband has dementia, he will see other women in our house and not me. When he does see me he wants to know their names and their stories, what do they want, what are they after. I tell him that they are me and no one else is here, he can't believe me anymore. Do I need to make up stories for each of these women? I do need help.


      • April 27, 2016 at 9:21 am | Posted by Kathy

        Hi, Gail~ I just got on here and don't know if you're still experiencing this issue with your husband. My mom sees people here often and especially one woman. She asks me questions about them so I told her that honestly I just can't see them so I need her to tell me more about them. She just smiles at me and then as she tries to tell me more she relaxes and says it's okay. It's not much but this just worked rather than making up stories. I do believe people walk in both worlds as they near death.


      • May 16, 2016 at 5:39 am | Posted by Rachel C

        I am so sorry. My grandmother has it and I can't imagine how I would handle things if it was my husband. You are truly amazing for being there for him. At one point my grandmother was in a nursing home, 3 months, but we moved her back in with us. I would volenteer three days a week at the nursing home and I watched how they handled the dementia patients. Most of the time, they play along with whatever the patients think. They can sense if you are extremely uncomfortable and that makes them uncomfortable, so it is important to do what you are the most comfortable with. If that means making up stories or constantly correcting him. God Bless!


    5. January 30, 2016 at 6:19 pm | Posted by SHIMI

      My wife is 83, she was diagnosed about two years ago with early dementia, she has all the signs that i have read on the comments here she remembers things from years ago, but her short term memory is very short, she will ask me the same questione over and over during each day, she has real problems operating the dishwasher, the TV the coffee pot, and i have watch her with the stove, its hard watching her go through this


    6. January 29, 2016 at 12:36 am | Posted by dale morris

      my wife (79) has severe dementia. Lately she goes to bed and can't go to sleep several times nightly. However once she goes to sleep she sleeps 12 to 14 hours. Too, she will pack a few cloths so her mom and dad can pick her up. they died 15 to 25 years ago. She packs weird things like toilet paper, a figurine. a couple of pictures, some of my underware etc .HELP!


      • April 27, 2016 at 9:26 am | Posted by Kathy

        Hi, Dale~ I don't know if you're still working on how to handle this. My mom would often pack up things to 'go home' or 'go to work'. I'd let her do her packing and offer to help. This brought her some peace. When she was ready, I'd either take her for a ride and then she'd forget about where we were going or, sometimes, she'd look outside and see that it was dark and I'd tell her that it's late so we're going to stay here tonight and go home tomorrow. She'd settle in for the night and feel at peace knowing she was heard.


    7. August 15, 2015 at 2:54 pm | Posted by quanda hollis

      my husband is73 and just sits and sleeps. he slides around when he is so called walking. he has been dionosed with alhs and is on namendarx.but don't really see a diference. he gets lost here in the house.he doesn't try to do any thing anymore. he has really just stopped doing anything, thanks


    8. July 24, 2015 at 7:31 am | Posted by katrina

      I coat my g'ma head to toe with Vaseline that has cocoa butter and use a lot of a+e ointment on her butt.


    9. May 26, 2015 at 4:28 pm | Posted by Erin

      My husband and I love with my mother in law who has Alzheimer's. I'm not sure what stage she's in but it's probably toward the moderate. She was diagnosed three years ago but has been having problems for eight years. She really isn't much of a problem except with eating. The real problem is me. My husband retired ten years ago when I was diagnosed with fibromyalgia. He decided to take care of me. Well he has a small part time job and I'm home alone with her. I feel like I can't take care of both of us and becoming very depressed. And forget to take my own meds. She has another son who is about an hour and a half a way and comes once a week he feels she is great but doesn't see all the day to day changes. She has has severe heart problems and is five ten and one hundred fifteen pounds and doesn't eat or drink enough to survive. Yesterday she looked right at her cat and couldn't recognize her. Three times. I feel ill die before her and she won't have anyone.


      • November 23, 2015 at 3:33 am | Posted by VA

        I feel your pain, my mom recently started these syptoms right in between one and two. I work from home which is causing me not even focus on my work, I have to stay up late into the evening for the ability to concentrate on my work. She's in a good mood and just a lot more blunt and extremely inpatient. I know it common for these patients to ant to go home, but how do I make her understand that the 9 year old she feels she needs to go and take care, is me and she did a great job raising me. I fear she will live the rest of her life thinking she abandoned her son, and the crying and demands become more frequent and threats. I was thinking of taking her back to her home so she could see he's not there, but I'm afraid it could backfire and no live in nurse is going to want to deal with this drama. I'm so worn out that I can't sleep, miss appointments feel that my son is being neglected and my wife will lose her patience soon.


    10. May 3, 2015 at 9:58 pm | Posted by Jerrie

      My mother-in-law has Alz., and had a sharp decline in abilities and had to be moved to a memory care facility from a retirement center. I was having a particularly hard time with her decline when I took her to see her doctor. We had to wait a long time and I felt overwhelmed as she babbled, laughed loudly and made strange noises the whole time. The nurse came in and evaluated her. At last the nurse turned to me and said, "She is really doing great." I was shocked because I couldn't see it. The nurse said, " Your mother-in-law is happy in her own world." That was a turning point for me, and I looked at Mom in a new light. She was happy, not worried about what was happening to her--not even aware. She was laughing, chatting about something in her world, safe and comfortable. Her problems seemed awful only because I was seeing them from the perspective of my world. She doesn't live in my world and never will again. But to her, her world is not an awful place. It is right where she is supposed to be. I can't bring her back to my world, but sometimes I can go to her world, laugh with her, tease and hug, walk the same circular path 15 times, hold the baby doll and stuffed animals and do all the things she enjoys. I feel the stress drain away and I am happy too.


    11. April 28, 2015 at 6:27 pm | Posted by diane

      Benadryl gel may help. I'm right there with you, but mine hasn't gotten to the itching yet. Does the book make you more sad? If so, I will not buy it.


    12. April 9, 2015 at 8:03 pm | Posted by Sandy D

      My Mom is in the last stage. She sleeps nearly all the time and just in the last day or two cannot swallow medication, so now I am crushing and putting it in pudding or applesauce. Mom was in assisted living for 2 1/2 years, but due to her moving farther into the disease process, she needed to be moved. I moved her home, so I can care for her with help from other caregivers. She doesn't know us, though she perked up over the weekend when my Son and his wife came from CO to see her. Today, she has not been able to get up at all. She has trouble with mobility since her last fall at the assisted living facility in January. I brought her home in February. She is just laying in bed. It's so hard to watch this once very active and sweet woman become so dilapidated! My concern is skin breakdown. She seems to have some sores (not on her backside where she lays, but on her neck). She scratches at them even though I have them covered. I've never seen this before. I'm not sure if this is normal to see as someone is preparing to pass on? She does not drink much and eats even less. She has a DNR in place, so there will not be any supportive services, such as a feeding tube or IV. We are just trying to make her comfortable and love on her as she gets ready to leave us. Any ideas on what to put on the sores, other than triple antibiotic? God bless us all as we help our loved ones transition into death. A good book which has helped me is "Glimpses of Heaven". The nurse who wrote it was a hospice nurse. Great resource for anyone facing the passing of a loved one.


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