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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. 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.

      Reply

    2. 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.

      Reply

    3. 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.

      Reply

    4. 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.

      Reply

    5. 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.

      Reply

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