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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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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

Last revised: October 28, 2011

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Thoughts and stories from others
  1. September 14, 2019 at 3:50 pm | Posted by Brett A Wright

    My mother is now 78...with the signs of alzheimers.She was involved in a car wreck over a year ago and it seems her wreck made it worse. I see several characteristics of the disease that she displays. Mood swings, not able to under what she does, sleep patterns are different, now she tends to wander off in a store with no reasoning, talks to the tv, tv being played way too loud, etc. Being as I am the only caregiver she has is slowly taking its toll on me. Everyday is a different situation.

    Reply

  2. July 30, 2019 at 6:08 pm | Posted by Jasika

    How did you get your mom to go to get tested for dementia? my mom is combative and uncooperative.

    Reply

  3. July 25, 2019 at 5:04 pm | Posted by Kathy

    Who do you call for hospice?

    Reply

  4. July 8, 2019 at 10:12 am | Posted by Walter Eremich Jr.

    My wife is final stage dementia. Fran sits on the toilet for 2-3 hours wiping herself and being concerned she is wet. No matter what I say or do will make her get up from the toilet. Fran suffers from lower back pain and consistent tummy pain. My heart is breaking as Fran will not listen to me. This situation is so frustrating!!

    Reply

    • July 28, 2019 at 1:05 am | Posted by Maureen

      I'm so sorry you are going through this....my mom is in late stages alzheimers.....I hope you will seek out and get some help!

      Reply

  5. March 25, 2019 at 7:55 am | Posted by s.heena

    hello.have you tried intermittent fasting for him

    Reply

  6. February 27, 2019 at 2:14 am | Posted by Yvonne Broman

    I wrote this poem for Caregivers ,,,The Caregiver , Things don't seem the same anymore He's forgotten what he knew before My days are filled doing the things he used to do How long will it be before he forgets youI question myself , can I be that strong To carry the whole load seems so wrong Thinking of the love we used to share Now I am loving you , and it seems your not thereAt night when I try to go to sleep I think of all the appointments I must keep And all the jobs that I must do "HE" is here but where are youI never thought my days would come to this Without a tender hug or even a kiss In the coming years, I pray I can deliver Knowing I'll only become the caregiver

    Reply

    • March 26, 2019 at 9:46 am | Posted by Rebeca Vargas

      Beautiful poem, I feel the same way. I'm doing all the things he used to do plus my regular chores. Yes, I feel tired, but God gives me the strength to keep being strong for him. There is no other explanation but that God is by my side keeping me from falling.

      Reply

    • May 11, 2019 at 7:00 pm | Posted by Rowan Jennings

      Hi YvonneHow excellently you have penned my thoughts and countless other folks as well'I have a web site scripturaltruths.org would you please give me permission to add it under the poetry section? I know it would be a blessing to many.Rowan

      Reply

  7. January 24, 2019 at 11:50 am | Posted by Mary dudenhefer

    My husband is starting to sleep more so sad we only stay home going out gives him anxiety

    Reply

  8. January 10, 2019 at 2:33 pm | Posted by Vivian Crespo

    Hello Betty, how is your husband doing? My grandma has being in the fetal position and just mumbling for a few weeks. I know she is suffering a lot, so I was wondering how long can she last like that...

    Reply

  9. December 13, 2018 at 11:52 pm | Posted by Susan O'Brian

    My mom 88, seems to have some late stage Alzhiemers. She is also 80% deaf. But wears hearing aides. I have found them in the weirdest places. I found salad bowls in her purse, coffee mugs in her walker. She sleeps for 6 to 8 hrs in the day and again at night. Her sleep patterns are very mixed up. Some days she's better. The other day she didn't know me. I'm her daughter. I was so upset. This disease is so sad. The government needs to realize us Baby Boomers are going to need even more help than the Greatest generation due to our huge numbers. God Bless the victims of this disease. 😢

    Reply

  10. December 5, 2018 at 7:48 pm | Posted by Betty Jean

    I feel your pain and financially hard As there are Many needs for them. My husbands in a fetal position and cannot talk just mumbles. The best thing I did was get Hospice in. They are so caring and will send someone to help with hygiene There is no cost to you for this service. I call them Angels. It is hard to get children to help cause it requires so much attention to take care of them. I look back and realize he has had this for 10 years. Heartbreaking.

    Reply

    • January 10, 2019 at 2:33 pm | Posted by Vivian Crespo

      Hello Betty, how is your husband doing? My grandma has being in the fetal position and just mumbling for a few weeks. I know she is suffering a lot, so I was wondering how long can she last like that...

      Reply

  11. December 3, 2018 at 2:41 pm | Posted by karen

    My husband 76 has Vascular Dementia/Alzheimer’s! This is such a horrible disease! I feel the pain of all of you dealing with this disease! My once gentle, loving, caring, jovial best friend has become mean, angry and grumpy. I am his only care giver 24/7; with occasional hour or so relief from his daughter, my daughter and daughter-in-law. My husband also has frozen leg syndrome which limits his ability to walk any distance, so I don’t have to worry he will wonder away, but worry he will fall; we live in a townhouse condo and he has fallen several times; twice down 6 or 8 steps; thank God he has not been injured! I’m 77 and everyday it gets harder and harder to deal with this disease and watch this wonderful man become a person I don’t know. Sundowners, memory loss, incontinence, frozen leg and being blamed for everything he can’t do or remember, being told I don’t help him or do anything for him, is taking its toll on me! I’ve contacted an attorney to see about getting him on Medicaid so we can get help and placement in memory care; this is a long difficult process and they want you to give up everything to get Medicaid! I pray for strength, patience and guidance as we journey through Dementia/Alzheimer’s. Thank for listening to me vent! God Bless you all! Pray for us and I’ll pray for you!

    Reply

    • December 13, 2018 at 11:35 pm | Posted by Susan O'Brian

      I wonder if your husband was a vet and served in an active war? If so, contact the VA through the internet or call. Look up Aids and Attendance online. You could get supplemental financial aid to help with home health aides. I'm going to do that as well. God Bless the caregivers and the ill. This is a devastating illness.

      Reply

      • December 16, 2018 at 4:03 am | Posted by Laraine

        What is there to say....No one knows the miserable existence we endure as a caregiver unless we are in the same set of circumstances.... To thine own self be true. Learn how to love yourself and be the best you, you can be for you, cos at the end of the day that's all you can relief on, YOU...

        Reply

      • March 25, 2019 at 9:03 am | Posted by s.heena

        hello have you tried intermittent fasting and travelling. may the disease be cured by the permission of god.

        Reply

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