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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. April 5, 2018 at 2:19 pm | Posted by Bill

    My wife has been diagnosed with Alzheimer’s, and she had been steadly declining for the last year or so. She got this terrible disease at a fairly young age. I’m her only caretaker. My kids do not live around us anymore, and other relatives seem to keep their distance as if they are either afraid or in denial. So much falls on my shoulders. I love My wife and I’m so sad to see her decline when I can’t do anything to save her. This disease sucks the life out of all who are remotely involved. What makes matters worse is that the legal [stuff] you have to go through to get any help from Medicaid. Everything has to be taken away before they can get help. God help all Alzheimer’s victims that they find a cure for this terrible disease. It seems that more people are being diagnosed with it at an alarming higher rate!

    Reply

  2. April 1, 2018 at 11:31 am | Posted by Jeanette Lewis

    My mother-in-law now has severe dementia, showing the first signs well over 10 years ago. She was never formally diagnosed as she has always been a very stubborn, proud, independent woman who would never visit a doctor or be tested. However, the doctor at the care home she's been in for the last four years believes it to be vascular dementia. Although she hasn't recognised any of us for at least two years, she had until recently has until recently been physically fit, even recovering from a broken hip to wander around again. Not now though. She is no longer walking and increasingly deeply sleepy. Today she couldn't be roused. I'm just wondering how soon the inevitable is likely to happen?

    Reply

  3. February 12, 2018 at 1:26 pm | Posted by Susan Champigny

    My name is Susan......I am 64yrs old living with Alzheimer' Disease. I struggle from day to day with memory, speaking, lack of energy, finding keys and, even if for a fleating moment, feel myself slip away silently. Please be kind to me. I soak up the sunshine's warmth in your touch, it is in your eyes that my fears are calmed, Your hugs speak loudly of how much you love Me. My inner being becomes whole again and my Heart is at peace.I struggle with knitting...... a craft I loved and now become frustrated with making mistakes or following directionsWhat joy I felt when others would give me such recognition of the goods I made. I will not concead to it's darkness or lonliness. I am

    Reply

  4. January 16, 2018 at 2:50 pm | Posted by Donna Hogan

    I am wishing the same for mom that the Lord takes her releasing from the grip Alzheimer's has on her for the last 9 years! She's in the last stages and it's hard but better some ways , no more running out of the house.

    Reply

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