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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. August 11, 2018 at 4:49 pm | Posted by Joann Bennett

    My mom lives alone and loves her privacy. I go there everyday and bring her fresh food and she's a good eater. But for the past couple of months she's telling me that people are just walking around in her trailer and I see signs of her throwing stuff at these people. It's not everyday but she seems to be seeing them more often. First it was during the night, now she'll claim it happens during the morning. She keeps a clean trailer, all dishes washed. She keeps her body clean. She also has a dog that she won't let me take outside and to go to the doctor I have to get my daughter to sit in the car and wait until the visit is over. Yes she accuses people stealing from her. I don't argue with her at all. She does not walk off from her trailer. She's good to shut her door and keep it locked. Her neighbors all have my phone number if they see anything unusual to call me. She's healthy, but this odd behavior is making her so unhappy. She has a heart doctors appointment this coming week. Told them she was acting like she wasn't getting enough oxygen to her brain. I'm alone in taking care of her. What's the best medicine that can stop these hallucinations.

    Reply

    • August 20, 2018 at 12:31 pm | Posted by Benjamin Dz.

      There are no easy answers, and what you have discribed is part of the progression. 1. Stop arguing. It is an emotional drain on both of you. If there are “people” just reassure her that there is no one there now, and look for ways to keep her engaged. If I’m understanding, there aren’t any people there when you are talking with her. These things often happen when you or I would let our minds wander. 2. Increase the lighting in the house. It reduces shadows that can be “people” and makes for a safer feeling. 3. Install cameras (web enabled, some are as inexpensive as $30). It lets you check in without being intrusive, and it can allow you to call her if you notice behaviors that need interruption. 4. Behaviors and personality will change. There are facilities that specialize in finding the best medication combination to address these issues. They are usually 10-20 day inpatient stays. Talk to your neurologist, GP, or other Alzheimer caregivers in your area. (This is not always an easy choice, but it is very helpful, especially with aggression.) 5. Begin the process and planning for the next steps: sitters, home health, daycare programs, etc. Look at options available with current insurance Medicaid/Medicare/private, contact local agencies for grants and additional services, and determine how much time you can actually devote to care. There will have to be some very real and heartbreaking conversations with your family and healthcare providers. Ultimately, you need to choose the safest options for your mom and healthiest path for you.I hope this helps

      Reply

    • September 5, 2018 at 9:30 pm | Posted by Stefani Gates

      Is there a chance that she has Parkinson's Disease? Hallucinations are a normal part of the progression.

      Reply

  2. August 10, 2018 at 6:27 pm | Posted by Lori

    This is an awful disease... and I'd like to emphasize it's a disease...my poor mother has it compounded by some very serious health issues. The worst part of all is my mother loved life & people...and these people she showered with attention her whole life don't even bother to come see her or call me to see how she is..she's still Sherry, still Mom, still Grandma... everyday I see the old Mom and the new Mom... my heart breaks for her that no one seems to really care about her but me...oh some of my family says they care but actions speak so much louder than words...where are they when I've been with her 24 x 7 since June...living their daily lives coming here for a short time for a 'visit' not really to help her or me... they may come visit... but not offer to take off some of the load I carry... this is the hardest thing I've ever done or hope that I have to do in my lifetime... She and I suffer everyday together... If there is a God please help us and the rest of those inflicted with this awful disease and the caregivers that give so much of themselves for their loved ones. And don't think for one minute they don't know what you're doing for them...they do in their own way, I have examples to proof it. For all of you out there that are the caregiver... I truly believe in some way we will be better for this experience and we will persevere some how some way even though it can seem like we just can't go on somehow we do...and please remember try as hard as you can to avoid the Nursing Home/ALF route---they caused my Mom more harm than good. We as a society need to wake up to this fact...we have a crisis going on...a silent killer... and your love one will suffer & so my friends will you if you can bare to stand by and watch...

    Reply

  3. July 10, 2018 at 2:37 pm | Posted by Joyce Logan

    It would a blessing if we, as the care givers of our husband or wife, could NOT remember how they were when we met and married. How they were able to do the simplest of things, but now can't remember from one minute to the next. Their needs are fairly simple, but constant and that is what takes its toll on the caregiver. If yours has started with Sun-downing your worry continues in the dark hours as well as in the daylight and though your heart is full of love for your husband or wife, sweet relief from the worry for even a day is a blessing. Stay strong and remember the Lord will not give you more than you can handle.

    Reply

  4. June 28, 2018 at 3:13 am | Posted by Cheryll Johnson

    My name is Cheryl, 73, husband Bob 81 and has dementia for the past 7 years. Lots of funny stories and lots of sad ones. I think he is going into the severe stage. I'm lucky, he is easy to handle still. I'm very much in control now and he counts on that. He cannot remember hardly anything now. He still feeds himself, but I order for him and cut up his food. He's a good eater yet. I caught him yesterday with my jeans on, and his pajama shirt on, thinking he was dressed for the day. This is the hardest thing I have ever done, is to be a caregiver for my husband. But I'm grateful still for so many things. I guess this is where God wants us to be for now. He was a wonderful husband to me. Now it's my turn to take care of him. Now I'm not saying I don't have days when I have to get right down on my knee's at the side of my bed, and ask God to help me through that day. Alzheimer's or dementia of any kind sucks the energy right out of the caregiver.

    Reply

    • June 29, 2018 at 11:13 pm | Posted by Angie Rose

      I,m also my 83 yr old husbands caregiver. I can relate to so much of what you are saying. Every day is different, except for the sleeping. My husband sleeps a lot. He seems to not want to engage in anything, or have any interest in what is going on around him. We were just outside this evening, I was setting up the bug zapper. In the past he would have been interested in what I was doing. He never even looked at where I was hanging it or what I was doing at all. I now feel like a person who lives alone, even though he is physically here, I can't depend on him to check on me. Hours can pass, and he never even seems to care that he hasn't seen me. It's scary. I keep my phone with me all the time now. I tripped the other day and fell. Nothing serious. I was outside gardening. It's moments like that when you realize you are now alone. He might look for me if he got hungry. Or not. He may just go to bed. He loves to go to bed early. So I spend my evening sewing or watching a movie. It's a lonely life. Our daughter does call and she comes out to the house when she can. But she works full time. Yes, this is the hardest thing I've ever experienced. We have had a good life together. We have been married over 50 yrs. had a lot of fun together. This is the saddest disease. It robs so much of the person with the Alzhiemers and is very difficult for the caregiver. I don't spend as much time crying anymore. But some days I wish I could run away. Take care. Stay strong.

      Reply

      • July 31, 2018 at 3:14 pm | Posted by fidelma

        I've just looked this issue up as my v v good friend is coming to visit and I consider this a respite visit. I've been v touched by your post. Where do you live? Take care and I hope you stay strong. xxx

        Reply

  5. May 17, 2018 at 6:26 pm | Posted by Tammy

    I agree my mothers has this Awful Disease I am here by myself dealing with the everything no help doors shut in my face n the cost these are our loved ones worked so hard n again the govement take it away I even called a Senator they called back the guy read of a script mom had to be in Assistant living because I couldn't transfer her any longer I have checked on many many homes what a joke plus I do not understand this disease I just keep reading n crying she is getting in the later stages because when she sleep n becoming more n more she is more n more confused such a sad awful awful sad disease

    Reply

    • September 15, 2018 at 6:30 pm | Posted by Jody Carpenter

      If your mom or dad was in the military , you can receive some financial aide from the VA. We are almost in our 10th year of dementia .. my husband is in a Veterans home & I’m close by .. helping take care of him . It is a horrible disease and we are definitely in the last stages. I will be glad when he is finally relieved from this horrible disease.

      Reply

  6. 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

  7. 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

  8. 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

  9. 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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