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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 3, 2021 at 2:47 am | Posted by Linda

    Medicaid can be a lifesaver, but you do have to apply, but it isn’t as difficult as you might think. Don’t give in to the temptation to berate yourself. Your doctor can help too if you admit you’re having an awful time of it. No one is a perfect caregiver but your loved one deserves a caregiver who is not mentally and physically worn out. Do it for them—get some help from Medicaid and reach out to professionals in your community. I couldn’t take care of my mother in law alone and I had to change somethings so I became serious about my weaknesses and asked for help from God and begged God to forgive my failings, and to guíde me from then on. Things changed. People started helping when I admitted I needed help. God became my strength in my time of trial. I hope that doesn’t sound preachy, but it is the truth.

    Reply

  2. July 25, 2021 at 10:34 pm | Posted by ruth berg

    its very hard to be the care giver

    Reply

  3. July 11, 2021 at 8:42 am | Posted by Joe Panico

    My wife of 50 years who is only 70 is Also afflicted. I am exhausted and Ashamed to say so but also cry a lot . I now have 8 hours help 3 days a week but still exhausted . Been sole caregiver for over 9 years. Son and his wife insist that I put her away but just can't do it. She babbles and scoots around on the floor a lot. I do everything for her and with the help of her meds I can still do the night shift. I had 24 hour care for a While but not rich. I know the day is coming but I just can't bear the thought of it.

    Reply

    • August 3, 2021 at 2:33 am | Posted by Linda

      I’m so sorry to read your story about your wife. Your heartbreak is palpable. You used the words “put her away” which if you’re talking about a nursing home, I doubt anyone would think of it that way. You could visit her every day and make sure she was getting great care but not completely wear yourself out. You said you’re not rich but finding 24/7 care at home would be prohibitive for anyone except the rich so a home may be your best option but even at that your state may help with the expense. Don’t go through this alone. Your doctor, friends and family and church, if you have one, can help you decide what to do, if you let them help. Again, don’t go it alone! This is too much for any one person to do alone. God bless you.

      Reply

  4. April 6, 2021 at 2:47 pm | Posted by Mike

    My wife is in the same situation. During the day we have an aid but when my wife gets home she has to take care of my mother in-law. My wife gets zero help from my sister in-law. There is a big inheritance involved and we’ve given up 14 years of our life because my in laws refused to sell the properties they inherited and ran into the ground. So without compensation we too care of my in-laws, the properties and renters needs. We haven’t had a vacation in five years and my sister in-law refuses to give us any help. She hasn’t seen her mother in three years. My father in-law passed on five years ago and my mother in-law is 89 with late stage Alzheimer’s. She no longer speaks she babbles sounding like a one year old. My wife takes care of her like a one year old changing and feeding her. My wife is overwhelmed and exhausted. She yells at her mother often lately. She gets angry and wants to run far away. We are praying for a miracle. My wife seldom spends time with me. Her parents made a slave of my wife and put themselves before me and our children.

    Reply

  5. January 22, 2021 at 10:44 am | Posted by Karen

    I have had my 92 year old father living with my husband and I for a year and a half. He also suffers from dementia. I have four other siblings that offer no help at all. I have tried my hardest not to feel resentment towards them. Due to the Covid 19 pandemic I do not have any PSW's to help me. My marriage is being strained because I have no time for my husband. He requires 24/7 care I am trying so hard to give him everything he needs. I have been losing patience with my father and have actually yelled at him which only leaves me feeling extreme guilt and I will cry for hours. This is not how I should be dealing with this cruel disease that is attacking my father! I am ashamed that I lose patience with him. I need help! Please, anyone else not feeling like the perfect caregiver!?

    Reply

    • February 6, 2021 at 7:50 pm | Posted by MJ Powers

      You’re not alone. I’m going through the exact same thing with my 94-year-old mother. Because of COVID, no PSWs and no physical help from my non-mask wearing, not socially distancing sister. Lots of family stress. Teenaged daughter is extremely uncomfortable with aging and Alzheimer’s. Nothing to do but soldier on. Praying tor vaccines so we can get some help. You’re doing your best, try not to be hard on yourself.

      Reply

  6. July 8, 2020 at 2:50 pm | Posted by Paula Ann Ross

    I feel like I can't go on with this. I need his love and support more now then ever. I have been put through the ringer with multiple myeloma since 2018. The effects of the Alzheimer must of been their for a while but not found till Jan. 2017 that put me in charge of fiances and all other important decision making. He still drives well. He has no interest of any kind as a husband. I find myself crying a lot and he gives no comfort to at all. I talk to him about this and he has no response to give to me. I just want him to hold me and tell me he loves me again.

    Reply

    • August 30, 2020 at 8:48 am | Posted by Anne

      I will pray for you today when I go to Mass. I am sorry you have to go through this . Try to look for things to be grateful for both today and in the past. Can you find a support group or friend to share your hardships with in your area? Take care

      Reply

      • January 28, 2021 at 3:08 pm | Posted by JUDY

        I I called Medicare to see I f I could get some help watching my husband whose is there n late stage Alzheimer’s and has a nodular Melanoma. They told me he’d need to be there n Medicaid. Suggestions needed.

        Reply

  7. April 26, 2020 at 1:11 am | Posted by Trudy Green

    Whatever he likes just let him eat that

    Reply

  8. February 28, 2020 at 8:58 pm | Posted by Caron

    That sounds like my life. My husband is in bed and I'm crying. Take care!

    Reply

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