Moderate (Middle-Stage) Alzheimer's Disease

Symptoms characteristic of early-stage Alzheimer's disease now become more evident as they worsen, become more frequent, and are harder to "cover up."

Memory: Repetitive statements and questions are very common, and they may occur within minutes of each other.

Communication and social skills: As ongoing memory lapses combine with greater difficulty in tracking conversations and contributing meaningfully to them, some people become more timid socially and more apprehensive about speaking up. Others become less inhibited and demonstrate less tact in social situations. In this Alzheimer's stage, it becomes common to confuse people, especially if they resemble one another (like a mother and daughter). Cognitive impairment and declining hand coordination affect written communication; someone who once wrote letters and sent birthday cards now stops. Many middle-stage Alzheimer's sufferers stop reading, too, and even TV programs may be too hard to follow.

Everyday life: Expect more difficulty with abstract thinking and with making good judgments. He or she may have trouble following written directions, such as cooking from a recipe or filling out a form. (Verbal instructions are more challenging, and problems with them are usually evident earlier.) Even routine, familiar activities that involve a sequence of steps, such as preparing a meal or dressing, may be difficult to complete. Someone who's still driving is at increased risk because of disorientation, decreased coordination, problems judging spatial relationships, and slower response times. Failing judgment makes him or her vulnerable to poor decisions regarding safety, health, or finances.

Personality: Mood changes and personality alterations become more obvious, especially late in the day or when he or she is tired. He or she may become distrustful of loved ones, including you, or make unfounded accusations. Anxiety is common and is sometimes expressed by rummaging through drawers, aggressive behavior, yelling, or wandering through or away from the house. Hallucinations or delusions occur. Depression is a risk, often characterized by changes in appetite and sleep habits (he or she may be a lot hungrier or less hungry than usual, for example, or sleep much more or less than usual).

Other: During middle-stage Alzheimer's, it's common to get disoriented in familiar environments as well as unfamiliar ones. Unplanned or new activities can be especially troubling. The sense of smell may be less sensitive, and incontinence becomes more common.