Alzheimer's: Late Mild-Stage

What You Need to Know About Late Mild-Stage Alzheimer's

How to Help the Person in Your Care

Changes in memory/other thinking skills

Repetition and mistakes are obvious. An inability to form or store new memories causes a loss of immediate memory (what just happened). This causes your loved one to repeat the same questions, comments, and ideas on ever-shorter cycles. Also noticeable to others: forgetting appointments or routine tasks, losing things (or getting lost), and having trouble with names, directions, or time.

Action steps

  • Use written reminders (to-do lists, calendars, post-it notes, a list of favorite cable channels) to minimize the number of basics that need to be remembered.

  • Label drawers and shelves to spare the person the challenge of figuring out what goes where or where to find things.

  • Use day-of-the-week or timer-driven medication dispensaries to help monitor when meds are taken.

  • Respond to repeated questions or statements as if you're hearing them for the first time -- even on the tenth. To break a jag, introduce a new subject ("That reminds me . . . "), or change activities or rooms.

Complex activities are not only difficult but dangerous. Lapses in judgment, indecisiveness, trouble following sequences, and memory loss make financial management and driving ) two of the biggest dangers now. Also affecting driving: poor visual-spatial skills, slowed reaction time, hesitancy.

Action steps

  • Monitor financial records for suspicious transactions (wire transfers, mail-order bills).

  • Remove credit cards and key documents from wallet. Leave minimal cash and nonessential identification or cards to preserve a sense of security and dignity.

  • While your loved one can still make decisions that reflect personal preferences, together decide who should pay bills, file taxes, and have power of attorney for finances.

  • Watch for signs of dangerous driving. Rule of thumb: If you're wary of having a child be the person's passenger (or of being one yourself), it's time to insist that the driver stop.

  • Consider testing by a driving evaluator to help encourage an insistent driver to give up the keys. Ask your local Area Agency on Aging or the Association for Driver Rehabilitation Specialists for a referral.

Changes in emotions/insight

The world is getting smaller. Coping and compensating with brain change is hard work. Possible side effects: less spontaneity, less initiative, and a greater tendency to be a follower. Losing interest in others and withdrawing socially are common. Even if quiet, pleasant personalities seem generally unchanged, look for a tendency to get more easily frustrated or anxious and to shift moods faster.

Action steps

  • Don't mistake self-focus for selfishness or moodiness for rudeness; they're signs of struggle with the dementia.

  • Encourage social outings, because the interaction is stimulating. There may be less resistance to one-on-one visits than to larger parties.

  • Get a doctor's input if interest seems to wane in everything about life; this indicates depression, which is different from the normal apathy of dementia.

Changes in physical function/personal care

May need help with everyday tasks. Though the person you're caring for can probably manage most personal care well, the fine-motor tasks, like managing ties and buttons, can take time. He or she may start to forget to wash hands or wipe well after toileting (inviting infection) or not drink enough (a dehydration risk). Missed or overdosed medication is another health risk.

Action steps

  • Without taking over, step up monitoring everyday care. Quietly check laundry for signs of soiling. Use medication dispensers with days of week or timers. Make sure soap, shampoo, and toothpaste are being used.

  • Offer liquids with meals and in between, and don't assume the person is still making his or her own meals -- look for signs they've actually been consumed.

  • Casually, without talking down, offer to finish ties or other fasteners that may be giving trouble: "Here, let me try."

  • Don't make a big deal about mistakes or appearance quirks, since they can't be helped. Preserving pride and self-esteem serves you better.

How to Take Care of You

You'll be eaten alive by worry and stress unless you start basic self-care now. It's natural focus on the person with dementia, but the reality is that the physical toll on caregivers over time is huge. Nurturing yourself does the person with dementia a favor, because healthy people provide better care.

Action steps

  • Don't keep dementia a secret from the world. Confide in at least one person to whom you can freely vent as needed. Vent privately online, too.

  • Exercise early in the day before time runs away from you. Good home-based choices: walking (up stairs, in yard, around block), weight lifting, yoga, treadmill, and exercise DVDs.

  • Instead of reforming your whole diet (stressful!), start with smarter snacking. Stock fresh or dried fruits, nuts, vegetables and hummus, string cheese, popcorn, green tea, flavored waters.

  • Make your own routine healthcare appointments for the coming year now, so they're in your calendar.

You'll need more help over time, not less. Even if you feel on top of the "new normal" now, abilities ranging from how to make choices to how to bathe will deteriorate. No single individual can manage dementia care all the way through, all alone.

Action steps

  • Call your local Area Agency on Aging to find out what resources are available to families dealing with dementia in your community. Really. Just do it.

  • If you're worrying from a distance, consider hiring a geriatric care manager who can be your eyes and ears on the ground.

  • Start a master list of everyone who's volunteered to help you or may be of help -- drivers, gardeners, errand-runners, sitters. When you're in a bind, turn to the list.

  • Let your employer know what's going on. Some companies offer eldercare or other work-life benefits, flextime, or dementia-specific educational resources. Legally, caregivers are considered the same at work as working parents.

You, not the person with dementia, will have to change. Erratic behavior, repetition, and rude comments aren't being said or done on purpose. The dementia causes them. The less the two of you butt heads over things that can't be controlled, the more you can learn how to work with the real adversary, the changing brain.

Action steps

  • Try to erase phrases like, "Try harder" or, "You're not concentrating enough." The person with dementia is doing the best he or she can. Berating or cajoling only adds frustration -- and leads to more mistakes.

  • Even if you're not the "group type," consider a support group for dementia caregivers. You'll learn strategies for communicating better, avoiding common problems, and more.

  • Learn the "why" behind common symptoms of dementia to help you redirect or avoid them.

Your emotional relationship with the person you are for will change despite all your love and help. That's because over time, everyone with dementia becomes more dependent. Old balances of power inevitably shift. "You'll still always love the person, but the emotional give-and-take will never be quite the same," says dementia family-care pioneer Lisa Gwyther, author of The Alzheimer's Action Plan.

Action steps

  • Let yourself grieve a little -- that's what you're experiencing, even during mild dementia. It's hard to see suffering and to let go of old expectations.

  • Live in the moment as best you can. Dwelling on old memories (home movies, photograph albums) or disrupted future plans (retirement, travel) can be unnecessarily painful.

  • Embrace the many good moments and days that still lie ahead. Dementia doesn't instantly erase the grace notes of laughter and gratitude.

How to Build Your Family/Support System

Know that denial is a common -- and strong -- emotion. Others may not see the subtle but increasing changes that you do. Or they may not want to think of their loved one as changing, because it means changes for their lives, too. Because the exact cause of dementia can't always be determined, some people choose to hear this as a lack of certainty that any impairment exists at all.

Action steps

  • Share what you see. Regularly update family and friends; the more they hear, the better they can understand.

  • Encourage others to spend time with the person who has dementia in order to share your front-row seat on what's happening (ideally for several days, not hours). Some things have to be experienced to be believed.

  • Share what you learn. Most people are unaware of the stages of dementia, how personality can change, and other basics. Passing along links to helpful articles and other resources teaches them.

Family and friends may not know how to help unless you make specific requests. What may look like obliviousness or refusal to help may be uncertainty. People aren't mind readers. Most haven't dealt with dementia before. Yet most of us actually like to contribute in some way and don't see being asked as an intrusion.

Action steps

  • When you ask for help, give details -- the exact task, time involved, directions, potential snags -- and as much advance notice as possible.

  • Divide categories of help among siblings or other family members if possible, so one person handles all insurance, another handles medical research, and so on.

  • Remember that help comes in many forms: someone doing errands so you don't have to, giving you time off, bringing food, driving to doctor visits, and -- especially -- paying for things (handy for long-distance or busy family members).

Others may find it easy to criticize, hard to collaborate. No two individuals have the same relationship or see things from the same vantage point. Disagreements occur, especially about emotional decisions. But you can circumvent some hard feelings.

Action steps

  • Explain that experts agree there's no single "right" way to handle dementia care. You can only do what seems best at the time.

  • Ask critics to stick to describing what they dislike about the situation, not about you personally. You're already doing the best you can, but try to be open to ideas, which could help.

  • Call a family meeting to discuss thorny issues. Separated by miles? Try a free family conference call.

about 3 years, said...

Both of my parents were diagnosed with dementia and although, we care for my mom in a more personal level because she lives with us, my father is in a nursing home because his condition was much more advance. However, we frequently visit with my dad as we also send my mom to an adult day care center. Having to care for our parents can be very tiring and or altering in ones own life but it is also rewarding to see how they nurtured their own children in caring for one another and how we are demonstrating it in return. We are very thankful for all the informative sites as this one which has helped us put things in perspective when it entails having to ask for help from other family members. Thank you.

about 3 years, said...

The information reaffirmed what I have been going through with my mom; kind of where she is in dealing with this disease; And that's not bad!!! Actually it is good to clearer on where she is at. And it makes me realize I am doing a lot more things better these days for mom.

almost 4 years, said...

It is so refreshing to read the above article. Husband has dementia, drives only once in a while and I think that is going to stop shortly. He has given over the "checkbook" to me totally. The income taxes are now mine for the last three years. Normally I do pretty good, but he has been mis-quoting different people. And then goes a little overboard to prove his point. Your article helped remind it is the disease not the person and he is not being mean. Thank you!!!

about 5 years, said...

I'm dealing with my mom with Alzheimer's. She is 87 and in the last stage. Sometimes I do feel alone and my sibilings live to far to she her on a everyday basis. The people at church wants to help, but I want to give my mom all the privacy that I can. I love her dearly.

over 5 years, said...

This is so helpful. It let's me know that I really am doing the right things in this stage of dementia for my Mother. She is still able to fix her coffee and cereal in the mornings and take her medication correctly. All because it is part of her every day routine. But if something happens outside of her routine she gets so nervous and confused. I can usually calm her and let her know I am here and will guide her through. I let her know that I will always be truthful to her and that she can trust me. She gets so scared sometimes because she knows her short term memory is pretty much gone and even if she is right she second guesses herself all the time. God bless her she is a sweetheart and I love her dearly. Thank you so much for all the good advice.

almost 6 years, said...

These suggestions are Godsends. Thank you so much. It has just recently dawned on me that my mother actually has dementia. I can look back six months or so and identify incidents that I thought were strange or even infuriating at the time, and now realize the cause. In the last couple of months, she has been zoning out rapidly. I recognize the symptoms listed in late mild stage. Plus now the cleaning lady is "stealing" things that have just been temporarily misplaced. It's a challenge and it's scary. Thank you again for such helpful information.

over 6 years, said...

It's good to read the Caregiver's Guide to this stage of dementia, especially the Action Steps advice. When there is so much for the carer to attend to and think about, these ready thought out tips are a blessing!

over 6 years, said...

This was very helpful. I am doing most of what it says having read some books on dementia that mentioned these very things. Thank you

almost 7 years, said...

This is an excellent summary -- right on target. It really is important to understand that by this point caregiver and dementia patient are walking parallel life paths...not an easy thing when it's a married couple. But, as long as the caregiver gets it, its easier. My husband often looks and sounds the way I always knew him, but he simply isn't. It's kind of twilight-zoney sometimes, and it's really important to keep to my reality. Fortunately I have some great friends who understand, and an internist who is empathetic and savvy about this,

almost 7 years, said...

reinforces many things I'm doing.

almost 7 years, said...

This is a Great article! It encompasses so much of what is going on in my household. My husband has vascular dementia, but the descriptions of the stages and behaviors apply very often. Also, most important, is the reminder to take care of me....I'm going to have a massage today!!!!

almost 7 years, said...

Hi GrandEd, Thanks for sharing your story with us. I'm sorry to hear about the situation you and you're wife are in. Finances can be very stressful, especially on top of a possible Alzheimer's diagnosis. One resource I recommend is our financial assistance topic center here: ( If you still have questions you are absolutely encouraged to ask them in our Ask & Answer section here : ( I hope that helps get you started, good luck! -- Emily | Community Manager

almost 7 years, said...

My wife has not been officially diagnosed with alzheimers, or any other form of dementia, as of this writing. We have an appointment with a neurologist in about 48 hours to begin the process for diagnosis. We have several issues, as do all folks in our position, but the foremost is finance. She is 64, turning 65 in late summer. I'm 55, therefore neither of us is eligible for Medicare coverage. Due to the naitional financial crisis, my work has been slow to non-existent over the past 2 years, and we have gone through our savings. We lost our insurance coverage 2 months ago, and at our ages, insurance is difficult to get, and expensive. If she is diagnosed, it will be impossible for her to get coverage prior to the Medicare eligibility in 4-5 months. What can we do in the meantime?

almost 7 years, said...

These articles are enormously helpful. There are so few people who really know how this process have to walk in these moccasins ... It does help to read about specific behaviors, such as when he repeats questions one after the other. Simple things -- like "Is it cold out today?" He'll ask me that two or three times in a row. When this first happened, I thought I was hearing things...My husband is so smart that this is very disconcerting: He can still psych out when I'm off guard and don't keep my reaction a nonreaction, at least sometimes. Other times, he's there, but not there...Thank you for all this information. It is truly useful.

about 7 years, said...

While I'm the one with Alzheimer's, it's still interesting what's going to possibly happen next. Yes, I hate it, but I do live one day at a time, that's about all we can do, and I know it.

about 7 years, said...

The entire article.

about 7 years, said...

I have Alzheimer's, altho it has run rampant thruout our family. Because this was not totally unexpected, my family is quietly helpful. My husband takes the brunt of the helping, but he does have our adult son and daughter that help a little to share the load, and will more so as time passes by and this disease goes to the next stage. I was put on Namenda immediately, and Aricept a few months down the road. I was diagnosed 2 1/2 years ago. I'm 63. I'm holding my own pretty much. I do use lists. I need to label my drawers for future ref, and clean out my closet. I'm trying to do a lot of things while I can to help lessen the burden later on. Trying to set up a meeting of a rep from to come to the house to visit with myself and my immediate family, all the suggestions that they have. It's a free service. It's really further than they usually go, so it may just have to be a phone call consultation with me. I hope not, but it may be out of her hands, as well as mine! lol! I have checked with the Agency on Aging in our little city, but all there is is a group for caregivers only once a month that my family could go to if they want. There is no local adult day care at this time. I am going to check with nursing homes to see what their Alzhiemer's units look like. I know I don't want to be in the one that my mom was in. Altho, in retrospect, it didn't have that many patients, so there might be better individual care. I'd like for a family member to take me to check into this, but I don't know if it's gonna happen. I've already done a will, a living will, put everything in my husband's name. He's thinking about a will so that I'll be taken care of at home til I have to go into a home. I personally don't want my family to have to take care of me when I am incontinent and can't take care of it myself. These are just facts of life when talking about Alzheimer's. I know sometimes we're exasparating, but we don't mean to be. My mom wasn't dangerous. I have high hopes of taking after her. lol! Do take some time here and there for yourself. That's where my husband should have plenty of help, thankfully. Our daughter is a stay at home mom so she'll be able to give him breaks. Our son works, but he'll have some weekend and evening time. He's good to take me places, as is my husband. Right now our daughter has her hands pretty full with her granddaughter, but that will be changing soon. Back to the care consultation. If it ends up being a phone call, I'll still be calling a family meeting to run thru the points that I've been told.