The Stages of Alzheimer's: What to Expect

What to expect as Alzheimer's progresses
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One vexing thing about Alzheimer's, especially in the beginning, is how its effects differ from person to person. The person you're caring for might not experience every symptom or behavioral change, and the disease's timetable can vary. A particular Alzheimer's stage may last years longer for one person than for another, and symptoms can be experienced at earlier or later stages than described below. Because Alzheimer's is a progressive disease, however, it always starts with mild symptoms and gradually worsens as it continues.

Mild (Early-Stage) Alzheimer's Disease

During this first Alzheimer's stage, someone with the disease is likely to continue his or her usual activities, with Alzheimer's-related changes being written off as "getting older," "stress," being "tired," or "simple mistakes."

Memory: Memory lapses are typically the first sign, often years ahead of later symptoms. At this stage, it's common to forget things more often or have trouble remembering details about even familiar topics. Of special difficulty will be recalling recent events and people met later in life, as well as learning and retaining new information. That's why asking repetitive questions is a hallmark of the disease, as is writing notes to oneself about things like where the car is parked. It's common, too, to repeat comments and stories within minutes without realizing it. (Long-term memory, such as childhood recollections, may remain fairly detailed.)

Communication and social skills: Someone with Alzheimer's may have trouble finding the right word. Often people in this early Alzheimer's stage are aware that something is amiss, though they may not be sure what's wrong. They therefore shy from situations where they feel put on the spot or vulnerable to embarrassing mistakes, such as social outings, time with friends, or even telephone conversations.

Everyday life:
At this stage, they're easily confused and distracted. They may find it hard to keep track of the time and miss appointments or favorite TV programs. Abstract thinking and making sound judgments become more difficult. They may lose the initiative to partake in activities that were once pleasurable (hobbies, a job) or routine (cooking, writing checks). They may misplace objects regularly or store them in unusual places, then forget where they put them.

Personality: Somone at this stage may seem to be acting unlike his or her old self. They may become irritable or angry when disease symptoms are disruptive or embarrassing. Mood swings are common and usually stem from frustration.

Other: You'll notice "good" days where the person you're concerned about seems unchanged and "bad" days when he or she is having trouble coping, especially in situations that are new, unusual, or otherwise stressful. At this stage, it's common to get lost, leave a stove burner on, lock one's self out of the car or house, or experience other such incidents.

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.

Severe (Late-Stage) Alzheimer's Disease

By this final Alzheimer's stage, it's common to be bedridden and completely dependent on others, as the person can no longer reason or manage the most basic self-care.

Memory: As memory problems worsen, they begin to affect recollections from even the distant past. He or she may no longer recognize even close family members, including a spouse or children. He or she may not even recognize his or her own self when looking at photos or in the mirror and may consistently forget to take medicine and do everyday tasks like tooth brushing.

Communication and social skills:
As language skills decline, many peole at this stage speak nonsensically. They may make strange sounds, hum, or moan. Or they might cease to speak altogether. It's likely by now that the person you're caring for is quite socially withdrawn and has abandoned many previously enjoyed and familiar activities.

Everyday life:
Even relatively simple, necessary activities, such as eating and taking care of personal hygiene, require assistance. Both gross motor skills (walking and sitting up) and fine motor skills (buttoning a shirt, holding a spoon) are affected. Falls and injuries are a risk as coordination and depth perception decline. Repetitive movements and actions are common. Someone at this stage spends a lot of time sleeping.

Because the changes have become so marked, he or she may seem nothing like his or her old self. Sometimes jolly people turn crotchety, while formerly stern people may become docile and benign. By the last stages of Alzheimer's, many people express no emotions at all.

Other: Monitoring health, nutrition, and safety and general caretaking is now a round-the-clock task. He or she may lose significant weight (because eating is difficult) and acquire infections or fall ill easily (because of general weakness). People weakened by this final Alzheimer's stage more often die from another health problem (pneumonia, secondary infection, cancer) than they do from Alzheimer's itself.

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

over 1 year, said...

I haven't commented here in a while but I now know my Dad certainly has dementia but has not been diagnosed with Alzheimer's because we have not had him tested. But at this point in his life (age 94 in June) I don't think it matters. I do however understand the mind also wears out along with the body and both his are wearing out!! It's a sad thing for a proud person to be reduced to an infant by this sad and debilitating disease of the mind no matter what it is called. I am 64 and not looking forward to growing older and facing the same challenges as my Dad, Mother (deceased) and countless others. My heart goes out to the proud men and women who have gone before me, for their sacrifice and dedication to our freedoms. I'm sorry they are going through the horrible disease. I guess if we live long enough we do come full circle!! Prayers and blessings for the caretakers and the challenges they are presented with each and every day!!!

over 1 year, said...

I have alz but so far, I can still remember my children's names and where they work but every day I still to be forgetting other things. I can still clean my house, wash and dry and fold and pack away clothes without any problems. I just can't communicate to anybody except my dog....she understands me and so do the grandchildren when they are here. They are Sophie, 9 and Oliver 7 and Lucas who is 2. Thank you, Linda mIller

about 2 years, said...

My Father in law has Alzheimer's. He was diagnosed in 2012. My Mother in law is frustrated and has trouble understanding that it is the illness that makes him ask the same question over and over. My husband and I try to be supportive but we both work full time and their other son has nothing to do with them. FIL had to go into a care home for 3 weeks while MIL had an operation and since he has come home he seems easier to deal with. before he went in to the home he would not leave the house and spent most of the day in bed. he has always been a bit violent towards MIL but this has been made worse by the frustration that he must be feeling. We find it hard to make MIL understand that she needs to be patient with him. We understand that it is also very frustrating for her that he keeps asking but we really don't know how to help

over 2 years, said...

I am so pleased to have found this site. I've been struggling for some time on my own with what strongly suspect is early onset dementia with my husband - although he denies there is anything amiss. It has got to point his children are almost as concerned as me. Crunch time came this week and I've finally spoken to his GP to run through the progressing signs and symptoms - he's immediately going to start tests as part of the normal checkup routines. What a relief! Although I feel awful having to do this, there comes a point where I feel I have to be brave. The day after I spoke to the GP was a very good day and I would almost think I had my husband back except for a couple of repetitive conversations. But he was his happy caring self. I almost thought I was making a mistake in taking to the GP - almost. I will embrace those days and enjoy every moment. Now to wait for some kind of diagnosis - deep down I feel I know what it will be, but knowing for sure will somehow be a relief I think. I hope.

over 2 years, said...

Looking for activities to keep my father with mid sage dementia, entertained. He was a writer but with no short term memory, can no longer read more that a short paragraphs. He has created a "word list" (his own dictionary) and list of puns but is losing interest. He plays a great card game of Crzay 8s. Maybe solitaire for when we can sit with him? Won't do word puzzles. Other ideas?

over 3 years, said...

this article describes more of dementia rather than the staging of actual Alzheimer's Disease

about 4 years, said...

New to site

about 4 years, said...

My husband has alzhiemers . He is in the middle stage. I just went to a support group 2 weeks ago and it was wonderful. I didn't know they had online conversations till now.

about 4 years, said...

This article was helpful as my wife passes from early stage to mid stage. How can I forward it to our local daughter who helps as much as she can with two teenage children in her home. We live in a lifecare facility.

over 4 years, said...

I was diagnosed about 4 years ago and have a wonderful helpful husband of over 50 years which really helps. I forget that I have this disease. we play cards with groups 4 times a week we are 77.

over 4 years, said...

Yes I believe my mom is entering this final stage...her health has rapidly decreased since the Christmas holidays. She is now unable to walk or stand and pretty much confined to bed. Difficultly eating and swallowing..mainly soft foods and lots of liquids. Can do no hygiene for herself. Nurse has visited and her vital signs are all good so that is good news!! Main goal now is to keep her from getting bedsores and keep her comfortable.

over 4 years, said...

Explanations about the different stages of Alzheimers and the tips on how to address the situations.

over 4 years, said...

This article is standing! I have early onset at age 61 and this is very helpful.

over 4 years, said...

Hi Paula, Thank you for sharing how everyone's experience is very personal and unique. My father had Alzheimer's and my mother and I were his caregivers. I am sure the one thing we have in common is how difficult it is to see how this disease consumes our loved one. Karen

over 4 years, said...

giving good examples of symptoms tha are common to each stage

almost 5 years, said...

Paula, These "stage" descriptions are so succinct. I learn something helpful from every article you write. Thank you.

almost 5 years, said...

I now can diagnose I am in the early stage of Alzheimer's and I now have a vew of my possible life expactancy. The explanation given of the different stages was easy to understand. Did not continu reading about the 5 signs of Alzheimer's because the explanation was so extensive or better said too extensive. So although it can be usefull on the long run it gets boring for me.

almost 5 years, said...

This sounds like what is happening with my husband. He was diagnosed with dementia Jan. 2013. I am coping but looking to get connected to a support group and to learn more. So far a lot of trial and error and a lot of learning to cope with his forgetfulness Not being able to depend on him is the hardest part so far, adjusting.

about 5 years, said...

My mother is in the late stage of ALZ. She was diagnosed 10 yrs ago with early onset (now 77) and I have cared for her in my home all this time. I am so frustrated at how the medical community treats (or lack of) ALZ patients. Her dentist refused to see her years ago, her physician said to put her on hospice which I did (she cant walk, incontinent, and totally relies on me for everything). Hospice kicked her off because she wasn't dying fast enough and that she was so well cared for they couldn't believe it. They dropped her on a Friday, offered me no solutions as to other options and said they were coming Monday to take her hospital bed away leaving me on a Friday afternoon to locate another bed for her. The hospice nurse asked me did I believe in God when I asked what I could do. Thanks alot and yes I do. No physician will make home visits because of her insurance (Humana Medicare). I hired a caregiver 8 years ago to stay with her when I am working and then I take care of her every single hour when I get home. I feel that the medical community does NOT care about ALZ and doesn't want to treat them. Am I supposed to be her doctor or drag her to the ED? This disease is cruel but the healthcare system is making it so very difficult to care for her. I will continue to the end as I promised her when she could still talk and understand years ago. This just sucks! Not caring for my mother, which is an honor and out of love, but having to battle healthcare for a woman who worked all her life, paid taxes, has insurance and is an american citizen. I am very scared for all of us in the future.