How many stages of Alzheimer's are there?

Thank you for your question. However, I must begin by saying that if you have a loved one whom you suspect may have dementia or is suffering from Alzheimer's disease, please have him or her evaluated by a geriatric neurologist. If, however, you are seeking the answer to that question for your own edification, I am happy to provide the following response.

Over the past several years, the patterns and stages of cognitive diseases and age-related mental decline have been well documented.

The first challenge facing anyone dealing with even the earliest indications of cognitive decline is to verify the origin of the problem, which goes back to being certain it is not depression or a physiological health problem that is causing signs or symptoms. The issue is that not everyone will experience every symptom and symptoms may occur at different times in different individuals. The reason for urgency in getting a definitive diagnosis is that people with Alzheimer's disease die an average of four to six years after diagnosis, but as stated earlier, the duration of the disease varies from 3 to 10 years. The earlier treatments, use of available medicines, and long range planning can be done, the better it is for both the patient and the family.

It cannot be overstated that if there are any symptoms of cognitive changes, be sure to have a competent neurologist or geriatrics-trained physician conduct tests to determine the actual problem. Watchful waiting does not help. Receiving a diagnosis of Alzheimer's disease is devastating, but so too is not planning for the future that both patient and the caregiver will face.

Years ago it was widely accepted that there were three main stages of Alzheimer's disease: Early or Mild Stage, Moderate or Mid-Stage, and Late, Severe or End -Stage. Today those stages have been expanded to accommodate the fuller scope of the progression of the disease, beginning with the earliest sub-stage of no memory loss.

We know that Alzheimer's disease neither progresses nor affects every victim in the same way, so these symptoms will not always fit every situation in terms of the degree of severity or the timeframe in which it might occur. There will be good and bad days, and symptoms will vary. Some people will experience many symptoms, others only a few, but the overall progress of the disease is fairly predictable.

In all stages, symptoms generally relate to the progressive impairment of mental processes including: memory function, communications problems, personality changes, erratic behavior, dependence and loss of control over bodily functions. Here are the 7-stages commonly associated with AD.

Stage 1: No cognitive impairment Individuals in this stage experience no memory problems. There are no signs of memory-related problems during daily activities or during normal medical interviews with a health care professional.

Stage 2: Very mild cognitive decline Individuals at this stage are self-aware that they have memory lapses, forget familiar words, and can't recall names or the location of their keys, or other everyday objects. But their problems are often hidden and not evident to family or friends, and may not be observed during a medical examination

Stage 3: Mild cognitive decline At this point in the progression of the disease, early-stage Alzheimer's can be diagnosed in some cases. Family and friends are more likely to begin noticing problems such as the person's: a. Inability to remember names or words. b. Decline in job performance. c. Confusion or poor judgment. d. Lack of energy or spontaneity. e. Difficulty performing routine tasks. f. Increased frequency of becoming angry or frustrated. g. Trouble communicating and understanding written material. h. Behaviors like withdrawing, avoiding people and new places. i. Minor memory loss, moods swings, and slower reactions to some verbal directions.

Stage 4: Moderate cognitive decline This stage is considered to be mild or early-stage Alzheimer's disease. Friends and family are aware of the cognitive decline, and a qualified medical professional is very likely to recognize the patient's cognitive issues. At this stage the problems can have a wide-ranging impact and may include: a. Inability to recall recent events. b. The individual may invent words. c. Difficulty recognizing familiar people. d. Fading memories of their own lives & personal events that happened. e. They may no longer be safe alone or may begin to wander outside of the home. f. Speech problems arise and understanding, reading and writing are more difficult. g. Loss of arithmetic skills "“ the patient is unable to count backward from 100 by 7s. h. Decreased knowledge of recent events such as what they did the previous weekend. i. Declining ability to do complex tasks like pay bills promptly or balancing a checkbook. j. The affected individual may seem withdrawn in socially or mentally challenging situations. k. Alzheimer's patients may demonstrate various behaviors that range from depression, to irritability, restlessness and apathy.

Stage 5: Mid-stage or Moderately severe cognitive decline In this stage, the Alzheimer's patient can still perform simple tasks independently, but often requires assistance with more complicated activities. Symptoms in this stage may include: a. Becoming more disoriented to time and place or disconnected from reality. b. Awareness of their loss of control, demonstrating various behaviors that range from depression, to irritability, restlessness, withdrawal and apathy. They may also experience sleep disturbances and may have increased difficulty eating, grooming and dressing. c. Assistance with day-to-day activities is more likely to be necessary. d. The need to be accompanied to all medical appointments so personal history, current contact information and recent episodes or events can be reported. e. Inaccurate recall of their personal history, although they generally recall their own name. f. The need for assistance in dressing for the proper season or occasion. Stage 6: Severe cognitive decline In this stage, memory difficulties continue to worsen, significant personality changes may emerge, and the patient may require extensive help with daily activities (ADLs). At this late stage patients: a. May recall their names, but not their personal history. b. Require assistance with several activities of daily living (ADLs). c. Are no longer aware of recent experiences, events or their surroundings. d. Recognize some familiar faces, but often forget the names of their spouse or caregivers.

Stage 7: End-Stage or Very severe cognitive decline This is the final stage of the disease when individuals lose the ability to respond to their environment, their ability to speak, and ultimately, the ability to control their own movements. Most patients: a. Suffer from impaired swallowing. b. Need help to eat, use finger foods or may have to be fed. c. Reflexes become abnormal and muscles become more rigid. d. Suffer from urinary and fecal incontinence and must be accompanied to the toilet. e. Lose their capacity for recognizable speech, but may say certain words on occasion. f. In the last stages, they lose the ability to walk without assistance, often followed by loss of their ability to sit without support, the ability to smile or even hold their heads upright.

In end stage Alzheimer's disease, death may come from pneumonia, inability to swallow, failure to thrive, or one of many other medical issues. The cause of death is not always Alzheimer's per se, but death often stems from having suffered and debilitated as a result of having had Alzheimer's disease.

I hope you find this explanation helpful, it was taken verbatim from my book, "Caring for a Loved One With Alzheimer's Disease." Again, if you're dealing with a loved one, and that is the basis for your question, I suggest you get a professional opinion from a geriatric neurologist to help with an accurate assessment and diagnosis.

Best of luck.