Stages of Alzheimer's Disease

If someone you care about has received a diagnosis of Alzheimer's disease, you may be wondering what to expect as the illness takes its course. First of all, you should know that Alzheimer's disease affects everyone differently, so people go through the various stages at different rates. On average, the duration of the disease is 7-10 years, although this can be shortened when diagnosis is delayed, and it may be much longer in some people. And while it's true that people with the illness will lose many of the abilities they once had, it's best to focus on the abilities that remain so you can make the most of the time you have together.

Alzheimer's disease can be divided into the following 4 main stages:

Mild (or early-stage Alzheimer's Disease)

When Alzheimer's disease is diagnosed early, the loss of abilities is often mild. At this stage, people with the disease, as well as their family, friends, co-workers, and medical practitioners, start to notice that they are struggling with communicating and logical thinking. At this stage, people can often continue living as they did before. They should be encouraged to participate in their own health decisions and help plan for their future care. In addition to medications, healthy lifestyle choices – including eating well, keeping mentally and physically active, staying connected to other people and finding ways to reduce stress – may slow the progression of the disease. Treatments may work best when started early, allowing a person with the disease more time to continue living independently.

The following table will help you understand the types of symptoms that occur at the mild stage of Alzheimer's' disease:

Symptom What may occur
Cognitive and memory problems may appear
  • Can make structured sentences and express himself/herself fluently but confuses and forgets names and words; makes up words, or stops talking to avoid mistakes
  • Repeats questions, phrases or stories, in the same conversation
  • Disoriented about time and place; becomes lost in unfamiliar places
  • Trouble concentrating and learning new things; avoidance of change
  • Withdraws from social and mental challenges
  • Misplaces valuable possessions: hides things or puts them in strange places and then forgets where they are
  • Difficulty handling challenges at work
Communication problems and mild forgetfulness begin
  • May converse “normally” until a memory lapse occurs
  • Able to respond to what people are saying, even if he or she has trouble keeping up with a conversation
  • Increasing difficulty understanding books, newspapers and other reading material
Personality changes occur
  • Mood shifts, depression
  • Apathetic, withdrawn, avoids people
  • Anxious, irritable, agitated
  • Exhibits repetitive behaviour
  • Easily angered when frustrated, tired, rushed or surprised
  • Withdraws from social and mental challenges
Physical changes begin
  • Mild coordination problems

Moderate (or mid-stage Alzheimer's Disease)

By the time the disease is diagnosed, it's often already in the moderate or mid-stage. If that's the case with someone you care about, then you've probably noticed a considerable decline in his or her functioning, memory and cognition, and even drastic personality changes. There has probably also been a marked change in appearance and hygiene, and he or she may well need a lot of help taking care of himself or herself.

This moderate stage of the disease is the longest, and medication has proven useful to treat the illness throughout this stage. The range of problems that may occur at the moderate stage of Alzheimer's disease include:

Symptom What may occur
Significant cognitive decline and memory problems
  • Can still distinguish familiar from unfamiliar faces but confuses names and faces of family and friends
  • Forgets recent events and his or her own history
  • Embarrassed by inability to remember and makes things up to compensate
  • Loses track of their possessions; may take others' belongings because he or she believes them to be their own
  • Can no longer think logically or clearly; can not concentrate, organise speaking or follow instructions
  • Has decreased understanding of arithmetic and money
  • Is disoriented in time and place
  • Difficulty making decisions
Impaired communication skills
  • Has problems speaking in complete sentences, understanding, reading, and writing. Some sentence structure remains
  • Repeats stories, words, questions and gestures
Personality changes become more significant
  • May become more apathetic, withdrawn, anxious, agitated
  • May have different behaviour if feeling threatened
  • Displays suspicion and paranoia: may accuse spouse of having an affair, or family members of stealing
  • Has hallucinations and delusions: may hear, see, smell, or taste things that aren't there
  • May experience an exaggeration of their normal personality traits
Idiosyncratic behaviours evolve
  • Loss of inhibition, such as overtly sexual behaviour or aggression
  • Paces, is restless, repeats movements; wrings hands, shreds tissues, handles certain objects over and over
  • Wanders, sometimes away from carers and the familiar; chats to self while wandering
  • Apprehension, withdrawal or passivity
Increasing dependence and need for help with the activities of daily living
  • May eat without help, but needs reminding to eat and drink
  • Needs help dressing for the weather or occasion; may need help putting clothing onto the correct body part
  • Needs help with grooming: bathing, brushing teeth, combing hair
  • Needs help using the toilet
  • May no longer be safe when left alone: may fall, burn, poison or neglect self; needs full-time supervision for safety
Physical decline progresses
  • Incontinence increases
  • Can't get comfortable in a chair or on the toilet
  • Experiences muscle twitches
  • Altered sleep/wake patterns
  • Changes in appetite
  • Changes in coordination and movement

Severe (or late stage Alzheimer's Disease)

By this stage, the progression of cognitive decline and the loss of independence may make the individual with the disease seem like a completely different person. The behaviours of the earlier stages disappear, and the person may seem more subdued. He or she is completely dependent on others for even the most basic activities of daily living, and the cognitive impairment is severe. At this point, what's most important is providing support and ensuring that the person with the disease is comfortable and enjoying the highest quality of life possible.

Symptom What may occur
Cognitive and memory problems further decline
  • Severely impaired memory, ability to process information, and orientation
  • Doesn't recognise familiar people, including spouse and family members
Verbal skills are nearly gone
  • Can no longer smile
  • Doesn't speak or speaks in illogical words or phrases
  • May call or cry out repetitively, or groan or mumble loudly
  • Can't write or understand reading material
Voluntary control of the body increasingly disappears
  • Can't control movements; muscles are rigid
  • Complete urinary and bowel incontinence
  • Cannot walk, stand, sit up, or hold up head without help; falls frequently if not assisted or supported; bedridden
  • Can't swallow easily, may choke on food
  • Can't move voluntarily
Complete dependence on others
  • Needs complete help with all activities of daily living
  • Requires full-time care
Health declines considerably
  • Loses weight
  • Reflexes are abnormal
The body shuts down
  • May refuse to eat or drink
  • May stop urinating
  • Sensory organs shut down
  • Exhausted, sleeps more
Idiosyncratic behaviours
  • May pat or touch things repeatedly

End of life

As a terminal illness, Alzheimer's disease progresses until the end of life, when extensive care is required. At that point, the focus should be on palliative care – promoting quality of life and comfort – by addressing the person's physical and emotional needs.

Symptom What may occur
Physical changes
  • Circulation may be poor – cold extremities, falling blood pressure
  • Skin breakdown and sores
  • Stops accepting food and drink
  • Build-up of secretions in the lungs and throat; dry mouth
  • Increased sleepiness
  • Lowered awareness of pain
  • Fever
  • Breathing and pulse may become irregular
Emotional issues
  • The person can still experience and sense emotions