The 7 Stages of Alzheimer’s Disease
With contributions from Angela Finlay.
Each individual with Alzheimer’s will experience it differently, but sufferers do tend to follow a similar path from the start of their illness to its end.
The precise number of stages is somewhat subjective. Some experts use a simple three-phase model, which consists of early, moderate and end. Others are using a granular breakdown that they feel is a more useful aid to understanding how the illness progresses.
Dr. Barry Reisberg of New York University developed the most widely used system. It breaks the progression of Alzheimer’s disease down into seven stages.
This outline for understanding the diseases progression has been adopted and used by many healthcare providers, as well as the Alzheimer’s Association.
Here is a summary of the seven stages of Alzheimer’s disease based on Dr. Resiberg’s ideas:
Stage 1: No Impairment
At this stage, Alzheimer’s disease is not detectable. There are no symptoms of dementia evident. That doesn’t mean that changes in the brain have not begun to occur.
The symptoms of Alzheimer’s may occur several years after the brain has begun to deteriorate.
Stage 2: Very Mild Decline
The individual might begin to notice minor memory problems or that they lose things around the house. At this stage though, it is difficult to differentiate the symptoms from normal age-related memory loss.
The person will still do well on memory tests, meaning the disease is unlikely to be detected by doctors or loved ones.
The person will still be able to do well on memory tests, which means even if the individual or their loved ones notice a change; they are unlikely to receive a diagnosis.
Though it can be difficult to receive a diagnosis at this stage, it’s still beneficial the earlier you can be aware of any symptoms starting to develop.
Research has shown that certain brain training activities, relationship building, and social interaction can all be beneficial in slowing the progress of Alzheimer’s disease. With that in mind, the earlier you can have these things in place for yourself or your loved one, the better.
Stage 3: Mild Decline
At this stage, it becomes more obvious to the friends and family members of the individual that they might be experiencing memory and cognitive difficulties.
Their performance on memory and cognitive tests will now be affected so doctors will be able to detect that they have impaired cognitive function. They may then refer for further tests and scans to give a firm diagnosis.
It’s also possible that your doctor could just diagnose mild cognitive impairment at this stage. It is estimated that this stage of dementia can last for up to seven years.
Patients who present in stage three will have begun to have difficulty in many areas, including finding the right word during conversations, remembering the names of new people that they meet, planning and organizing.
Stage three sufferers may also frequently lose their personal possessions, including valuables that would normally be entirely secure. There have been many tools developed these days that are widely available and designed to help people with memory loss.
One of these tools is an object locator, which could be very useful indeed to a person in this stage of Alzheimer’s disease.
Stage 4: Moderate Decline
In stage four of Alzheimer’s disease, clear symptoms become apparent. Individuals begin to have difficulty with simple arithmetic, they may forget details about their own history, and they will have poor short-term memory.
They will probably find at this stage that they are unable to manage their finances and pay bills.
It’s at this stage that most people with Alzheimer’s disease reach out for help as their condition has reached a stage where it is impossible to ignore and is making their daily lives difficult. At this stage, the doctor would probably offer a Mini-Mental State Examination (MMSE). This simple test takes about ten minutes and involves your doctor asking you a series of questions that are designed to uncover and memory issues you might be having.
The average length of time that people with Alzheimer’s disease spend in Stage 4 is two years.
Stage 5: Moderately Severe Decline
During the fifth stage of Alzheimer’s, patients will begin to need help with numerous day-to-day activities. People in stage five of the disease may experience significant confusion, an inability to recall simple details about themselves, such as their own phone number and difficulty dressing appropriately.
However, people in stage five maintain a degree of functionality. They can typically still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.
At this stage, it can be really valuable to spend time with your loved one looking over old photographs and talking about memories from years gone by. Not only do people in this stage of Alzheimer’s disease usually enjoy these activities immensely, but it also reminds them of who they are as a person and removes their focus from the difficulties they are currently having. It feels good to remember things, and there is some evidence that it is beneficial in exercising their minds and slowing the progress of the disease.
You might like to consider at this stage having somebody check on your loved one a few times a day. They usually don’t require constant care, but it’s worth having somebody checking in to make sure they’re ok and spend some time with them. If family members or friends are unable to make this time commitment, there are domiciliary care agencies that will provide you with visits.
Stage 6: Severe Decline
Individuals with the sixth stage of Alzheimer’s disease will often need constant supervision and frequently require professional care. It’s at this time that you may like to consider a care home for your loved one where they will receive 24-hour care. Some families choose to move their loved ones into their homes and give up work to care for them. It’s important to find a solution that works for your family.
The symptoms a person in this stage of Alzheimer’s disease will usually experience include confusion, a lack of awareness of the environment and surroundings, major personality changes and potential behavior problems. They will usually need assistance with activities of daily living, such as toileting and bathing.
They can become unable to recognize faces except for their closest friends and relatives. They are often unable to remember most details of their personal history and also usually lose bowel and bladder function. It’s not uncommon for them to become prone to wandering.
Not only is the individual with Alzheimer’s disease likely to become distressed by their symptoms, but it can also be an upsetting time for their carers and loved ones. It is not an easy thing to watch your family member go through, and you may experience feelings of grief since it can seem that they are no longer the same person.
All of these feelings are a completely normal part of the process, and it’s so important that you access support to enable you to support your family as best you can. Speak to your doctor about what support is available in you your local area.
It is thought that this stage of the disease lasts, on average, 2.5 years.
Stages 7: Very Severe Decline
Stage seven is the final stage of the disease. Alzheimer’s is a terminal illness, and patients in stage seven are nearing the end. Many people with Alzheimer’s disease don’t even make it to this stage and pass away before they reach it, often due to other health conditions such as heart attack or stroke.
In stage seven of the disease, patients lose the ability to respond to their environment or communicate. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of the illness, patients may lose their ability to swallow. If this happens, it is often decided that they should be fed through a tube in their stomach.
If you aren’t already accessing permanent care services, then you may like to get something in place now. Even if you have your loved one at home with you, you will usually benefit from medical input and some assistance with their care. Caring for a loved one in the final stages of Alzheimer’s can be exhausting and challenging on so many levels, it’s really important to make sure that you are well supported.
This is a tough stage to cope with for anybody who loves the affected person, but many people take comfort from the fact that at this stage, the person with Alzheimer’s has no awareness of what is happening to them. So long as due care and attention are paid to their calm and comfort, then there’s no reason why their lives can’t end peacefully and beautifully.
Changes to Watch For
Early Stages
As brain cells begin to deteriorate, memory and cognition begin to falter, and these can bring along some personality and behavioral changes. Many people with early-stage Alzheimer’s continue to live independently, and may not show many outward signs of cognitive problems. However, you may notice subtle changes in their demeanor, like:
- Frustration and embarrassment. When it becomes more difficult to remember and organize simple tasks, it’s natural for a person to get frustrated, especially when their physical ability is unaffected.
- Depression and isolation. As patients notice the signs of Alzheimer’s in themselves, depression and discouragement can set in quickly. Many people imagine their grim future, and begin to withdraw from the people and things they love in the present.
- Mild confusion. Cognitive impairment happens gradually, and the earliest symptoms are memory loss and mild confusion. People may have difficulty recalling events, processing information or making decisions.
- Anxiety and irritability. Fear, fatigue and uncertainty can come with confusion. Dealing with the new challenges of information processing can make many people lash out at the world around them, even though they are frustrated with themselves.
Later Stages
As the brain continues to deteriorate, mental processes drastically decline and basic physical processes begin to suffer. They may experience difficulty with swallowing, walking and communicating verbally, and eventually will need full-time personal care. Behavioral and psychiatric symptoms common in late-stage Alzheimer’s include:
- Anger, agitation and aggression. Sudden angry outbursts are common, as is restlessness, pacing, and wringing hands or shredding papers or tissue. Some people may begin to get physically violent when changes are made to their routine or environment.
- Hallucinations and delusions. Hallucinations (hearing and seeing things that aren’t there) and delusions (strong belief in things that aren’t real) can be exceptionally difficult to address, and may interfere with logical actions and daily tasks.
- Suspicion. As an Alzheimer’s patient loses their power of recollection, they may grow suspicious of people and things that were once familiar and comforting. It can be one of the most difficult changes for family and caregivers to experience.
- Sleep disturbances and sundowning. The phenomenon known as sundowning refers to the change in behavior some Alzheimer’s patients experience later in the day and into the evening. Up to 20 percent of people with Alzheimer’s will experience more confusion and agitation late in the day, and many are restless during the night.
- Wandering. A particularly dangerous late-stage symptom, wandering can lead to injury and worry. When it becomes too difficult to predict and control, and long-term, close care facility is often the best choice for patient and caregiver.
- Repetition. Repeating words, thoughts or instructions is very common as memory fades, and can be frustrating to indulge.
The middle stages of Alzheimer’s often last for many years, and can bring varying degrees of early and later symptoms. Typically, patients who have passed the first days of mild cognitive impairment but haven’t yet experienced massive cognitive decline will have trouble expressing their thoughts and performing routine tasks. Anger and frustration are common during this period, and unexpected or unpredictable behaviors may increase in intensity and frequency.
Tips for Caregivers Dealing With Behavioral Changes
In the early stages of Alzheimer’s, it’s important to offer lots of optimism, compassion, love and assistance. Remember that these “early stages" can last for years, and that means your loved-one could continue to function well and happily for a long time before cognitive problems progress. Be a good companion, helping out with cues and reminders, and encouraging communication and enjoyable activities.
It can take a lot of patience and energy to keep up with the pervasive physical and psychological challenges as Alzheimer’s progresses into later stages, but it’s important to stay as calm as possible and honor requests while simultaneously working “behind the scenes" to ensure a safe and secure living environment.
Tap into helpful resources, like support groups for caregivers, a trusted doctor, and close friends and relatives for an emotional outlet and helpful advice. The more worn out you feel as a caregiver, the more difficult it will be to stay in control of your responsibilities and your own happiness.