Stages Of Alzheimer's
Stage 1 To 7: What To Expect

Alzheimer's Stages

Contents

• What Are The Stages Of Alzheimer's?
• Stage 1: No Symptoms
• Stage 2: Mild Cognitive Decline
• Stage 3: Others Start To Notice
• Stage 4: Early Stage Alzheimer's
• Stage 5: Middle Stage Alzheimer's
• Stage 6: Severe Alzheimer's
• Stage 7: Final Stage

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Alzheimer's Disease

What Are The Stages Of Alzheimer's?

The following is an outline of the 7 stages of Alzheimer's devised by the clinical director at the New York University School of Medicine's Silberstein Aging and Dementia Research Center. Not all patients will experience the same symptoms or rate of progression; however it does give you an indication of what to expect.

Notes

1. It is not always possible to place a person with Alzheimer's in a specific stage because the stages tend to overlap.
2. How long does it take to die? On average patients live 7 years after the diagnosis of Alzheimer's, although some may only last 2 years and others survive for 20 years and more.

Stage 1: No Symptoms

The person experiences no symptoms of Alzheimer's. An interview with a doctor does not indicate any sign of dementia.

Stage 2: Mild Cognitive Decline

Person may have trouble finding the right word, take longer to react, experience short term memory lapses (forgetting the location of everyday objects). May also have difficulties doing mathematical calculations. She may or may not be aware she has a problem handling these routine tasks. Family members or co-workers are unlikely to notice any difference. If they do, they may try to cover up the problems by putting them down to stress, overwork or just a natural sign of aging. No symptoms of dementia can be found during a routine medical examination.

Stage 3: Others Start To Notice

As the disease progresses, others will start to notice changes in the person. She will frequently seem emotionally cold or lethargic. She may struggle coming up with the right name for an object, calling a wrist watch a hand watch for example or 'that thing, what do you call it'. She may have problems remembering names of new people she is introduced to; forget material she has just read; misplace or lose a valuable object and have greater difficulty in planning or organizing anything. A doctor may be able to detect memory or concentration problems during an interview.

Stage 4: Early Stage Alzheimer's

At this point a medical interview should reveal clear-cut symptoms in the following areas:

• Recent events are being forgotten while a clear memory of distant events is retained.
• Difficulty in performing mental arithmetic, such as counting back from 100 by 7s.
• Greater difficulty in planning events such as preparing a dinner party, paying bills or managing financial accounts.
• Becoming moody, bad tempered and withdrawn, particularly in social situations.

Stage 5: Middle Stage Alzheimer's

At this stage people begin to need help with every-day activities. They may:

• Have gaps in their memory, not remembering their own phone number or address for example.
• Become confused about what time of day it is, month or season.
• Have trouble doing less challenging mental arithmetic, such as counting back from 20s by 2s.
• Become frequently angry and aim their frustration at family members, who in turn may end up returning the same feelings.
• Still remember important details about themselves and their family.
• Be able still to eat or go to the toilet without assistance.

Even at this stage of the disease some families deny the diagnosis and refuse outside help. They will however start to feel a sense of loss, guilt and fear and may even neglect their own health.

Stage 6: Severe Alzheimer's

Memory continues to worsen and the person increasingly needs help with everyday activities. At this stage they may:

• Need help dressing properly or they end up putting the wrong shoes on the wrong feet, or wearing a pajamas over daytime clothes.
• Have problems increasingly controlling their bowels or bladder.
• Still remember their own name but have problems with their own personal history.
• Still recognize familiar or unfamiliar faces but have problems remembering names.
• Develop irregular sleep patterns, for example getting up in the night and sleeping during the day.
• Develop major personality changes, becoming suspicious or delusion. For example accusing the caregiver of stealing items or of being an impostor. They may show repetitive behavior like shredding tissues or hand-wringing.
• Wander out in the street and become lost.

Stage 7: Final Stage

In the final stage of the disease the patient requires 24 hour care. She is apathetic and unaware of her environment. She is not aware of her state of cleanliness or dress. She is unable to communicate with words and cannot control her bowel or bladder function. She has little memory, short-term or long-term. Many lose the ability to smile or hold their head up without support. The muscles grow rigid and swallowing is impaired. Eventually many patients end up lying in the fetal position shutting down their entire body and mind. It is only at this point that some families, emotionally and physically exhausted, resign themselves to putting their loved one into a nursing home. Most experience deep grief at having to do this. The final stage can last from several weeks to several years. Another option at this stage is hospice care. These facilities provide dignity by offering comfort and care to people with terminal illnesses. To qualify under Medicare, a doctor must diagnose a person with Alzheimer's as having less than 6 months to live. Ideally, end-of-life care wishes should be discussed with a person with dementia while they still have the capacity to make decisions about life-sustaining treatment.

Related Articles on Memory Loss

For more advice, see the following:

• Causes of Alzheimer's: Does it run in families?
• Treatment for Alzheimer's: Is there a cure?
• Alternative treatment for alzheimer's: Diet, supplements, exercise.
• How to prevent Alzheimer's: Prevention advice.

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