7 Stages of Alzheimer’s

Alzheimer’s disease is often described in general terms as going through 3 steps:

  1. Mild / Early stage.
  2. Moderate / Mid stage.
  3. Severe / Late stage.

However, for more meaningful terms between professionals, caregivers and patients, a more detailed process has been characterised in the 7 stages of Alzheimer’s. The seven stages are based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

The 7 stages of Alzheimer’s

Stage 1 – Normal.

This system calls a mentally healthy person at any age “Stage 1”.

  • No memory problems
  • No problems with orientation
  • Person – your name, who you are;
  • Place – what country, state, city you live in, where you are;
  • Time – what day, date, season it is
  • No problems with judgement
  • No difficulties with communication skills
  • No problems with daily activities
Stage 2 – Normal Aged Forgetfulness.

More than half of all people ages 65 and older complain of cognitive difficulties. This is considered a normal part of ageing.

  • Occasional lapses in memory, usually undetectable to family and friends
  • Slight cognitive problems, also undetectable to friends and family, might also not be visible on medical exam
Stage 3 – Mild Cognitive Impairment.

At this point, there are mild changes in memory, communication skills and/or behaviour, noticeable to family members and friends. Symptoms might be picked up by an alert physician. Many people will not decline further than this point. Notwithstanding, a majority do progress to Mild Alzheimer’s within two to four years.

  • Problems remembering names, words for objects
  • Difficulties functioning at work and in social settings
  • Problems remembering newly-read material
  • Misplacing important items with increasing frequency
  • Decline in organisational skills and the ability to plan
  • Repeating questions and evident anxiety
Stage 4 – Mild Alzheimer’s.

Cognitive symptoms are more obvious now. A neurologist can confidently diagnose Alzheimer’s disease and treat it with medications that have been proven effective in slowing it down.

  • Difficulty remembering personal details, recent events
  • Some confusion possible (ie: might put towel in fridge)
  • Impaired mathematical ability, financial management (trouble managing a check book – for those who did not have trouble managing one before)
  • Social withdrawal
  • Moodiness, depression
Stage 5 – Moderate Alzheimer’s.

This is the stage at which it is not possible for a person with Alzheimer’s to live alone.

  • Severe memory loss, e.g., may not remember basic personal contact information such as current address or phone number
  • Disorientation (not knowing the day/date/season, and/or location/country/state/city)
  • No longer safe to cook, even if the sufferer can manage or remember the logistics of the process, due to severe short-term memory difficulties and confusion
  • Wandering risk; might get lost once leaving the home
  • Decreased personal hygiene skills
  • Increased desire to sleep is common
Stage 6 – Moderately Severe Alzheimer’s.

It is at this stage that family members often suffer the most, because the loved one with Alzheimer’s loses much of the ability to recognise those around him or her, even a spouse, sibling, parent or child. Personality changes are common as well.

  • Severe memory loss continues to intensify
  • Withdrawal from surroundings
  • Wandering
  • Reduced awareness of recent events
  • Problems recognising loved ones, although it is still possible to differentiate between those who are familiar and those who are not
  • “Sundowning”, if it has not yet begun, makes its appearance at this point – this is the phenomenon of increased restlessness and agitation toward sundown (hence the name), in the late afternoon and evening hours
  • Bathroom management becomes difficult; at this stage it often is necessary to switch to diapers due to incontinence, wetting and other such problems using the bathroom independently
  • Paranoia, suspiciousness
  • Shadowing, extreme anxiety, following a loved one around the house due to fears of being alone
  • Repetitive, compulsive behaviour (verbal and/or nonverbal)
Stage 7 – Severe Alzheimer’s.

This is the final stage of Alzheimer’s disease, at which the long goodbye comes to an end. Even though the Alzheimer’s person may somewhere inside really hear and understand what is being said, he or she can no longer respond, other than possibly to speak a word or phrase.

  • Communication is very limited
  • Physical systems begin to deteriorate
  • Gross motor coordination shuts down, may not be able to sit
  • Swallowing may become difficult, choking is a risk

Although I have never come across a similar breakdown for the stages of dementia with Lewy bodies, visit ‘Stages of DLB – Our Journey‘ for a breakdown of how Mum’s illness progressed.

Information supplied by Alzheimer’s & Dementia Weekly.