The seven stages of Alzheimer’s disease

By Penn Medicine, Dec 31, 2020, Updated Feb 25, 2022

Misplacing your car keys, calling your neighbor by the wrong name or forgetting to buy bread at the grocery store are common memory lapses. But with age, forgetfulness happens more often, and it’s easy to begin questioning what’s normal — like if it’s a sign of Alzheimer’s disease.

Alzheimer’s disease is the most common form of dementia, which is a term to describe the loss of cognitive functioning. Over time, Alzheimer’s can lead to an inability to carry out daily activities, such as getting dressed, having conversations.

If someone you care about is experiencing signs of Alzheimer’s, knowing the signs of each stage can help you assist in managing the disease.

“There’s no cure for Alzheimer’s,” explains David Wolk, MD, co-director of the Penn Memory Center, “but there are medications that can keep the symptoms from getting worse for a period of time.”

Remember, Alzheimer’s affects everyone differently. The timing and severity may be different for each person, and it can be difficult to determine which stage your loved one is in because stages may overlap and are only meant to be a guideline.

Stage 1: Before Symptoms Appear

Just like with many diseases, changes in the brain that are related to Alzheimer’s begin before symptoms are noticeable.

“This time period — often called ‘pre-clinical Alzheimer’s disease’ — likely begins 10 or 15 years before people have symptoms,” says Dr. Wolk. “Currently, there is no treatment for this pre-clinical stage, but we hope in the future that we will have medicines that can halt the progress before people have symptoms and prevent the disease.”

Because the risk of Alzheimer’s increases with age, it’s important to keep up with regular primary care visits to allow for screening to detect the earliest signs of disease. If you notice your loved one’s cognitive abilities beginning to slip, that may mean they’re entering the second stage of Alzheimer’s disease.

Stage 2: Basic Forgetfulness

Everyone can be forgetful from time to time, and that’s likely to happen more often with age. Very early stages of Alzheimer’s can look like normal-aged forgetfulness.

Your loved one might have memory lapses, including forgetting people’s names or where they left their keys, but they can still drive, work and be social. However, these memory lapses become more frequent. You will probably notice this before your loved one does — and you may be able to get them treatment sooner to slow the progression.

Stage 3: Noticeable Memory Difficulties

“For many, this stage brings noticeable changes, and it will become harder to blame age. It’s common to be diagnosed in this stage, because this is when a person’s daily routine becomes more disrupted,” explains Dr. Wolk.

Common difficulties in this stage go beyond forgetting names and misplacing objects. Your loved one may:

  • Have trouble remembering recently read material, such as books or magazines
  • Find remember plans and organizing increasingly difficult
  • Have more difficulty retrieving a name or word
  • Experience challenges in social settings or at work

This stage may bring about more anxiety for your loved one, and some people may even deny that anything is wrong. These feelings are normal, but not talking to a physician will only allow symptoms to get worse. The best way to keep symptoms at bay is to talk to your loved one’s physician about treatment options, including medications, and care planning.

Stage 4: More Than Memory Loss

“In this stage, damage to the brain often involves other aspects of cognition outside of memory, including some difficult with language, organization, and calculations.  These problems can make it more challenging for your loved one to perform daily tasks,” says Dr. Wolk.

During this stage — which can last for many years — your loved one will experience major difficulties with memory. They may still remember significant details about their life, such as who they are married to or what state they live in. Their memory of the distant past will usually be significantly better than their memory of day-to-day information, such as what they saw on the news or a conversation from earlier in the day.

Other challenges during this stage include:

  • Confusion about what day it is and where they are
  • Increased risk of wandering off or getting lost
  • Changes in sleep patterns, such as restlessness at night and sleeping during the day
  • Difficulty choosing appropriate clothing for the weather or the occasion

During this stage, situations that require a lot of thinking, such as being at a social gathering, can be very frustrating, and it’s common to feel moody or withdrawn.

“Because of the damage to the brain cells, your loved one may also experience other personality changes, such as feeling suspicious of others, having less interest in things, or feeling depressed,” explains Dr. Wolk. “These kinds of symptoms can often be improved with medications.”

Stage 5: Decreased Independence

Until now, your loved one may have been able to live on their own with no significant challenges. You may have dropped in to check on them every so often, but for the most part, they were able to function without your regular assistance.

In this stage, your loved one will likely have trouble remembering people that are important to them, such as close family and friends. They may struggle with learning new things, and basic tasks like getting dressed might be too much for them.

Emotional changes are also common during this stage, including:

  • Hallucinations: Seeing things that aren’t there
  • Delusions: False beliefs that you believe to be true
  • Paranoia: The feeling that others are against you

Stage 6: Severe Symptoms

Living on your own requires you to be able to respond to your environment, like knowing what to do if the fire alarm goes off or the phone rings. During stage 6, this becomes difficult for people with Alzheimer’s. Your loved one will be experiencing more significant symptoms at this time, which impact his or her ability to manage their own care and they will be more dependent on others,” says Dr. Wolk.

Communicating may also become difficult during this stage. Your loved one may still use words and phrases, but communicating about specific thoughts, such as where they’re experiencing pain, can be challenging.

Significant personality changes may continue to occur, including increased anxiety, hallucinations, delusions and paranoia. As their independence continues to decrease, your loved one may become more frustrated with you. There are both medicines and behavioral strategies that may help in these instances which you can discuss with your care team. 

While the above behavioral changes are not universal and some patients may be content throughout the course of the disease.  However, when they do occur, one should remember that they are unaware of what they’re doing at this point, so don’t take it personally.

Stage 7: Lack of Physical Control

Alzheimer’s destroys brain cells, and eventually, this can cause severe mental and physical impairment. Your loved one’s body may begin to shut down as their mind struggles to communicate and delegate tasks effectively.

At this point, your loved one’s needs will significantly increase. They may need round-the-clock care for help with walking, sitting and eventually swallowing.

Because of their reduced mobility, their body can also become vulnerable to infections, such as pneumonia. To help avoid infections, keep their teeth and mouth clean, treat cuts and scrapes with an antibiotic ointment right away, and make sure they get their flu shot each year.

You Know What Stage of Alzheimer’s Your Loved One Is in — Now What?

Knowing how far the dementia from Alzheimer’s has progressed is important, but that’s just the beginning. With this knowledge, you can communicate more easily with your loved one’s physicians and ensure they’re getting the treatment they need.

You’ll also be able to prepare for what comes next by getting medical supplies, such as a wheelchair, learning about ways to cope with symptoms or preparing for extra assistance, such as an assisted living facility.

Your Role as a Caregiver: Assistance, Support and Care

Caring for someone with Alzheimer’s can be demanding — physically, financially and emotionally. You may find yourself overwhelmed with daily needs and decisions, while coping with the fact that someone you care about is gradually losing their independence.

Be sure to rely on your support network, including other family members, friends, physicians and support groups. It’s important to take care of yourself first in order to provide the care and support your loved one needs.

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