The Seven Stages of Alzheimer’s Disease

Reprinted by Permission from the Dementia Care News

The Seven Stages of Alzheimer’s describes the main stages of Alzheimer’s and the pattern of symptoms that typically occur in individuals living with Alzheimer’s dementia. It is important to note that not everyone living with Alzheimer’s or related dementia will experience the same symptoms or progress at the same rate over time.

As a result, the Seven Stages of Alzheimer’s should be looked at as guidelines for expectations.

People with Alzheimer’s typically live an average of 8 years after diagnosis but may survive anywhere from 3 to 20 years. The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Department of Psychiatry at the New York University Langone Medical Center.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe, and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage, and late-stage categories.

Stage 1 Symptoms: No Impairment (Normal Function)

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2 Symptoms: Very Mild Cognitive Decline

May be normal age-related changes or the earliest signs of Alzheimer’s disease. Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses, or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family, or co-workers.

Stage 3 Symptoms: Mild Cognitive Decline

Early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms:

Friends, family, or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

  • Word- or name-finding problems noticeable to family or close associates.
  • Decreased ability to remember names when introduced to new people.
  • Performance issues in social or work settings noticeable to family, friends, or co-workers.
  • Reading a passage and retaining little material.
  • Losing or misplacing a valuable object.
  • Decline in ability to plan or organize.

Stage 4 Symptoms: Moderate Cognitive Decline (Mild or Early-Stage Alzheimer’s Disease)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

  • Decreased knowledge of recent occasions or current events.
  • Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s.
  • Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances.
  • Reduced memory of personal history.
  • The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

Stage 5 Symptoms: Moderately Severe Cognitive Decline (Moderate or Mid-Stage Alzheimer’s Disease)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated.

  • Become confused about where they are or about the date, day of the week, or season.
  • Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s.
  • Need help choosing proper clothing for the season or the occasion.
  • Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children.
  • Usually require no assistance with eating or using the toilet.

Stage 6 Symptoms: Severe Cognitive Decline (Moderately Severe or Mid-Stage Alzheimer’s Disease)

Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

  • Lose most awareness of recent experiences and events as well as of their surroundings.
  • Recollect their personal history imperfectly, although they generally recall their own name.
  • Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces.
  • Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet.
  • Experience disruption of their normal sleep/waking cycle.
  • Need help with handling details of toileting (flushing toilet, wiping, and disposing of tissue properly).
  • Have increasing episodes of urinary or fecal incontinence.
  • Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding.
  • Tend to wander and become lost.

Stage 7 Symptoms: Very Severe Cognitive Decline (Severe or Late-Stage Alzheimer’s Disease)

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement.

  • Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered.
  • Individuals need help with eating and toileting and there is general incontinence of urine.
  • Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up.
  • Reflexes become abnormal and muscles grow rigid.
  • Swallowing is impaired.