The Stages of Alzheimer’s – What You Need to Know

The Alzheimer’s Association clearly defines seven clinical stages of Alzheimer’s disease, but many physicians describe the illness in three stages.  These are: early, middle and late.

As you might imagine, dementia symptoms in the early stage are usually mild, symptoms in the middle stage are moderate, and symptoms in the late stage are often severe.  It can help to read more about the kinds of symptoms you might expect at each stage and that’s what you’ll find below.

You may also appreciate the video at the bottom of this post which gives an easy-to-understand overview of the stages and what to expect.

The early stage:

The early stage of Alzheimer’s disease is often characterized by an inability to remember common words and names. A person at this stage of the disease may also lose or misplace things of value on a regular basis, be unable to retain information they read in a short passage, and begin to have difficulty in social or work settings that is noticeable to others.

More than just forgetfulness

We all lose our keys, misplace our earrings and forget names from time to time.  But in the person with Alzheimer’s, forgetting doesn’t just happen occasionally. Instead, a pattern develops.  And that pattern is pervasive, meaning that it can be seen in various part of a person’s life, in other words, at work, at home, in social settings, etc.  In this way it can’t be explained by outside circumstances alone, like stress or lack of sleep, because it’s not situational.  It’s all the time.

In the beginning, changes may be subtle and harder to pinpoint

In fact, by the time a person is diagnosed with Alzheimer’s disease or another dementia they may have been living with the illness for several years. Often family and the person with the illness is aware that something is wrong. However, even when the evidence is clear, it is never easy to face that something may be wrong.  This is a big reason why cover-ups are quite common in the early stage.

What are cover-ups?

Let’s say for instance that a person with early stage Alzheimer’s disease does not recall what he/she had for breakfast or even that he/she had breakfast at all.  This is quite common, but it’s also something that your parent may not easily admit to.  If you were to ask a direct question, for example:

“What did you have for breakfast this morning, dad?”

It’s likely that you’d get a response such as:

“Oh, the usual.”

This is a non-specific answer, but it satisfies the question so that the person with the illness can get by.

Cover-ups are common when words are hard to find

If for example, the person with the illness has forgotten the word “fork”, he or she may say something like:

“Hand me one of those utensil with tines.”

In this way cover-ups are like a work-around strategy for those with memory impairment.  And generally speaking, the farther a person went in school, the better able he or she will be to conceal the decline that is occurring.

The middle stage:

In the middle stage of Alzheimer’s, the impairments in functioning are significantly more obvious and are occurring in all areas of a person’s life (social, emotional, vocational, etc.).  Short-term memory for things like current events and special occasions is significantly diminished and may be non-existent.

Short-term memory loss creates the need for help at home

A person in the middle stage of Alzheimer’s disease is often no longer able to remember anything in the short-term.  Current events and special occasions that have recently been celebrated are lost.  Along with this information, it’s not uncommon for people with middle stage Alzheimer’s to forget whether they’ve eaten, bathed, taken medications, etc.  This is the primary reason that living alone becomes difficult and unsafe.

Language and logical thinking are significantly impaired

As Alzheimer’s disease progresses to the middle stage, the plaques and tangles which are the hallmark signs of the illness, begin to spread into the parts of the brain that control language and logical thinking.  Impairments in both of these areas present some significant challenges, but perhaps the most significant deficit in the middle stage is the impairment in executive functioning.

What is executive functioning?

 

Many of the things you do every day involve a set of complex steps, although you may have never thought of it this way.  Consider the example of brushing your teeth.

When you enter the bathroom to brush your teeth the first thing you do is to identify the toothbrush.  Next, you probably turn on the water and wet your brush.  Following that you probably retrieve the toothpaste and apply it to the toothbrush.  After you brush your upper and lower teeth, you most likely rinse your mouth (if you use a mouthwash, there are a few additional steps here), turn the water off and put your toothbrush away.

In total, brushing your teeth takes approximately ten successive steps – more if mouthwash is involved.  Executive functioning is the ability to recall and carry out a series of steps related to a task.  However, Alzheimer’s disease impairs this ability so that the person with the illness may not recall the steps or may not remember the appropriate order which makes task completion impossible.

Why executive functioning is so critical

Now that you know what executive functioning is, consider for a minute all the day-to-day tasks that require it.  Did you put taking a shower or bath on your list?  What about following a recipe or even making a pot of tea?  We use our executive functioning skills to change our clothes, use the toilet, drive and write checks too.

As the person with Alzheimer’s disease loses his/her ability to function effectively in the world around them, changes in personality are common.  This occurs, in part, because the person with the illness is trying to make sense of what’s happening.

Continuous supervision becomes necessary

It’s possible that Alzheimer’s disease may not be recognized in an older adult until he/she has reached the middle stage, particularly if family lives at a distance.  Perhaps you’re one of the many adult daughters or sons who provide care to an aging parent long-distance.  On a visit it becomes clear to you that your aging parent has not bathed or shaved.  There is no food in the refrigerator despite the weekly reports of trips to the grocery store. Another common way in which Alzheimer’s is “discovered” is that bills are unpaid.

The big take-away point here is this: Once a person reaches the middle stage of Alzheimer’s disease they cannot be left alone and often require constant supervision (i.e. day and night).

The Late Stage:

In the late stage of Alzheimer’s disease the plaques and tangles continue to spread to the parts of the brain that regulate emotions, and help us to understand what we see, hear and smell.

Delusions, that is, firmly held false beliefs that a person clings to despite being presented with evidence to the contrary, are common, as are hallucinations, or see things that are there.

In addition, sleep disturbances often lead to wandering in the late stage of Alzheimer’s disease.  People with the illness also become unable to control bladder and bowel functioning.  The ability to know how they are and/or to recognize those around them is also significantly impaired at this stage.

At the bitter end…

Up until the end it can be challenging to pinpoint where one stage of Alzheimer’s ends and the next begins.  However, the final symptoms of Alzheimer’s are unmistakable. A person with this disease is unable to understand what others are saying or to communicate clearly, unable to feed him or herself, unable to walk, and unable to smile.

Gradually their bodies become rigid and they lose their ability to swallow. If the person does not die of other causes, Alzheimer’s disease eventually kills them by destroying their brain’s ability to regulate breathing and the heartbeat.

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Video: How Alzheimer’s Affects the Brain

If you are caring for an older adult with Alzheimer’s disease, support is essential.  I hope you’ll read How to Care For Someone With Alzheimer’s Without Losing Yourself and contact me if you have specific questions about the information I have presented here.

Related posts:

1. Alzheimer’s Disease 101
2. Dementia vs. Alzheimer’s – What’s the Difference?
3. The Most Important Questions to Ask at the Early Stage of Alzheimer’s Disease
4. A Guide to Planning Care in the Middle Stage of Alzheimer’s Disease
5. Alzheimer’s
6. Who Was Alzheimer and What Did He Find?
7. The 3 Things You Most Need to Know about Alzheimer’s