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.

 Let’s take a closer look at each of these three broad stages and what you can 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.

While we all lose our keys, misplace our earrings and forget names from time to time, the person with Alzheimer’s does so more often than not. In addition to this pattern of short-term memory loss, it also becomes clear to others that his or her functioning is diminishing not just in one setting, but in various settings. Changes in driving are common in the early stage and some changes in personality may also be evident.

By the time many in the early stage of Alzheimer’s disease or another dementia are diagnosed, they may have been living with the illness for several years.

Often family and the person themselves, is aware that something is wrong, but symptoms seem vague or they are explained away by other factors. However, even when the evidence is clear, it is never easy to admit to one’s self or to someone else that changes with memory and functioning are occurring.  People for whom this is particularly difficult may try hard to cover-up their own deficits and often quite successfully, during the early stage.

 A cover-up for short-term memory loss:

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

“Oh, the usual.”

A cover-up for difficulty with word finding:

“Hand me one of those utensil with tines,” instead of using the word “fork”.

(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.).  If you could dissect the brain of someone in the middle stage of the disease you’d likely find that the hippocampus (the part of the brain that enables us to form new memories) is almost, if not completely, destroyed. 

You’d also likely see that plaques and tangles (the structures originally identified by Aloysius Alzheimer) had spread into the parts of the brain that control language and logical thinking.

What this means is that a person in the middle stage of Alzheimer’s disease is often no longer able to remember anything in the short-term, such as current events or special occasions that might have recently been celebrated. What’s more, their executive functioning is diminishing as well.

You might not have ever heard the term “executive functioning” before, so let me explain it:

Consider the example of brushing your teeth.

If you brushed your teeth this morning, you completed a set of complex steps that require executive functioning without even realizing it.  First you identified the toothbrush, turned on the water and made sure your brush was wet. Next, you retrieved the toothpaste and put it on the brush.  Then you brushed your teeth, then you probably rinsed your mouth, turned off the water and put the toothbrush away.

I just counted nine steps that must occur in a certain sequence to be effective.  This ability to recall, understand and execute a series of steps is executive functioning.

Obviously, you don’t only need executive functioning for brushing your teeth – you need it for bathing, for cooking, for changing your clothes for going to the bathroom, for writing checks for placing a phone call, for driving and on and on. When a person’s executive functioning is impaired, you may begin to notice personality changes as he or she becomes less able to take care of themselves and function effectively in the world around them.

As a result, a person in the middle stage of Alzheimer’s disease may develop significant personality changes as he or she becomes less able to take care of themselves and function effectively in the world around them.  Families that I have worked with me have commented:

“My father just stopped bathing regularly.”

“My wife always pays the bills, but I just found out that several have been unpaid for months.”

Of course there are other things that could explain the two behaviors described in the examples above, but a loss of executive functioning is one explanation.  It’s possible that the person stopped bathing or paying the bills because he or she can’t remember the steps.

Once a person reaches the middle stage of Alzheimer’s disease they usually require constant supervision and should not be left alone.

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.

Also, people at this stage often have delusions – that is, they have firmly held, false beliefs that they cling to despite being presented with evidence to the contrary, and they can also have hallucinations – they see things that are there.

Sleep disturbances are also quite common during the late stage of Alzheimer’s disease as is wandering. The person who up until now has been able to toilet, albeit with assistance now can no longer control his or her bladder or bowel.  Severe confusion related to who they are, where they are and who the people around them are is also very common in the late stage of the disease.

 At the bitter end…

Because the stages of Alzheimer’s disease can go on for multiple years, it is sometimes hard to determine where one stage ends and another begins.

However, the final symptoms of Alzheimer’s are unmistakable. 

In the end, 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.

Are you providing care to someone with Alzheimer’s?  If so, what stage is that person at and what are the behaviors that you see?

Tweet This Post

• Share on Facebook
• Stumble this Post
• Bookmark on Delicious

Interested in Receiving the Lasted Articles in your Email?
Subscribe Now