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The Stages of Alzheimer’s – What to Know and Expect

The Alzheimer’s Association clearly defines seven clinical stages of Alzheimer’s disease.

But many physicians cluster the stages into the following three. These are: early, middle and late.
stages of Alzheimer's
As you might imagine, dementia symptoms in the early stages of Alzheimer’s are usually mild, symptoms in the middle stages of Alzheimer’s are moderate, and symptoms in the late stages of Alzheimer’s are often severe.  What follows is information about what you can expect at each of the stages of Alzheimer’s.

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 Stages of Alzheimer’s 

The early stages:

The early stages of Alzheimer’s disease are often characterized by an inability to remember common words and names. It is also common to lose or misplace things of value, to have difficulty retaining information read in a short passage, and to begin to have noticeable difficulty in social or work settings.

The early stages of Alzheimer’s are 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 happens frequently. 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, he/she may have been living with the illness for several years. Subtle changes make it easy for all involved to deny what’s happening. Particularly for the person with Alzheimer’s, acknowledging the changes is often a big blow to the go. This is why cover-ups are quite common in the early stages of Alzheimer’s.

What are cover-ups?

Let’s say for instance that a person within the early stages of Alzheimer’s can’t remember what she had for breakfast or even that she had breakfast at all.  Admitting so isn’t easy, so the older adult may try to “cover-up” the truth when asked a direct question. Here’s an example:

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

“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 Stages of Alzheimer’s

The middle stages:

In the middle stages 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 loss creates the need for help at home

A person in the middle stages 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.  People within the middle stages of Alzheimer’s can’t remember if 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 in the middle stages of Alzheimer’s

As Alzheimer’s disease progresses to the middle stages, the plaques and tangles begin to spread into the parts of the brain that control language and logical thinking.  This in turn impacts executive functioning.

What is executive functioning?

Executive functioning is the ability to recall and carry out a series of steps related to a task.  Alzheimer’s disease impairs executive functioning so that the person with the illness can’t remember the steps or the appropriate order in which to take them.

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 turn on the water and wet your brush.  Then you reach for the toothpaste and apply it to the toothbrush.  After brushing you might rinse your mouth, turn the water off and put your toothbrush away.

In total, brushing your teeth takes approximately ten successive steps – more if mouthwash is involved.

Consider all the day-to-day tasks that require executive functioning!

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.

Without executive functioning, continuous supervision becomes necessary

Once a person reaches the middle stages of Alzheimer’s disease they cannot be left alone and often require constant supervision (i.e. day and night).

The Stages of Alzheimer’s

The Late Stage:

In the late stages 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 stages 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




{ 3 comments… add one }
  • Angie January 27, 2014, 7:24 PM

    Dear All:
    My dad is now at the later stages of this horrible disease. He is bed bound and has worn diapers for over 2yrs. We found no change to the meds they prescribed for this during the “early stages” He became aggressive & wouldn’t bathe. We even had to put child proof knobs, because he got out and forgot how to get home he was found by the police twice. If we tried to clean or change him he would hit and punch you. He can no longer communicate, has no appetite and is forgetting to swallow. Basically, he is shutting down. The only advise is to have help to get through this as it gets worse as it progresses you will feel overwhelmed, ran down, frustrated and just EXHAUSTED! Us kids we rotate days with a schedule and hired help for a few hours daily. I pray he doesn’t suffer much longer with this awful disease. My prayers are with all of you who are experiencing this. God Bless. Angie

  • Maria December 30, 2013, 6:31 AM

    If you trust the new doctor, give the new medication a chance to help. And get some help if you don’t already have it. You need someone to help you with the care so that you can take a break every now and again.

  • teresa m November 3, 2013, 7:37 PM

    years and worries about everything and nothing don’t like anything to eat everything taste bad and stays thirsty, cant sleep without a pill, we have to sit with her to get her to eat and make her take a bath and wash her hair and dress she want go anywhere thinks people are out to hurt my dad and her. she has a new doctor he has started he on seriquil cr but so far no change she is pacing the floors and talking nonstop and running us to death, what else can we do . thank you teresa

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