The Stages of Alzheimer’s

By: Carol Combs, MSW, Oxford’s Memory Care Program Coordinator

Don'sBackyard_Faded_pathAlzheimer’s disease is an irreversible, progressive brain disease causing a slow decline in memory, language, reasoning, judgment, and daily functioning. It typically develops gradually and worsens over the course of several years. This progression is often referred to as stages, but not everyone will experience the same symptoms at the same rate. There are common patterns of symptom progression and a person’s abilities will change through the course of the disease.

Stages are typically referred to as early, middle and late or mild, moderate and severe. It is important to recognize these stages are a rough guide based on averages; each stage could be as brief as a year or as long as ten years. The stages can help patients and families understand what they might expect and plan accordingly.

Early stage symptoms

  • Increased forgetfulness, memory loss for recent events
  • Poor concentration
  • Repetitiveness: telling the same story over and over
  • Difficulty with word finding, expressing thoughts
  • Difficulty with decision making, problem solving or complex tasks
  • Misplacing objects or getting lost in familiar places
  • Mood or personality changes, less tolerance
  • Slower to react or learn something new
  • Needs support/supervision to continue living alone

In the early stage, most people can still live alone and carry out daily tasks, but may need assistance with finances, appointments, meal planning or cooking. This is a good time to organize and simplify daily routines and assess the home for safety. Depression and withdrawal from social activities is not uncommon in this stage and the person may try to hide the memory losses he/she is experiencing.

Middle stage symptoms

  • Increased memory loss, may not recognize family
  • Communication difficulties
  • Problems with reading, writing and numbers
  • Loss of impulse control, poor judgment
  • Difficulty with dressing, bathing, toileting
  • Aggression as a response to frustration
  • Inappropriate behaviors including resisting care, agitation, wandering
  • Delusions or hallucinations
  • Abnormal sleep/wake cycles
  • Needs full time supervision

In the middle stage, the patient may be more unpredictable and daily activities will be more challenging. Inability to perform tasks such as cooking and driving may lead to unsafe situations. At this stage, many will need full time supervision to remain in their home. Behaviors such as suspicion, wandering, resisting care, agitation and sleep disturbance may be displayed. Frustration is common because the person cannot make sense of the world around them. The behaviors are not intentional and are best dealt with by staying calm, using redirection or distraction, reminiscence and reassurance.

Late stage symptoms

  • Needs to be bathed, dressed, fed, turned
  • Loses ability to verbalize; may yell, groan or grunt
  • Loss of bodily functions, incontinent
  • Flat affect; where their faces show very little emotion
  • Unable to recognize others or themselves
  • Immobility
  • Appears apathetic, lethargic
  • Requires total care, may be appropriate for nursing home placement

With the increased cognitive losses, the patient will become calmer; less distressed by the changes happening to them and appear more apathetic.  Physical losses increase with incontinence, immobility, diminished speech and inability to perform any daily functions.  Physical wellbeing and comfort care become the primary concern. When the patient reaches this final stage additional in-home care including Hospice care may be needed to assist the caregiver.

In all stages, family and caregivers need to obtain available in-home care, seek support, utilize community resources and ensure that legal and financial affairs are in order.

If an individual has not been diagnosed with Alzheimer’s but is displaying any of these symptoms, he or she should seek a medical assessment promptly. If you have questions or concerns our Memory Care Program Coordinator would be glad to assist you.  Additional information is also available through the Alzheimer’s Association at www.alz.org.