The Seven Stages and Symptoms of Alzheimer's Disease

Alzheimer's disease is a progressive neurological disorder that leads to personality changes, memory loss, intellectual slowing, and other symptoms. Although each person with Alzheimer's is different, most progress through a series of stages, each of which is characterized by more serious Alzheimer's symptoms.

The following seven stages were developed by researchers and physicians to describe how you or your loved one will change over time.

Your doctor might collapse the seven stages into early/middle/late or mild/moderate/severe, so these classifications are provided as well.

Stage 1 (Absence of Impairment)

There are no problems with memory, orientation, judgment, communication, or daily activities. You or your loved one is a normally functioning adult.

Stage 2 (Minimal Impairment)

You or your loved one might be experiencing some lapses in memory or other cognitive problems, but neither family nor friends are able to detect any changes. A medical exam would not reveal any problems either.

Stage 3 (Noticeable Cognitive Decline)

Family members and friends recognize mild changes in memory, communication patterns, or behavior. A visit to the doctor might result in a diagnosis of early-stage or mild Alzheimer's disease, but not always. Common symptoms in this stage include:

• Problems producing people's names or the right words for objects

• Noticeable difficulty functioning in employment or social settings
• Forgetting material that has just been read
• Misplacing important objects with increasing frequency
• Decrease in planning or organizational skills

Stage 4 (Early-Stage/Mild Alzheimer's)

Cognitive decline is more evident. You or your loved one may become more forgetful of recent events or personal details.

Other problems include impaired mathematical ability (for instance, difficulty counting backwards from 100 by 9's), a diminished ability to carry out complex tasks like throwing a party or managing finances, moodiness, and social withdrawal.

Stage 5 (Middle-Stage/Moderate Alzheimer's)

Some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including symptoms such as:

• An inability to recall one's own contact information or key details about one's history
• Disorientation to time and/or place
• Decreased judgment and skills in regard to personal care

Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members and can eat and use the bathroom without assistance.

Stage 6 (Middle-Stage/Moderate to Late-Stage/Severe Alzheimer's)

This is often the most difficult stage for caregivers because it's characterized by personality and behavior changes. In addition, memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include:

• Reduced awareness of one's surroundings and of recent events
• Problems recognizing one's spouse and other close family members, although faces are still distinguished between familiar and unfamiliar

• Sundowning, which is increased restlessness and agitation in the late afternoon and evening
• Difficulty using the bathroom independently
• Bowel and bladder incontinence
• Suspicion and paranoia
• Repetitive behavior (verbal and/or nonverbal)
• Wandering

Stage 7 (Late-Stage/Severe Alzheimer's)

In the final stage, it is usually no longer possible to respond very much to the surrounding environment. You or your loved one may be able to speak words or short phrases, but communication is extremely limited. Basic physical functions begin to shut down, such as motor coordination and the ability to swallow. Total care is required around the clock.

Although the stages provide a blueprint for the progression of Alzheimer's symptoms, not everyone advances through the stages similarly. Caregivers report that their loved ones sometimes seem to be in two or more stages at once, and the rate at which people advance through the stages is highly individual. Still, the stages help us understand Alzheimer's symptoms and prepare for their accompanying challenges.

-Edited by Esther Heerema, MSW