What to Expect in the Middle Stages of Alzheimer's Disease

All about Mid-Stage (Moderate) Dementia

The middle stages of Alzheimer’s can also be referred to as mid-stage dementia, moderate Alzheimer’s, moderately severe cognitive decline or severe cognitive decline (according to the model of Barry Reisberg, M.D).

Each stage of Alzheimer’s has its own challenges, and the middle stage is no exception. There are differences between how people will progress through Alzheimer’s, but symptoms generally follow a similar route. Here are some of the possible changes you might see as you or your loved one moves through the middle stages of Alzheimer’s.

Nurse helping woman walk with walker
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Changes in Memory

While in the early stages of Alzheimer’s, your loved one might be upset by and notice his or her poor short term memory. In the middle stages, however, people are often less aware of this decline, even though the decline is greater as dementia progresses.

Mid-stage dementia usually affects the long-term memory, as opposed to just the short-term. The ability to make appropriate decisions also declines.

Decreased, and Sometimes Inappropriate, Social Interactions

As dementia progresses, people often withdraw and interact with others less frequently. They may also display some inappropriate social behaviors such as decreased inhibitions that can make others uncomfortable.

Restlessness, Including Agitation and Wandering

Agitation often increases in the middle stages of dementia. Sometimes, sundowning behaviors develop as well. It's important to remember that challenging behaviors are typically a way for the patient to communicate needs.

Altered Perception of Surroundings, Such as Paranoia and Delusions

Some people in the middle stages of Alzheimer's experience fearfulness, anxiety, or delusions or paranoia. They may become suspicious and accuse you of stealing their money or trying to hurt them. When you respond to them, it's important for you to remember that the disease is affecting the way they see and interpret reality. Rather than taking it personally, remind yourself that this is not a choice your loved one is making; it's beyond his or her control so do your best to reassure him or her of your love and care for them.

Personal Grooming May Decline

Your loved one might display poor grooming such as not showering frequently, styling her hair, or wearing mismatched or soiled clothes.This is often related to forgetfulness—both of the need to accomplish the task, as well as how to actually perform it.

Appetite and Sleep Changes

Frequently, decreases in appetite and/or weight loss can develop as dementia progresses. Sleeping patterns may also be altered as well, varying from dozing off frequently in the day to an inability to fall or stay asleep overnight.

Physical Abilities Such as Balance and Walking May Decline

Unlike other types of dementia such as frontotemporal dementia and Lewy body dementia, Alzheimer's doesn't usually affect the person's physical abilities until they are into the middle to even late stages. As the disease progresses, the person's balance and coordination will likely decrease, and general motor functioning such as walking and limb movements become more difficult.

How to Respond to the Challenges of Middle Stage Dementia

The middle stages of Alzheimer's are often a very challenging time for both the person with dementia and his caregivers. Here are a couple of suggestions to keep in mind.

Evaluate the Cause

One way to view the behaviors that may emerge during this stage is to think of them as functional, in that the person is attempting to communicate a need, rather than problematic. So, if your loved one is wandering around, consider the possibility that he or she might be looking for a bathroom, feeling hungry or needing to go for a walk. This might change your response so that rather than directing them to sit down again, you might walk with them and ask if she needs to use the bathroom.

When responding to increased confusion or behavior concerns, it's important to consider whether the person is feeling ill, lonely or bored, and just can't express these feelings verbally. If your loved one's confusion increases suddenly, it's possible that he has an infection such as a urinary tract infection. If they become quite agitated, consider that possibility that they might be in pain. And, if they are lonely or bored, providing some positive, meaningful social interaction might decrease some of those behaviors.

A Word from Verywell

Many people we speak with feel guilty about taking time away from their loved one and doing something for themselves. They often express that their role is to be with their loved one, and yet they are running on empty, both physically and emotionally.

While your desire to constantly support your family member is admirable, remember that you will not be much help to that person if you are so run down that you become sick, or so burned out that you have no energy left to respond patiently and gently to her.

The middle stages of dementia are often the most challenging ones, so consider this your reminder to take a regular break from caring for your loved one so that you can continue to be loving and supportive as she fights the disease. You are needed, so take good care of yourself.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Fisher Center for Alzheimer's Research Foundation. Clinical stages of Alzheimer's.

  2. Cleveland Clinic. Stages of Alzheimer's disease. Reviewed March 18, 2019

  3. Pérez AS. Review of Alzheimer’s disease: treatments and new pharmacological strategies. Pharmaceutical Science and Technology. 2019 June;3(1):7-21. doi:10.11648/j.pst.20190301.12

  4. U.S. Department of Health and Human Services, National Institute on Aging. What are the signs of Alzheimer's disease? Reviewed May 16, 2017.

  5. Dufour AB, Shaffer ML, D'agata EM, Habtemariam D, Mitchell SL. Survival after suspected urinary tract infection in individuals with advanced dementia. J Am Geriatr Soc. 2015;63(12):2472-2477. doi:10.1111/jgs.13833

Additional Reading

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.