Stages of Alzheimer's

Alzheimer's disease is often described in terms of early, middle and late stages. These are general rather than precise terms. Each person is unique. The symptoms that occur, when they occur and how long they last will vary in each case.

Early stage

Early in the disease, short-term memory loss occurs. Other problems go along with this:

• being unusually forgetful;
• having a hard time concentrating;
• having a hard time coming up with the right word;
• making poor choices or showing bad judgment.

During this stage, subtle changes in personality may occur. The person may also not be able to adapt to changes in old routines.

Although symptoms may seem to come on quite quickly, the problem often builds very slowly. Many times the symptoms are first noticed after the person has been under some strain. A change of homes, an illness, or a trip can over-tax a person in the early stage of the disorder.

Depression is one of the more common symptoms in the early stage of the disease. The signs of depression may include seeming sadder, quieter or more negative than usual, sleeping too much or too little, losing an unusual amount of weight, drinking more than usual or not seeming aware of or interested in things.

In this stage of the illness, the impaired person may still be able to do most things with a certain amount of help. Hard as it may be, this is also the time to plan for the future when the patient's disability will become more severe.

Middle stage

The middle stage of Alzheimer's disease is characterized by more and more severe memory loss. The person is often not able to recognize family and friends. The person's judgment gets worse and worse. Sometimes the patient has delusions. He or she is less and less able to learn or adapt to new situations. The person may also have striking personality changes, become very active and lose language abilities. The impaired person may become unable to remember even basic safety rules. Thus daily activities such as cooking, driving or using appliances may pose a danger. The impaired person may also be subject to restlessness, wandering and sleep disturbances. You may have to watch over the person closely. You may have to keep the person from doing things he or she is used to. This part of care giving can be very hard.

The patient's extreme shifts in mood can pose other problems for the caregiver. Sudden outbursts of anger or fits of extreme worry may occur. The person may accuse you or others of doing bad things to him or her, like stealing or cheating. Anger may appear because the person is frustrated. The disease reduces the person's ability to perform all adult activities so that the person, increasingly, can neither understand nor make himself or herself understood. Alzheimer's patients may even burst out angrily with no apparent explanation.

Being no longer able to figure out the world and cope with it may cause the person to be anxious or nervous. Patients may cry easily, repeat certain questions or actions over and over, or walk non-stop and without clear purpose. If impaired people become very suspicious, they may accuse others of plotting against them or of trying to steal from them. They may go to great lengths to guard against imagined threats. Sometimes they may even strike out against their caregivers, mistaking care efforts for attempted assaults.

Even in this stage, the impaired person can keep on enjoying many activities. To do this, care has to be managed well, and any other health or emotional problems have to be treated promptly. To assure this goal, you will need to keep increasing the network of people and services that help you to provide care. The task of care giving may well expand beyond the ability of any one person.

Late stage

In the late stage of Alzheimer's disease, patients may be able to carry out activities, but they lack the mental skills to do them with a clear purpose. Patients often become severely disoriented, losing touch with the world more and more. The impaired person may become ever more involved in delusions. (The person will believe in the delusions, but they will have no basis in fact.)

Late in the disease there is also likely to be a flattening of expression. You may not be able to tell whether the person is feeling happy or sad, angry or frightened. You may wonder if the person is sensing anything at all. Even the very impaired person may still be able to experience pleasure and pain.

Patients become more and more quiet and withdrawn. They show only the slightest response to others or no response at all. Spouses and close family members often say, toward the end of the disease process, that the person who "used to be" no longer exists.

During this stage of the disease, physical disability also may become extreme. The person may become bedridden and incontinent (not able to control bladder and bowel functions). Skilled nursing care may be required in the final stages before death. Alzheimer's disease is the fourth leading cause of death among Americans over the age of sixty-five. Still, people do not, as a rule, die directly from the disease. The more usual direct causes of death are infections, physical disorders or accidents such as choking on food.

Understanding Stages of Alzheimer's Recommended Resources:

University of California

UAB - Alzheimer's Disease Center