Stages of Alzheimer’s Disease: What to Expect as it Progresses
Learning about the 3-stage and 7-stage models of Alzheimer’s can help you understand the progression of symptoms, make plans for appropriate care, and better prepare for the future.
What are the stages of Alzheimer's?
Alzheimer’s disease follows a gradual progression through different stages, worsening over the course of years or decades. While even a lengthy timeline may offer little comfort following an Alzheimer’s diagnosis, by understanding the different stages of the disease, you can track the progression of your symptoms and plan for appropriate care.
When examining the different stages, however, it’s important to remember that everyone with Alzheimer’s disease progresses differently, and there are steps you can take to slow the onset of symptoms at each stage. Furthermore, cognitive, physical, and functional phases often overlap, the time in each stage varies from patient to patient, and not everyone experiences all symptoms. There are also new dementia medications and other treatments being developed that may well help to slow or reduce the rate of cognitive decline and prolong your quality of life.
Two commonly used models of Alzheimer’s progression are the 7-stage model and 3-stage model. Either of them can offer useful roadmaps for both people with the disease and their caregivers.
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Stages of Alzheimer's disease: 3-stage model
The 3-stage Alzheimer’s disease model can give you a general understanding of how the condition progresses. The model describes three phases, each with broad symptoms and an expected time range.
Stage 1 – Mild/Early
Many people at this stage experience frequent recent memory loss, particularly of recent conversations and events. They may ask repeated questions and have some problems expressing and understanding language.
Mild coordination problems include having difficulty writing and using objects. Depression and apathy can occur, accompanied by mood swings. They may need reminders for daily activities and have difficulty driving.
Duration: 2 to 4 years.
Stage 2 – Moderate/Middle
People at this stage can likely no longer cover up their problems. Pervasive and persistent memory loss includes forgetfulness about their personal history and inability to recognize friends and family. They may experience rambling speech, unusual reasoning, and confusion about current events, time, and place. They’re more likely to become lost in familiar settings, experience sleep disturbances, and undergo changes in mood and behavior, which can be aggravated by stress and change.
Experiencing delusions, aggression, and uninhibited behavior are common. Mobility and coordination are affected by slowness, rigidity, and tremors. They need structure, reminders, and assistance with the activities of daily living.
Duration: 2 to 10 years.
Stage 3 – Severe/Late
In late-stage Alzheimer’s, most people are confused about the past and present. They lose the ability to remember, communicate, or process information. They’re generally incapacitated with severe to total loss of verbal skills, unable to care for themselves, and likely immobile and prone to falls.
Problems with swallowing, incontinence, and illness are also common. Many also experience extreme problems with mood, behavior, hallucinations, and delirium. They need around-the-clock care.
Duration: 1 to 3+ years.
Stages of Alzheimer's disease: 7-stage model
A doctor may also use a diagnostic framework with five, six, or seven levels. The levels are arranged by the severity of impairment. Progression through these stages usually lasts from 8 to 10 years, but again, it differs from person to person and can stretch out for as long as 20 years.
Sample 7-stage model of Alzheimer’s disease:
Stage 1 – No Impairment
Memory and cognitive abilities appear normal.
Stage 2 – Minimal Impairment/Normal Forgetfulness
Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel.
Stage 3 – Early Confusional/Mild Cognitive Impairment
While subtle difficulties begin to impact function, the person may try to cover up their problems. They may have difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur.
Duration: 2 to 7 years.
Stage 4 – Late Confusional/Mild Alzheimer's disease
Mathematical challenges can cause problems with handling finances. Increasingly, the person will forget recent events and conversations, although most people in this stage still know themselves and their family members.
Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping are common. The person often withdraws from social situations, becomes defensive, and denies any problems.
Duration: roughly 2 years.
Stage 5 – Early Dementia/Moderate Alzheimer's disease
Decline is more severe and the person requires assistance. They’re no longer able to manage independently or recall personal history details and contact information. They’re frequently disoriented regarding place or time.
People in this stage experience a severe decline in numerical abilities and judgment skills, which can leave them vulnerable to scams and safety problems. Basic daily living tasks like eating and dressing require increased supervision.
Duration: average of 1.5 years.
Stage 6 – Middle Dementia/Moderately Severe Alzheimer's disease
People in this stage are often no longer aware of present events and unable to accurately remember the past. They progressively lose the ability to take care of daily living activities like dressing, toileting, and eating, but are still able to respond to nonverbal stimuli, and communicate pleasure and pain via behavior.
Agitation and hallucinations often show up in the late afternoon or evening. Dramatic personality changes such as wandering or suspicion of family members are common. Many can’t remember close family members, but know they are familiar.
Duration: approximately 2.5 years.
Stage 7 – Late or Severe Dementia and Failure to Thrive
In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Total support around the clock is needed for all functions of daily living and care.
Duration: impacted by quality of care, but average length is 1 to 2.5 years.
Coping with mild or early Alzheimer’s
Even when symptoms are still mild or barely noticeable, it’s normal to feel fearful and uncertain about the future. The stigma surrounding Alzheimer’s can impact your self-esteem and you may believe that your opportunities in life have run dry—that it’s too late to learn new things, develop new relationships, or have a meaningful impact on the world. Initial symptoms, such as minor lapses in memory, may only exacerbate your worries.
Practice acceptance. Hearing the diagnosis can be a painful experience for everyone involved. Be patient with yourself as you grieve. Expect to feel waves of difficult or even conflicting emotions. You might initially feel denial over the diagnosis or intense anger and frustration at the unfairness of the situation. Emotions like fear, despair, and disbelief may also seem to suddenly come and go. Whether you or a loved one is receiving the diagnosis, know that all of these feelings are normal, and everyone processes their grief at a different pace.
Make a plan. While it's never too early to make decisions about your future financial, legal, and care provision, creating a plan can also help restore some sense of control. Who will assume control over your finances as the disease progresses? Will late-stage care take place at home or at a nursing facility? If you’re the caregiver, be sure to include your loved one in the decision-making process so they don’t you’re stripping them of their independence or minimizing their voice.
Look for additional support. Start by looking into available resources that may help ease your burden going forward. Support groups can put you in touch with people who understand your pain and can offer useful coping tips as the disease progresses.
Take steps to slow Alzheimer’s symptoms. Although there's no cure, there are things you can do to help delay the disease’s progression. Staying mentally mental stimulated, getting regular exercise, and managing stress, for example, can all prove beneficial. If you’re the caregiver, consider ways you can support your loved one in staying healthy.
Challenge the stigma. Know that life doesn’t end with an Alzheimer’s diagnosis. Even if you have early dementia, try to connect with others and welcome new friends into your life. Embrace self-improvement by learning new skills. Continue to keep up with your favorite hobbies or pastimes. As a caregiver, encourage your loved one to pursue the activities that they’ve always enjoyed.
Coping with moderate or middle Alzheimer’s
At this stage, it’s harder for you to hide your symptoms from loved ones. You may be frustrated at your loss of independence and growing need for care or embarrassed about your emotional outbursts, confusion, or physical impairments.
As a caregiver, you’ll need to be physically and emotionally adaptable. Your loved one might begin to react in ways that seem completely out of character. They might be slower to understand what you’re saying to them, and unable to drive or handle other daily tasks. These changes can leave you feeling stressed and exhausted at a time when you’re trying to be calm and patient.
Know that structure is vital now. Whether you’re the caregiver or being cared for, daily routines will make life easier. Try to get dressed, have meals, exercise, and sleep at the same time each day. Routines help create a sense of order and predictability, which can reduce stress and bouts of confusion. Be ready to adjust the daily schedule as your needs continue to change. For instance, you may need to shorten your daily workouts to accommodate a decrease in physical endurance or strength.
Do what you can and accept help when necessary. As someone with Alzheimer’s, you might feel like your caregiver is overstepping boundaries or infantilizing you. Try to communicate your feelings and let them know which tasks you are confident handling on your own. But be willing to acknowledge your limitations and be willing to compromise. For example, your caregiver could lay out your clothes in the morning but give you privacy to dress yourself.
Leave space for autonomy. As a caregiver, you might feel discouraged if your loved one refuses your help or if they become defensive and agitated. Remain empathetic and try to see things from their perspective. Your loved one is likely questioning their self-worth or feeling as if they’ve lost control of their life. Give them space to handle certain tasks, even if you need to supervise or double-check they've done things correctly. When it comes to financial decisions and online correspondence, keep an eye out for scams that may target elders.
Adjust your communication habits. Don’t rush conversations. A person with moderate Alzheimer’s will need extra time to recall words or process what you've said. Speak slowly and convey one idea at a time to avoid confusion. Gently correct them if they mix up details. Offer guidance if they lose their train of thought, and be ready to answer the same question more than once. At the same time, be respectful and avoid talking down to them. Comments like, “How could you forget my name?” can make your loved one feel ashamed about their memory lapses.
Coping with late or severe Alzheimer’s
During the late stages of the disease, caregiving can be especially emotional, strenuous, and time-consuming. You may be responsible for everything from your loved one’s daily hygiene to their finances. You’ll also endure the pain of witnessing your loved one lose more of themselves to the disease.
Behavioral changes, such as aggressiveness and wandering, may only add to your stress. It can seem as if the person you used to know has completely slipped away. Even so, there are ways to cope with this difficult phase and find meaning in your interactions.
Watch for health problems. Your loved one is at increased risk of illness and injury, but they may not be able to verbalize their pain. Look for nonverbal signs of distress, such as wincing or trembling, as well as symptoms like swelling and fever.
Practice self-care. You can’t take care of your loved one if you don’t take care of yourself. Take time to manage stress, be around friends, enjoy your hobbies, and pursue your goals.
Recognize your limits. While you may be reluctant to share the caregiving burden, pushing yourself too hard can result in physical and mental exhaustion and burnout. Reaching burnout won’t help your loved one either, as you’ll struggle to keep up with their needs or behavioral changes. Ask for help from family members and friends, or seek respite care. In the late stages of care, when your loved one needs total support, you may want to consider a care facility.
Find ways to soothe your loved one and bond with them. Even in the late stages, sensory experiences such as familiar music, food, or pictures can provide comfort to your loved one. Spend time together holding hands or sitting on the porch enjoying the sun. Read books to them and verbally express your love, even if you’re not sure they understand. These types of experiences can help you feel close to your loved one even during the final stages of the disease.
Having Alzheimer's disease can be a frightening and challenging experience. But there are steps you can take to help reaffirm your identity, explore new sources of joy, and maintain a rich and fulfilling life for longer. Read: Living with Alzheimer's or Dementia.
Authors: Lawrence Robinson, Jeanne Segal, Ph.D., and Sheldon Reid.
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Last updated: December 15, 2022