When Alzheimer’s Is Mild, Moderate, or Severe

Alzheimer’s disease usually starts silently, with brain changes that begin years before anyone notices a problem.

When symptoms start, they are usually mild at first. Forgetfulness is often the first sign. This isn’t everyday forgetfulness that everyone gets from time to time. It’s more than that. For instance, someone with mild Alzheimer's may get lost in familiar settings and ask the same questions repeatedly. If it happens a lot and causes problems in your daily life, that can be a sign.

Over time, the condition affects more and more of the brain. As that happens, Alzheimer’s shifts from mild to moderate to severe. This process usually takes several years. Doctors call it the “progression” of the disease.

Although there is no cure, it can help you to know what to expect so you can plan to meet your loved one’s needs in each stage.

There are no hard-and-fast lines between mild and moderate stages, or moderate and severe stages, but over time you can expect to see changes such as the following.

Signs of Moderate Alzheimer's

You may notice that someone in this stage of the disease has more trouble with:

Memory. He or she may forget details about their past.

Chores. It may be hard to do tasks that have several steps, such as:

  • Cleaning the house
  • Getting dressed
  • Using the telephone

Communication. Your friend or relative might:

  • Have trouble finding the right word
  • Lose track of what they planned to say
  • Struggle to understand what other people say to them

Behavior. People with moderate Alzheimer's may:

  • Become frustrated or angry more easily than they used to
  • See or hear things that aren't really there
  • Seem paranoid about unreal threats
  • Act impulsively
  • Wander away from home and get lost

But they can still remember details about their lives and the people around them. And they can take care of some tasks on their own.

Even so, they will need help from a caregiver, such as a friend or family member, to keep them safe, calm, and clean. Although they can be somewhat independent, they may no longer be able to live on their own.

They are not able to drive at this point. So they will need someone to take them to doctor visits, to see friends or do things they enjoy, and do other errands with them.

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Signs of Severe Alzheimer's

As your loved one gets into this phase, they may start to have:

More intense problems with memory and communications. He or she will have trouble remembering the names of people they care about. They may not be able to communicate with others. They may not notice when someone speaks to them.

Trouble with basic, personal tasks. In this stage, it’s hard for them to do things like:

  • Feed themselves
  • Use the restroom
  • Get dressed

Eventually, they may not be able to control when they go to the bathroom and may have trouble swallowing.

Other health problems, including:

  • Weight loss
  • Skin infections
  • Pneumonia

Walking may become harder. In time, they might not be able to walk at all.

Sleep changes. Your loved one may sleep more during the day and sleep more lightly at night.

In this stage, people with Alzheimer's disease need a lot of help from caregivers. Many families find that, as much as they may want to, they can no longer take care of their loved one at home. If that’s you, look into facilities such as nursing homes that provide professional care day and night.

When someone nears the end of their life, hospice may be a good option. That does not necessarily mean moving them to another location. Hospice care can happen anywhere. It’s a team approach that focuses on comfort, pain management and other medical needs, emotional concerns, and spiritual support (if desired) for the person and their family.

WebMD Medical Reference Reviewed by Neil Lava, MD on December 10, 2017

Sources

SOURCES:

National Institutes of Health: "Alzheimer's disease fact sheet," "About Alzheimer's disease: Symptoms."

Goldman's Cecil Medicine, 24th edition, Saunders, 2012.

Alzheimer's Association: "Seven stages of Alzheimer's," "Middle-stage caregiving," "Late-stage caregiving."

American Hospice Association: “FAQ: What is hospice care?”

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