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7 Stages of Alzheimer's Disease

Medically Reviewed by Christopher Melinosky, MD on June 05, 2021

You can help support your loved one with Alzheimer's by learning more about how the condition unfolds.

The stages don't always fall into neat boxes, and the symptoms might vary -- but they can be a guide and help you plan for your friend or relative's care. Doctors call these different stages the progression of the disease.

There is no cure for Alzheimer's disease, so it can help 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, but over time, you can expect changes like the ones below.

Stage 1: Normal Outward Behavior

Alzheimer’s disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won't have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer's.

As they move into the next six stages, your friend or relative with Alzheimer's will see more and more changes in their thinking and reasoning.

Stage 2: Very Mild Changes

You still might not notice anything amiss in your loved one's behavior, but they may be picking up on small differences, things that even a doctor doesn't catch. This could include forgetting words or misplacing objects.

At this stage, subtle symptoms of Alzheimer's don't interfere with their ability to work or live independently.

Keep in mind that these symptoms might not be Alzheimer's at all, but simply normal changes from aging.

Stage 3: Mild Decline

It's at this point that you start to notice changes in your loved one's thinking and reasoning, such as:

  • Forgets something they just read
  • Asks the same question over and over
  • Has more and more trouble making plans or organizing
  • Can't remember names when meeting new people

You can help by being your loved one's "memory" for them, making sure they pay bills and get to appointments on time. You can also suggest they ease stress by retiring from work and putting their legal and financial affairs in order.

Stage 4: Moderate Decline

During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your friend or family member might:

  • Forget details about themselves
  • Have trouble putting the right date and amount on a check
  • Forget what month or season it is
  • Have trouble cooking meals or even ordering from a menu
  • Struggle to use the telephone
  • Not understand what is said to them
  • Struggle to do tasks with multiple steps like cleaning the house.

You can help with everyday chores and their safety. Make sure they aren't driving anymore, and that no one tries to take advantage of them financially.

Stage 5: Moderately Severe Decline

Your loved one might start to lose track of where they are and what time it is. They might have trouble remembering their address, phone number, or where they went to school. They could get confused about what kind of clothes to wear for the day or season.

You can help by laying out their clothing in the morning. It can help them dress by themselves and keep a sense of independence.

If they repeat the same question, answer with an even, reassuring voice. They might be asking the question less to get an answer and more to just know you're there.

Even if your loved one can't remember facts and details, they might still be able to tell a story. Invite them to use their imagination at those times.

Stage 6: Severe Decline

As Alzheimer's progresses, your loved one might recognize faces but forget names. They might also mistake a person for someone else, for instance, think their wife is their mother. Delusions might set in, such as thinking they need to go to work even though they no longer have a job.

You might need to help them go to the bathroom.

It might be hard to talk, but you can still connect with them through the senses. Many people with Alzheimer's love hearing music, being read to, or looking over old photos.

At this stage, your loved one might struggle to:

  • Feed themselves
  • Swallow
  • Get dressed

They also might have:

Stage 7: Very Severe Decline

Many basic abilities in a person with Alzheimer's, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping them use a spoon, and making sure they drink. This is important, as many people at this stage can no longer tell when they're thirsty.

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 doesn't 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

Sources

SOURCES:

Alzheimer's Association: "Early-Stage Caregiving, "Late-Stage Caregiving," "Middle-Stage Caregiving, "Seven Stages of Alzheimer's."

Fisher Center for Alzheimer's Research Foundation: "Clinical Stages of Alzheimer's."

Fritsch, T. The Gerontologist, March 18, 2009.

Johns Hopkins Medicine: "Stages of Alzheimer's Disease."

Lloyd, J. Dementia, Dec. 29, 2014.

Daniel L. Murman, MD, director, behavioral and geriatric neurology program, professor of neurological sciences, University of Nebraska Medical Center, Omaha.

National Institute on Aging: "Understanding How AD Changes People-Challenges and Coping Strategies."

Wood, D.L. Biological Research Nursing, October 2002.

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

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

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

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