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Stages of Alzheimer's Disease

Carrie Steckl, Ph.D., edited by Natalie Staats Reiss, Ph.D.

Although each person with Alzheimer's is different, most individuals progress through a series of stages characterized by gradually increased impairment and changes in behavior. Mental health professionals generally categorize AD into seven stages, but these are often consolidated into early/middle/late stages or mild/moderate/severe stages. Each stage is described below in regard to common symptoms and level of cognitive functioning:

  • Stage 1 (No Impairment) - The person does not report or display any problems with memory, orientation, judgment, communication, or daily activities. The person is a normally functioning adult.

  • Stage 2 (Very Mild Decline) - The person reports some lapses in memory, such as frequently misplacing familiar objects or forgetting the names of familiar people (e.g., neighbors). However, neither family nor friends are able to detect any changes, and a psychological exam would probably not reveal any problems, either.

  • Stage 3 (Mild Cognitive Impairment) - Family members and friends start to recognize that the person has mild changes in memory, communication patterns, or behavior. Common symptoms in this stage include problems remembering names or the right words for objects, getting lost more frequently, difficulty functioning in employment or social settings, forgetting material that has just been read, misplacing important objects with increasing frequency, a decrease in planning or organizational skills, decreased concentration, and increased anxiety about the symptoms.

  • Stage 4 (Mild/Early-Stage Alzheimer's) - Now, the person's cognitive problems are more obvious. The person may become more forgetful of recent events or personal details. Other problems include impaired mathematical ability (e.g., counting backwards from 100 by 7s), a diminished ability to carry out complex tasks (e.g., managing money), denial about the disease, and social withdrawal (e.g., a reluctance to interact with other people, often out of shame or embarrassment due to the symptoms).

  • Stage 5 (Moderate/Middle-Stage Alzheimer's) - In this stage, some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including an inability to recall key details about one's history (e.g., one's birthplace, schools attended), disorientation to time and/or place (i.e., not knowing the time or where one is), and decreased judgment and skills in regard to personal care (e.g., inability to dress or groom oneself appropriately). Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members; they also can eat and use the bathroom without assistance.

  • Stage 6 (Moderate/Middle-Stage to Severe/Late-Stage Alzheimer's) - This stage is characterized by drastic personality and behavior changes and is often the most difficult for caregivers. A person's memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include reduced awareness of one's surroundings and of recent events, problems recognizing one's spouse and other close family members, sundowning (i.e., increased restlessness and agitation in the late afternoon and evening), difficulty using the bathroom independently, bowel and bladder incontinence, suspicion, repetitive verbal and nonverbal behavior (repeating the same word or phrase over and over, or repeating a motion like clapping), and wandering.

  • Stage 7 (Severe/Late-Stage Alzheimer's) - In the final stage, people can no longer respond to the surrounding environment. They may be able to speak words or short phrases, but communication is extremely limited. Basic functions begin to shut down, such as motor coordination and the ability to swallow. Total care is required around the clock.

Although the stages described above are a helpful blueprint for understanding the progression of Alzheimer's disease, individuals do not always move through the stages in a linear way. For instance, it can seem like a person is in two stages at once, or that the person is switching back and forth between stages in a cyclical fashion. Also, there is no average length of time spent in each stage - the progression through the stages is highly individual.