7 Stages of Alzheimer's

THE SEVEN STAGES OF ALZHEIMER'S are helpful in finding the words to discuss Alzheimer's. Caregivers find them particularly useful in support groups, as well as in conversations with doctors, family and care professionals.

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Although the progression of Alzheimer's disease can be slowed down today thanks to today's medications, it cannot as of yet be stopped. The process is described in general terms as going through 3 steps:

1. Mild Alzheimer’s
2. Moderate Alzheimer’s
3. Severe Alzheimer’s.

For more meaningful terms between professionals, caregivers and patients, a more detailed process has been characterized in seven stages. The seven stages are based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Stage 1 – Normal

This system calls a mentally healthy person at any age “Stage 1”.

• No memory problems
• No problems with orientation
  • person – your name, who you are;
  • place – what country, state, city you live in, where you are;
  • time – what day, date, season it is
• No problems with judgment
• No difficulties with communication skills
• No problems with daily activities

Stage 2 – Normal Aged Forgetfulness

More than half of all people ages 65 and older complain of cognitive difficulties. This is considered a normal part of aging.

• Occasional lapses in memory, usually undetectable to family and friends
• Slight cognitive problems, also undetectable to friends and family, might also not be visible on medical exam

Stage 3 – Mild Cognitive Impairment

At this point, there are mild changes in memory, communication skills and/or behavior, noticeable to family members and friends. Symptoms might be picked up by an alert physician. Many people will not decline further than this point. Notwithstanding, a majority do progress to Mild Alzheimer’s within two to four years.

• Problems remembering names, words for objects
• Difficulties functioning at work and in social settings
• Problems remembering newly-read material
• Misplacing important items with increasing frequency
• Decline in organizational skills and the ability to plan
• Repeating questions and evident anxiety

Stage 4 – Mild Alzheimer’s

Cognitive symptoms are more obvious now. A neurologist can confidently diagnose Alzheimer's disease and treat it with medications that have been proven effective in slowing it down.

• Difficulty remembering personal details, recent events
• Some confusion possible (ie: might put towel in fridge)
• Impaired mathematical ability, financial management (trouble managing a checkbook – for those who did not have trouble managing one before)
• Social withdrawal
• Moodiness, depression

Stage 5 – Moderate Alzheimer's

This is the stage at which it is not possible for a person with Alzheimer's to live alone.

• Severe memory loss, e.g., may not remember basic personal contact information such as current address or phone number
• Disorientation (not knowing the day/date/season, and/or location/country/state/city)
• No longer safe to cook, even if the sufferer can manage or remember the logistics of the process, due to severe short-term memory difficulties and confusion
• Wandering risk; might get lost once leaving the home
• Decreased personal hygiene skills
• Increased desire to sleep is common

Stage 6 – Moderately Severe Alzheimer's

It is at this stage that family members often suffer the most, because the loved one with Alzheimer's loses much of the ability to recognize those around him or her, even a spouse, sibling, parent or child. Personality changes are common as well.

• Severe memory loss continues to intensify
• Withdrawal from surroundings
• Wandering
• Reduced awareness of recent events
• Problems recognizing loved ones, although it is still possible to differentiate between those who are familiar and those who are not
• "Sundowning", if it has not yet begun, makes its appearance at this point – this is the phenomenon of increased restlessness and agitation toward sundown (hence the name), in the late afternoon and evening hours
• Bathroom management becomes difficult; at this stage it often is necessary to switch to diapers due to incontinence, wetting and other such problems using the bathroom independently
• Paranoia, suspiciousness
• Shadowing, extreme anxiety, following a loved one around the house due to fears of being alone
• Repetitive, compulsive behavior (verbal and/or nonverbal)

Stage 7 – Severe Alzheimer's

This is the final stage of Alzheimer's disease, at which the long goodbye comes to an end. Even though the Alzheimer's person may somewhere inside really hear and understand what is being said, he or she can no longer respond, other than possibly to speak a word or phrase.

• Communication is very limited
• Physical systems begin to deteriorate
• Gross motor coordination shuts down, may not be able to sit
• Swallowing may become difficult, choking is a risk

The last stage of Alzheimer's disease, as with any other illness, is a very individual matter and no two journeys end the same way. People with Alzheimer’s seem to experience little physical pain. What is certain, however, is that every Alzheimer's journey ends – as does every other. May they all be peaceful and pain free.

A Fresh Perspective

For a new, insight-filled perspective on the stages of Alzheimer's, check out the video:
Teepa Snow Illustrates Alzheimer's Stages
In this video, Teepa Snow shows what to expect, while keeping the focus on the person, not the disease.