Defining the Stages of Alzheimer's

Sunrise Senior Living  |  May 5, 2016

A diagnosis of Alzheimer’s disease for yourself or your loved one may be met with sadness, fear and confusion about what’s to come. While not every person will experience the same symptoms or progress at the same rate, many will experience a similar trajectory of stages.  Experts have used different models to act as a guide through the typical stages; some use a five stage model, others use a seven stage model and there is also a simple three-phase model (early, moderate and late).

Dr. Barry Reisberg of New York University developed one of the most common methods for categorizing the progression, called the Seven Stages of Alzheimer’s. These stages can help set expectations for the person with memory loss and their families.

Stage 1: Normal

At this point in stage one, there are no memory problems or other detectable symptoms. Only a PET scan (an imaging test that shows how the brain is working) can reveal Alzheimer’s.

Stage 2: Normal Aged Forgetfulness

Minor memory problems may start to become noticeable to the person affected during stage two, but the symptoms may still be easy to miss by friends, family and even physicians.  This could include losing things around the house, forgetting a word or failing to recall a familiar name. During this stage, family members might be in denial that their loved one may have Alzheimer’s or another form of dementia. It’s common to blame memory loss on getting older, dealing with a mid-life crisis or having a high level of stress. It’s important to know which warning signs should not be avoided, according to Rita Altman, senior vice president of Memory Care & Program Services for Sunrise Senior Living.

Stage 3: Mild Cognitive Impairment

During stage three, friends and family may start to notice changes in memory, thinking and reasoning. Medical testing may expose some cognitive impairment, and individuals may have difficulties in the following areas:

  • Recalling something he/she just read
  • Finding the correct word to use during conversation
  • Retaining the answer to recent questions
  • Organizing and making plans
  • Remembering the names of new acquaintances 

Stage 4: Mild Alzheimer’s Disease

At stage four, specific symptoms of Alzheimer’s are apparent. Individuals in this stage have difficulty managing some of their activities of daily living, which often causes them to withdraw from participating in these activities.

 Those in stage four will:

  • Have difficulty with simple math
  • Forget what month or season it is
  • Have trouble with performing complex tasks, such as paying bills, managing finances or shopping for groceries and cooking meals
  • Forget personal details

Stage 5: Moderate Alzheimer’s Disease

During the fifth stage of Alzheimer’s, major gaps in memory emerge. Individuals may need help with many basic daily activities and start to lose track of where they are and what time it is. Confusion about what types of clothes are appropriate for the current season may occur.

At this point, loved ones can help by laying out clothing in the morning, answering questions (even if asked multiple times) using a calm, reassuring voice, listening with empathy to stories (although the facts and details of what they are saying may be not seem accurate) and avoid correcting them by pointing out reality or getting into power struggles.  

Stage 6: Moderately Severe Alzheimer’s Disease

At this stage, individuals need constant supervision to help maintain safety and frequently require professional care. They may mistake a person for someone else – perhaps thinking their son is their husband. Delusions might set in, such as thinking they need to go to work even if they have no job.

Individuals may need help with dressing and using the bathroom and have increased episodes of bladder or bowl incontinence. Wandering and becoming lost also becomes common at this stage.

At this point, conversation may become difficult, but sensory connections can still be made. Listening to music, being read to and looking over old photos to reminisce are some suggested activities to help continue bringing joy and meaning. It’s important to continue to talk with them, focusing on the key words that they are expressing as well as the emotions behind what they are saying.

Stage 7: Severe Alzheimer’s Disease

This is the final stage of the disease, when many basic abilities, such as eating, walking and sitting up, become virtually impossible. Individuals lose the ability to respond to their environment, speak and, ultimately, control movement.

According to the Alzheimer’s Association, these seven stages can be grouped into the three general stages: mild (stages 1-4), moderate (stages 5-6) and severe (stage 7).

Currently, there is no cure for Alzheimer’s. However, as researchers continue to explore ways that may help improve quality of life and alter the course of the disease, there are things that may help reduce the risk factors for developing Alzheimer’s. Rita Altman recently explored three simple lifestyle choices that may help. According to Rita, some dementia experts suggest that lifestyle improvements have an even greater effect than drugs. She encourages people to not sit around and wait for that pill to cure memory loss and instead start making healthier choices today.