Alzheimer’s disease is a progressive neurological disease that leads to changes in the patient’s personality, memory, and intellectual abilities as well as other symptoms. Each person with Alzheimer’s (AD) is different however, they still move through a series of stages, each with its own progressively serious set of symptoms. These stages have been documented by experts in the field and provide a useful system for learning how the disease unfolds. Different people with AD do not always experience the same set of symptoms or progress through the stages at the same rate. Most, however, die within four to six years after being diagnosed but the duration can vary from three to twenty years.
The seven stages of AD were developed by physicians and researchers to describe how the changes take place over time. These stages may also be classified into categories of either mild/moderate/ severe or early/middle/late. The seven stages of AD are:
Stage 1- The patient is still able to function normally without any impairment. They have not experienced any problems with memory, judgment, orientation, communication or other daily activities. No problems are evident during regular check-ups.
Stage 2- This stages marks the beginning of very mild cognitive impairments. It can be hard to tell whether these changes are due to aging or if they are the earliest signs of Alzheimer’s disease. The patient may experience lapses in memory or other cognitive problems, primarily forgetting familiar names or words, the location of keys, glasses or any other everyday object. Nothing is revealed during a medical exam and family, friends and co-workers are still unable to detect any changes.
Stage 3- Once this stage is reached, Alzhiemer’s can be diagnosed in some but not all patients. Mild changes in memory, behavior or communication abilities may be recognized by family and friends. A medical exam may lead to a diagnoses of early stage or mild AD. The symptoms for this stage are:
A decrease in the ability to remember names or words for objects
Noticeable performance issues in social or work settings
Frequently misplaces important objects
Forgetting material that has just been read
A decrease in organizational and planning skills
Stage 4- During this stage the cognitive decline becomes more noticeable. The individual may have trouble remembering personal details or recent events. They may also have problems with managing finances and experience periods of moodiness and social withdrawal. This stage reveals obvious deficencies in
Remembering recent events or occasions
The ability to perform challenging mental mathematics such as counting backwards from 100 by 5’s
Paying bills and managing finances or planning dinner for guests
Memories of personal history
Stage 5- Major gaps in memory and cognitive function are more pronounced in this stage. The patient requires assistance with daily activities. The symptoms are getting worse but the individual still knows their own name and those of family members. They can still feed themselves and take care of their toileting needs. Symptoms of this stage include:
Disorientation to time and place such as the date,the day of the week or the season
The inability to recall one’s contact information such as their current address or telephone number or important details about personal history including where they went to school
A decrease in judgment and personal care skills
Difficulties with less challenging mental mathematics such as counting backwards from 20 by 2’s
Difficulties choosing appropriate clothing for the season or occasion
Stage 6- In this stage, problems with memory continue to worsen, significant changes in personality may appear and the patients needs more help with the activities of day to day living. This is usually the most challenging stage for caregivers due to the changes in personality and mood. The most common symptoms of this stage are:
Loss of awareness of surroundings and recent events
Problems with recognizing one’s spouse and other family members, even though faces still appear as familar and unfamiliar
Sundowning or increased agitation during the late afternoon and evening
Needing help with getting dressed properly, may make mistakes such as putting shoes on the wrong feet or putting daytime clothes on over pajamas
Bowel and bladder incontinence
Wandering and becoming lost
Experiencing delusions, compulsive repetitive behavior such as tissue shredding or hand wringing, and/or hallucinations
Requiring help with toileting; for example flushing the toilet, and wiping and proper disposal of tissue
Stage 7- This stage marks a very severe cognitive decline and is commonly referred to as late stage AD. During this final stage, the patient loses the ability to respond to their environment, the ability to speak and finally the ability to control movement. Basic functions such as swallowing begin to shut down making around the clock care necessary. During this final stage AD patients:
Experience a general bladder incontinence and require with toileting
Need help with eating
Lose the ability to walk followed by the ability to sit up without support, the ability to hold their head up and the ability to smile.
The muscles become rigid and the reflexes abnormal
The stages of Alzheimer’s are merely a blueprint for the progression of the disease. Some caregivers say that their loved ones often appear to be multiple stages at one time. There is also no set time frame at which patients move through the various stages. The stages are instrumental in helping us understand the symptoms of Alzheimer’s and allow us to prepare for the challenges before us.