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What Are the Stages of Alzheimer's?

Alzheimer's disease is a type of dementia that causes a person to have difficulty thinking, reasoning, and recalling memories. Alzheimer's is a progressive disease and it has seven different stages, beginning with mild memory loss, leading to significant loss of the ability to speak, eat, and more.
Alzheimer's disease is a type of dementia that causes a person to have difficulty thinking, reasoning, and recalling memories. Alzheimer's is a progressive disease and it has seven different stages, beginning with mild memory loss, leading to significant loss of the ability to speak, eat, and more.

Alzheimer’s disease is the most common cause of dementia, which refers to a group of brain disorders that cause problems with thinking, reasoning, judgment, and memory. Alzheimer’s is a progressive disease that usually starts with mild memory loss and can eventually lead to problems severe enough to interfere with a person’s daily activities and independence.

The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, breaks down an overview of seven stages of cognitive function in patients with dementia such as Alzheimer’s. 

  • Stages 1-3 are pre-dementia stages
  • Stages 4-7 are dementia stages
  • Beginning in stage 5, an individual can no longer survive without assistance
The Stages of Alzheimer's
Stage Description
Stage 1: No cognitive decline
  • Patients still function normally and do not exhibit any memory problems or other symptoms of dementia

Stage 2: Very mild cognitive decline (age associated memory impairment)
  • Minor memory problems such as losing things around the house or forgetting names may occur
  • Memory loss may be normal age-related memory loss
  • Patients still do well on memory tests and dementia may not be detected by doctors at this stage

Stage 3: Mild cognitive decline (mild cognitive impairment)
  • Cognitive problems become apparent at this stage
  • Performance on memory tests is affected and impaired cognitive function can be detected
  • People in stage 3 will have difficulty in many areas including:
    • Getting lost easily
    • Decline in performance at work
    • Finding the right word during conversations
    • Organizing and planning
    • Forgetting names of friends and family
    • Frequently losing personal possessions and important objects
    • Problems remembering information read in a book 
    • Difficulty concentrating
  • Mild to moderate anxiety may occur as symptoms interfere with day-to-day activities
Stage 4: Moderate cognitive decline (mild dementia)
  • Symptoms of the dementia are apparent, such as:
    • Difficulty with simple math/unable to manage finances and pay bills
    • Poor short-term memory 
    • Difficulty remembering details about their personal histories
    • Decreased knowledge of current events
    • Disorientation
  • Patients may start to become socially withdrawn and show changes in personality and mood
  • Denial of symptoms as a defense mechanism is common
  • In this stage, patients can still recognize familiar faces and travel to familiar locations, but they will often avoid challenging situations to hide symptoms or to prevent stress and anxiety
Stage 5: Moderately severe cognitive decline (moderate dementia)
 
  • Patients begin to need assistance with day-to-day activities and may have symptoms such as: 
    • The main sign of this stage is inability to remember simple details about themselves such as their own phone number or their home address
    • Disorientation regarding time and place
    • Difficulty dressing appropriately
    • Significant confusion
    • Difficulty making decisions
    • However, people in this stage usually still have some basic functionality such as:
      • Can bathe and toilet independently
      • Can eat on their own
      • Usually still know their own name, close family member’s names, and some details about personal history, especially childhood

Stage 6: Severe cognitive decline (moderately severe dementia)
  • Patients in this stage need constant supervision and often require professional care. Symptoms include:
    • Needing assistance with daily activities such as toileting and bathing
    • Confusion or lack of awareness of surroundings
    • Inability to recognize faces other than close friends and relatives
    • Inability to remember most details of personal history
    • Significant personality changes 
    • Potential behavior problems
    • Loss of bladder and bowel control
    • Wandering
    • Delusions/hallucinations 
    • Obsessive behavior 
    • Anxiety, aggression, and agitation
    • Loss of willpower
    • Difficulty sleeping
Stages 7: Very severe cognitive decline (severe dementia)
 
  • Alzheimer’s is a terminal illness and patients in this stage are nearing death. Symptoms include:
    • Loss of the ability to speak or respond to the environment
    • Patients may still be able to utter words and phrases, but they have no insight into their condition
    • Assistance is needed with all activities of daily living including walking, eating, and using the bathroom
    • People may lose their ability to swallow in the final stages 

What Are Symptoms of Alzheimer's?

Symptoms of Alzheimer’s are usually mild to begin with, and slowly and progressively worsen.  

Early symptoms of mild Alzheimer’s disease may include:

  • Forgetfulness/memory loss
  • Confusion
  • Problems with language, such as being unable to find the right words for things
  • Repeating questions
  • Difficulty concentrating 
  • Problems with reasoning
  • Difficulty with everyday tasks such as paying bills or balancing a checkbook
  • Wandering and getting lost in familiar places
  • Poor judgment 
  • Losing things
  • Mood and personality changes
  • Increased anxiety and/or aggression

As Alzheimer’s disease progresses, symptoms of moderate Alzheimer’s may include:

  • Increased memory loss and confusion 
  • Episodes of anger or aggression
  • Depression 
  • Inability to learn new things 
  • Difficulty with language and problems reading, writing, and working with numbers 
  • Problems with logical thinking
  • Shortened attention span 
  • Difficulty coping with new situations 
  • Difficulty performing tasks that require several steps, such as getting dressed 
  • Inability to recognize family and friends 
  • Impulsive behaviors
  • Restlessness, agitation, anxiety, tearfulness, wandering 
  • Repeating words or movements, muscle twitches
  • Loss of interest in surroundings (apathy)
  • Seeing things that aren't there (hallucinations)
  • Believing things that aren't true (delusions)
  • Paranoia
  • Disorientation

Symptoms of severe Alzheimer’s disease may include:

What Causes Alzheimer's?

The exact cause of Alzheimer’s disease is unknown, but late-onset Alzheimer’s is due to a series of brain changes that occur over a long period of time. It is believed a combination of genetic, environmental, and lifestyle factors may play a role.

Early-onset Alzheimer’s disease may be caused by a genetic mutation.

Risk factors for developing Alzheimer’s disease include: 

  • Age over than 60 years; becomes much more common in people older than 80
  • Family history 
  • High blood pressure
  • Smoking
  • Diabetes 
  • Sedentary lifestyle or social isolation 
    • People who stay physically active, socially connected, and mentally engaged seem to be less likely to develop dementia 

How Is Alzheimer's Diagnosed?

Doctors usually diagnose Alzheimer’s disease based on a patient’s history and symptoms, along with information provided by family members. 

Doctors may also perform memory and other cognitive tests to assess the degree of difficulty with different types of problems. These tests can be given again and monitored over time to observe any decline in function.

Other tests that may be indicated to help confirm Alzheimer’s disease or another form of dementia, or to rule out other conditions include:

  • Blood tests to check for: 
    • Chemical or hormonal imbalance 
    • Vitamin deficiency 
  • Brain scans 
    • Usually magnetic resonance imaging (MRI) to look for other problems 
    • Positron emission tomography (PET) scans can show the abnormal protein deposits in Alzheimer disease, but it is usually only performed for research studies
    • Scans may also help identify the type of dementia, based on certain characteristic brain changes 
  • Lumbar puncture (spinal tap) can also help identify the type of dementia

What Is the Treatment for Alzheimer's?

There is no single treatment for Alzheimer’s disease and the condition currently cannot be cured. 

Treatment for Alzheimer’s disease includes:

  • Medications 
    • To help maintain mental function in mild to moderate Alzheimer’s disease 
      • Donepezil (Aricept) (can also be used to treat severe Alzheimer’s)
      • Rivastigmine (Exelon)
      • Galantamine (Razadyne) 
    • To help maintain mental function in moderate to severe Alzheimer’s disease 
      • Memantine (Namenda)
      • Rivastigmine (Exelon patch)
      • Memantine and donepezil (Namzaric) 
  • Behavioral therapy to manage behavioral problems
    • Changing the person's environment (e.g., regular exercise, avoiding triggers that cause sadness, socializing with others, engaging in pleasant activities that a person enjoys)
  • To manage depression
  • To manage aggression
    • Determine what triggers the aggression 
    • Family members can learn strategies to help lessen triggers and confrontations
    • May be treated with therapy or medication, depending on the cause 
  • To manage sleep problems
    • May be treated with medications
    • Behavior changes such as
      • limiting daytime naps,
      • increasing physical activity,
      • avoiding caffeine and alcohol in the evening,
      • maintaining daily rhythms,
      • using artificial lighting when needed during the day, and
      • avoiding bright light exposures during the night to help maintain normal wake-sleep cycles
  • To manage safety issues, because people with Alzheimer’s disease often fall and hurt themselves
    • Wear sturdy, comfortable shoes
    • Secure loose rugs or use non-skid backing on rugs
    • Hide loose wires or electrical cords
    • Maintain well-lit walkways

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References
https://www.uptodate.com/contents/dementia-including-alzheimer-disease-beyond-the-basics?search=Dementia&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5

https://www.fhca.org/members/qi/clinadmin/global.pdf

https://www.cdc.gov/aging/aginginfo/alzheimers.htm

https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet