A progressive disease
The discovery that you or a loved one has Alzheimer’s disease can be an emotional experience. Whether you’re a family member or someone with the condition, this progressive disease will slowly impact your daily life. The first step to managing it is to learn more about Alzheimer’s, from how it progresses to treatment options.
Alzheimer’s disease is the most common type of dementia, a general term for a decline in mental abilities. With Alzheimer’s disease, someone will experience a decline their abilities to:
- speak, or find words
- problem solve
- express themselves
In the early stages, Alzheimer’s disease can interfere with day-to-day tasks. In the later stages, someone with Alzheimer’s will depend on others to complete basic tasks. There are a total of seven stages associated with this condition.
There’s no cure yet for Alzheimer’s, but treatment and interventions can help slow the progression. By knowing what to expect from each stage, you can be better prepared for what is to come.
The general stages of Alzheimer’s disease
The typical progression of Alzheimer’s disease is:
|Stage||Average time frame|
|mild, or early stage||2 to 4 years|
|moderate, or middle stage||2 to 10 years|
|severe, or late stage||1 to 3 years|
Doctors also use Dr. Barry Resiberg’s seven major clinical stages from the “Global Deterioration Scale” to help with diagnosis. There is no universally agreed upon staging system, so healthcare providers may use the one that they are most familiar with. Read on to learn more about these stages and what you can do to help someone with progressive Alzheimer’s.
Preclinical Alzheimer’s or no impairment
You may only know about your risk for Alzheimer’s disease due to family history. Or your doctor may identify biomarkers that indicate your risk.
Your doctor will interview you about memory problems, if you’re at risk for Alzheimer’s. But there will be no noticeable symptoms during the first stage, which can last for years or decades.
Caregiver support: Someone in this stage is fully independent. They may not even know they have the disease.
Very mild impairment or normal forgetfulness
Alzheimer’s disease affects mainly older adults, over the age of 65 years. At this age, it’s common to have slight functional difficulties like forgetfulness.
But for stage 2 Alzheimer’s, the decline will happen at a greater rate than similarly aged people without Alzheimer’s. For example, they may forget familiar words, a family member’s name, or where they placed something.
Caregiver support: Symptoms at stage 2 won’t interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.
Mild impairment or decline
The symptoms of Alzheimer’s are less clear during stage 3. While the entire stage lasts about seven years, the symptoms will slowly become clearer over a period of two to four years. Only people close to someone in this stage may notice the signs. Work quality will decline, and they may have trouble learning new skills.
Other examples of stage 3 signs include:
- getting lost even when traveling a familiar route
- finding it hard to remember the right words or names
- being unable to remember what you just read
- not remembering new names or people
- misplacing or losing a valuable object
- decreasing concentration during testing
Your doctor or clinician may also have to conduct a more intense interview than usual to discover cases of memory loss.
Caregiver support: At this stage, someone with Alzheimer’s may need counseling, especially if they have complex job responsibilities. They may experience mild to moderate anxiety and denial.
Mild Alzheimer’s or moderate decline
Stage 4 lasts about two years and marks the beginning of diagnosable Alzheimer’s disease. You or your loved one will have more trouble with complex but everyday tasks. Mood changes such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in a challenging situation.
New signs of decline that appear in stage 4 may include:
- decreasing awareness of current or recent events
- losing memory of personal history
- trouble with handling finances and bills
- inability to count backward from 100 by 7s
A clinician will also look for a decline in areas mentioned in stage 3, but there’s often no change since then.
Caregiver support: It’ll still be possible for someone to recall weather conditions, important events, and addresses. But they may ask for help with other tasks such as writing checks, ordering food, and buying groceries.
Moderate dementia or moderately severe decline
Stage 5 lasts about 1 1/2 years and requires a lot of support. Those who don’t have enough support often experience feelings of anger and suspiciousness. People in this stage will remember their own names and close family members, but major events, weather conditions, or their current address can be difficult to recall. They’ll also show some confusion regarding time or place and have difficulty counting backward.
Caregiver support: They’ll need assistance with daily tasks and can no longer live independently. Personal hygiene and eating won’t be an issue yet, but they may have trouble picking the right clothing for the weather or taking care of finances.
Moderately severe Alzheimer’s
During stage 6, there are five identifiable characteristics that develop over the course of 2 1/2 years.
6a. Clothes: In addition to being unable to choose their clothes, someone with stage 6 Alzheimer’s will need help putting them on correctly.
6b. Hygiene: A decline in oral hygiene begins and they’ll need help adjusting the water temperature before baths.
6c-6e. Toilet: At first, some people will forget to flush or throw tissue paper away. As the disease progresses, they’ll lose control of their bladder and bowels and need help with cleanliness.
By this stage, memory is much worse, especially around current news and life events. Counting backward from 10 will be difficult. Your loved one may also confuse family members with other people and display personality changes. They may experience:
- a fear of being alone
They may also start stuttering and become frustrated with this. It’s important to continue counseling for behavioral and psychological problems.
Caregiver support: Assistance with personal care, from daily tasks to hygiene, is necessary by this stage. They may also start to sleep more during the day and wander at night.
There are sub-stages to this final stage, which last about one to 1 1/2 years each.
7a: Speech is limited to six words or fewer. Your doctor will need to repeat questions during the interview.
7b: Speech declines to only one recognizable word.
7c: Speed is lost.
7d: They’ll be unable to sit up independently.
7e: Grim facial movements replace smiles.
7f: They’ll no longer be able to hold their head up.
Body movements will become more rigid and cause severe pain. About 40 percent of people with Alzheimer’s also form contractures, or shortening and hardening of muscles, tendons, and other tissues. They’ll also develop infantile reflexes like sucking.
Caregiver support: At this stage, the individual’s ability to respond to the environment is lost. They’ll need help with almost all their daily tasks, including eating or moving. Some people will become immobile during this stage. The most frequent cause of death in someone with stage 7 Alzheimer’s is pneumonia.
Prevention and treatment
Although there’s no cure for Alzheimer’s, treatment and prevention can slow each stage of the disease. The goal of treatment is to manage mental function and behavior and slow the symptoms down.
Dietary changes, supplements, exercises for the body and mind, and medications can have positive impacts on symptoms of the disease. Medications help regulate neurotransmitters for thinking, memory, and communication skills. But these drugs won’t cure the disease. After a while they may not work. Someone with Alzheimer’s may also need to be reminded to take their medication.
Treating behavioral symptoms with counseling and therapy may benefit someone with Alzheimer’s. It can make them feel more comfortable and ease the process for their caregivers.
Doctors sometimes prescribe antidepressants and antianxiety medications to control mood and behavioral problems.
Moderate exercises like walking can also improve mood and provide other benefits, such as a healthier heart, joints, and muscles. But due to memory problems, some people with Alzheimer's shouldn’t walk or exercise outside the home alone.
Caring for someone with Alzheimer’s disease is a great task. You'll experience a range of emotions as a caregiver. You need help and support, as well as time off from your duties. Support groups can help you learn and exchange best practices and strategies for coping with difficult situations.
Alzheimer’s is a progressive disease, with people living an average of four to eight years after diagnosis. It'll be easier to cope if you know what to expect from each stage of the disease, and if you get help from family and friends.