Stages of Alzheimer's

It is difficult to place a patient with Alzheimer's disease in a specific stage. However, symptoms seem to progress in a recognizable pattern and these stages provide a framework for understanding the disease. It is important to remember they are not uniform in every patient and the stages often overlap.

1. First stage - 2 to 4 years leading up to and including diagnosis.

Symptoms:

• Recent memory loss begins to affect job performance.
• What was he or she just told to do?
• Confusion about places - gets lost on way to work.
• Loses initiative -can't start anything.
• Loses spontaneity, the spark or zest for life.
• Mood/personality changes - patient becomes anxious about symptoms, avoids people.
• Poor judgment - makes bad decisions.
• Takes longer with routine chores
• Trouble handling money, paying bills.

• Forgets which bills are paid. Can't remember phone numbers.
• Loses things; can't remember grocery list.
• Arrives at wrong time or place, or constantly rechecks calendar.
• "Mother's not the same - she's withdrawn, disinterested".
• She spent all day making dinner and forgot to serve several courses.
• She paid the bills three times over, or didn't pay for three months.

2. Second Stage - 2 to 10 years after diagnosis [longest stage]

Symptoms:

• Increasing memory loss and confusion.
• Shorter attention span.
• Problems recognizing close friends and/or family.
• Repetitive statements and/or movements.
• Restless, especially in late afternoon and at night.
• Occasional muscle twitches or jerking.
• Perceptual motor problems.
• Difficulty organizing thoughts, thinking logically.
• Can't find right words - makes up stories to fill in blanks.
• Problems with reading, writing and numbers.
• May be suspicious, irritable, fidgety, teary or silly.
• Loss of impulse control - sloppy - won't bathe or afraid to bathe - trouble dressing.
• Gains and then loses weight.
• May see or hear things that are not there.
• Needs full-time supervision.

• Can't remember visits immediately after you leave.
• Repetitive movements or statements.
• Sleeps often; awakens frequently at night and may get up and wander.
• Perceptual motor problems - difficulty getting into a chair, setting the table.
• Can't find the right words.
• Problems with reading, numbers - can't follow written signs, write name, add or subtract.
• Suspicious - may accuse spouse of hiding things, infidelity, may act childish.
• Loss of impulse control - sloppier table manners. May undress at inappropriate times or in the wrong place.
• Huge appetite for junk food and other people's food; forgets when last meal was eaten, then gradually loses all interest in food.

3. Terminal Stage - 1 to 3 years.

Symptoms:

• Can't recognize family or image of self in mirror.
• Loses weight even with good diet.
• Little capacity for self care.
• Can't communicate with words.
• May put everything in mouth or touch everything.
• Can't control bowels or bladder.
• May have seizures, experience difficultly with swallowing, skin infections.

• Looks in mirror and talks to own image.
• Needs help with bathing, dressing, eating, and toileting.
• May groan, scream or make grunting sounds.
• Sleeps more.

Back to Top