Middle-stage Alzheimer’s – what you need to know

This is the point in which symptoms become increasingly acute and difficult in comparison to early-stage Alzheimer’s.

This is the point in which symptoms become increasingly acute and difficult in comparison to early-stage Alzheimer’s.

For family members this stage of Alzheimer’s disease where the level of care needs begin to increase. As dementia progresses daily activities can become more taxing for a person with Alzheimer’s.

This mid-stage is all about being adaptable, calm and patient with increasingly difficult circumstances.

Memory loss, among other symptoms can severely impair someone’s ability to remain independent. It usually means increasing reliance on additional support.

‘As Alzheimer’s disease progresses, the changes become more marked. The person will need more support to help them manage their day-to-day life.’

For family carers, the middle stages can spell the start of frequent personal care requirements. These are generally characterised by support with washing, dressing and occasionally toileting – although this can vary significantly from person to person.

If you’re looking after a loved one, you may start to notice individual quirks related to their cognitive decline. In response, you’ll likely have developed strategies to cope.

However, with the support and advice from a medical professional or GP, the middle stages are the best time to put a professional carer in the home.

This will allow your loved one to begin to accept them into their routine for the most acute stages that are unfortunately yet to come. That aside, they can simply be a great support, offering lots of practical help.

Middle-stage Alzheimer’s symptoms

The specific symptoms at each stage of the disease vary from one person to the next, and are linked to personal history. However, this gives a good overview of some of the issues you may see for someone with moderate Alzheimer’s, at the middle stage of dementia.

Fading memories

What may have been slight forgetfulness at the early stages of the disease progresses to more acute memory problems. This can create seemingly significant moments of intense sadness and confusion for all involved.

Memory loss is likely to be temporary but can continue for increasingly sustained periods. Moments that have the biggest emotional impact on families tend to be forgetting names of loved ones and recognising anecdotes of past events.

Mood swings

People with dementia don’t just experience memory problems. It’s also likely you’ll notice an impact on their emotions. Particularly as the disease progresses, it’s likely you may begin to notice mood swings – such as your loved one becoming increasingly confused or withdrawn.

This can be particularly challenging in complex social situations, which can become more ever more distressing. For some, emotional challenges are particularly severe at night. ‘Sundowning’ often means people get disorientated and distressed about the change from day to night.


Disorientation can be characterised by a sense of mental confusion, and a loss of a sense of direction. This can be about the time of day, day of the week, and the week of the year, as well as where they are.

However, trouble with orientation can be more concrete. You may notice your loved one finds it increasingly difficult to maintain balance, as they struggle with depth perception. This can make it hard to walk upstairs, or even through doorways.

As well as these general symptoms, there are certain other behavioural changes that you maybegin to notice:

  • Walking off in the middle of the night, or when a difficult situation arises.
  • Telling lies, seeming delusions – or even, in more severe cases, hallucinations.
  • Inability to remember when to wash and eat – it’s not uncommon for them to become frail and unhygienic.



An aspect of middle-stage Alzheimer’s that can be tough for family members, especially those caring for someone with dementia, can be toileting needs. Unfortunately, the degeneration of the brain impacts the muscle groups needed for going to the toilet, as with anywhere else.

This can lead to an increased risk of incontinence, with decreased ability to control the bladder, the bowel, or both. For the happiness of everyone involved, it’s a good idea to a professional carer in to help.

Trouble sleeping

Sleeping patterns change, with ‘sundowning’ making people feel down when going to sleep, and increased interruptions through the night. These interruptions are linked to disorientation about the time of day, as well as issues around incontinence.

If you’re a family member caring for a loved one who’s waking in the middle of the night, it can have a really significant impact on your ability to live a normal life.


Communication coping strategies

It can become difficult to communicate, as cognitive abilities decrease. This can feel painful, and like someone you love is drifting away.

But, it’s important to remember there are ups and downs, good days and bad days, as well as some very effective ways to make communication that little bit easier.

  • Use cues: Photographs, notes, or written words and hand gestures can be a highly effective way of prompting an understanding of what you’re trying to get across.
  • Include information upfront: To avoid awkward moments where your loved one forgets names and relatives, try include information upfront, ‘Hello Mother, it’s your son Jon, and your granddaughter, Jenny’.
  • Maintain eye contact: Keeping a gaze fixed on your elderly relative can often help maintain their concentration on the conversation.
  • Reduce distractions: Other ways to help keep concentration include removing other audio/visual distractions such as the radio, telephone, television.
  • Keep it simple: Use simple language, simple words and simple sentences, while being sure to talk to your loved one like an adult, not a child.
  • Listen to what they’re saying: Listen carefully to what they’re saying, and what they’re trying to communicate. Engage in their responses.

‘Often, even if it’s not clearly expressed, mood swings can be to do with the frustration of no longer being capable of doing things that used to be easy.’

Mood swing coping strategies

Mood swings are a common symptom of Alzheimer’s disease. They can change quickly, unexpectedly, so it’s important to arm yourself with coping strategies:

  • Read between the lines: Try to identify the underlying issues that are causing the mood swings, and acknowledge the emotions being expressed.
  • Focus on the positives: Often, even if it’s not clearly expressed, mood swings can be to do with the frustration of no longer being capable of doing things that used to be easy. Try and engage your loved one with activities, hobbies and interests that they can still do.
  • Push a healthy lifestyle: Help your loved one to engage in physical activities, cook or ask your carer to cook nutritious meals and encourage them to retain their social life.
  • Don’t argue: You don’t need to express your disagreement with an opinion, or engage them in an argument.
  • Comfort them: Hugs, hand-holding and simply saying it’s ok can help comfort someone. Why not try and fetch them a cup of tea?
  • Remember: What’s worked once is likely to work again in the future so try and start to remember habits and quirks.

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