Stages of Alzheimer’s

Diagnostic framework

A diagnostic framework with seven levels is often used in combination with the three-stage model. This closely tracks the person’s progression through the different stages of the disease, so that appropriate interventions can be made.

Stage One – no impairment

There is no noticeable decline in memory or cognitive abilities, and this stage is unlikely to be diagnosed, although research has shown that Alzheimer’s Disease can begin many years before any symptoms appear.

Stage Two – very mild cognitive decline

You are unlikely to notice much in the way of memory lapses in your loved one, and they may simply be due to normal age- related decline. However, if your loved one becomes increasingly irritable when they do forget things, this might indicate very early Alzheimer’s Disease.

Stage Three – mild cognitive decline

Your loved one may begin to have problems remembering words or where they have put things, but they can cover this up well at this stage. Their planning and organisational abilities can be reduced, sometimes causing problems with life at home or work. Mood changes and depression sometimes occur, but it is not always possible for doctors to definitively diagnose the disease at this stage.

Stage four – moderate cognitive decline

This stage frequently lasts about two years, and accurate diagnosis is possible. There is increased memory loss, particularly for recent conversations and events.

Difficulties with handling money and carrying out sequential tasks such as driving or cooking may be experienced. Social interactions can become challenging, causing your loved one to withdraw. If you broach the subject, they may deny having any problems and become quite defensive.

Stage five – moderately severe cognitive decline

At this stage, the person will need elderly care. They will be unable to live independently and may often be disoriented about place and time. They may be unable to remember details of their personal history or contact information, and their judgement is likely to be impaired, so they will need increased supervision to avoid safety problems. Although they may still be able to eat and use the toilet independently, they may need help with some ADLs.

Stage six – severe cognitive decline

In this stage, your loved one may have a complete lack of awareness of what is happening in the present. They will need assistance with most daily activities and can often experience ‘sundowning’, meaning they become agitated in the evenings. They can be prone to wandering, so need supervision to ensure their safety. This stage commonly lasts around two years.

Stage seven – very severe cognitive decline

When they reach the final stage of the disease, your loved one may have extremely limited speech, swallowing difficulties, be incontinent and unable to walk or even sit. They will need support with all functions of daily living and are often more susceptible to illnesses such as infections.

Although it is distressing witnessing your loved one progressing through the disease, it helps a little if you are aware of what to expect.
There are different ways of categorising the stages of Alzheimer’s Disease, but the three-stage model is commonly used for understanding the disease progression and where your loved-one is within it. Naturally, individuals with the disease will all have a different experience, and not everyone will experience all the symptoms.