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Alzheimer's: Recognising the Stages

The three main stages of Alzheimer’s are:

  • Stage One - mild/early
  • Stage Two - moderate/middle
  • Stage Three - severe/late

The stages can be broken down by a diagnostic framework through the different stages of the disease:

  • Stage One - no impairment
  • Stage Two - very mild cognitive decline
  • Stage Three - mild cognitive decline
  • Stage Four - moderate cognitive decline
  • Stage Five - moderately severe cognitive decline
  • Stage Six - severe cognitive decline
  • Stage Seven - very severe cognitive decline

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.

Knowing the likely stages will help in understanding what you can do to slow down the onset of symptoms and planning future care options.

The Three-Stage Alzheimer’s Disease model

Stage One - mild/early

This stage commonly lasts between two and four years and is characterised by short-term memory loss, when your loved one may forget about recent conversations and events. They may ask the same question repeatedly and can sometimes have difficulty in expressing themselves and understanding language.

Sometimes, a person in this stage of the disease will find that they have problems using familiar objects, writing or driving a car. They can become depressed or apathetic and may need prompting to carry out normal daily activities.

Stage Two - moderate/middle

At this stage, the person will no longer be able to conceal the problems they are having. Memory loss can worsen, and your loved one may be unable to recognise familiar people, even family members or those providing companion care.

This can be very hurtful, particularly if your loved one becomes suspicious of you or has mood swings, causing them to become aggressive. This level of dementia care can be difficult, but trained carers will be able to support you and your loved one through it.

Speech can become rambling, and the person may be confused about time and place. Even in familiar surroundings, someone at this stage may be unable to find their way around and can often be delusional. Sometimes, their behaviour becomes uninhibited, and they may act inappropriately - for example, undressing in a public place.

Physically, your loved one’s mobility can be affected, and they may lose coordination. They will benefit from frequent reminders about many aspects of life. The elderly care needed at this stage includes help with the activities of daily living (ADLs) such as washing, dressing and mobilising. This stage typically lasts from two to ten years.

Stage Three - severe/late

This final stage in the progression of the disease can last between one and three years. At this point, your loved one will lose many of their cognitive abilities, such as memory, information processing and communication.

Confusion about past and present is common, and they are likely to be extremely incapacitated, unable to care for themselves and often unable to communicate verbally at all. Their behaviour and mood can cause severe problems, and delirium and hallucination are common.

Physically, they may have swallowing difficulties requiring specialist interventions, and they are often incontinent. The dementia care needed at this time has to be 24-hour, preferably in the form of live-in care at home.

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.

Mikis’ care story

In this short video, Nick and Maro explain their reasons for choosing Elder live-in care.

They discuss how live-in care has allowed Nick’s father Mikis to stay independent in his own home while making a new friend at the same time.

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.

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