4 Stages of Alzheimer’s Disease

Elderly Man with Stage 3 Alzheimer's

The following is an excerpt from our upcoming ebook, Living Well with Alzheimer’s Disease, available for free on our website on November 1, 2013. This chapter outlines the stages of Alzheimer’s in a couple different ways.

There are several systems by which professionals gauge Alzheimers stages. Because each brain is unique, the progression of the disease varies from person to person – which symptoms appear first, the progression of symptoms, and the length of each stage. Because of individual variations in the progression of AD, many professionals use loose terms to define Alzheimer’s disease stages: mild or early, moderate or middle, severe or late, and end of life. Another system breaks it down further into seven Alzheimer’s stages based on the amount of cognitive decline. Below is a chart describing how the two systems compare:

Stage 1: Mild or Early Stage

Cognitive impairment at this stage is so mild and/or sporadic that many people are not diagnosed until late in this stage or early in the next.

Stage 1: No impairment

In this stage, changes are taking place at the molecular level in the brain, but no symptoms have appeared. Currently, we do not have the tools to diagnose AD at this stage, but research is being done to improve our diagnostic capabilities.

Symptoms for Alzheimer’s stage 1 include forgetfulness, mood swings, manageable behavioral changes and occasional difficulty with communication.

Stage 2: Very Mild Cognitive Decline

Small memory lapses, but no signs of dementia can be detected in a medical exam.

Stage 2: Moderate or Middle Stage

Brain function continues to decline. Many people are still aware of their condition, and most need help with various activities of daily living.

Stage 3: Mild Cognitive Decline

Family and friends begin to notice difficulties with getting the right word, remembering names, losing or misplacing things, performing everyday tasks, planning and organizing. A medical examination during this Alzheimer’s stage may reveal problems with memory and/or concentration.

This Alzheimer’s stage often seems the longest. Since cognitive impairment is gradual, it can take years before noticeable deterioration begins to dictate major changes in strategy and tactics to manage the disease.

Stage 4: Moderate Cognitive Decline

Medical examination shows clear symptoms: short term memory impairment, inability to perform mental mathematics, inability to perform complex tasks involving multiple steps even with clear directions, moodiness or becoming withdrawn in social settings.

Stage 3: Severe or Late Stage

Eventually people with AD become unable to communicate and no longer recognize their loved ones. Many times, family can no longer care for them. They need help with all physical tasks and many need 24-hour care which a single caregiver cannot manage. This is the stage when Alzheimer’s disease patients tend to wander and become lost.

Stage 5: Moderately Severe Cognitive Decline

Noticeable gaps in cognition, severe short-term memory lapses, disoriented to place and time, need help with many daily tasks, such as getting dressed or cutting food into bite-sized pieces. Most can still feed themselves and attend to their own toilet functions.

Stage 4: End of Life

In this final Alzheimer’s stage, they lose the ability to walk, move by themselves, smile or control bladder and bowels. At this stage, the brain can no longer communicate with the rest of the body. The care required is extensive. Palliative care or hospice focuses on making them as comfortable as possible.

Stage 6: Severe Cognitive Decline

At this stage, AD patients no longer have any short-term memory, knowledge of time or place, or understanding of how to perform simple tasks. They may experience major changes in personality, sleep disturbances and develop delusional or compulsive behaviour patterns.

Many families insist that their loved ones in the final Alzheimer’s disease stages spend their last days at home in the environment that was familiar to them. They will need home support services, and the ideal is to be assisted by a palliative care team.

Stage 7: Very Severe Cognitive Decline

Patients can no longer respond to their environment. Muscles, while they can still move them, become rigid, eventually swallowing is impaired. They are physically frail and lose weight. Life-threatening illnesses such as pneumonia and influenza are more likely to strike.


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