Seven Stages of Alzheimer’s

Do you know what to expect during the course of Alzheimer's disease? There are seven stages that describe each phase of this debilitating disease. Not everyone who has AD will have all of these symptoms, nor will they necessarily have the symptoms in the order listed, but by using this guide, you can get an idea of the progressive decline of the patient's cognitive functions.  Alzheimer's disease usually lasts from three to 20 years. During this time, cognitive function steadily decreases.  In many cases, patients do not die of Alzheimer’s itself, but other complications, such as pneumonia, heart failure or infections. Let's examine the seven stages:

• Stage One: There are no symptoms at all. The patient has no memory impairment nor does he have any visible signs of other cognitive decline.
  

• Stage Two: The patient will notice some mild memory loss. He or she will usually start by misplacing objects or forgetting names that are well known to them. He or she may wonder about the memory loss, but will usually blame it on aging.
  

• Stage Three: The victim will notice an increase in memory impairment. They may make a trip to the store and forget how to get back home. Their work performance may suffer because the patient may forget important details while working on a project. They may start trying to think of what a particular object is called, and the frequency of forgetting names of people they should know well will probably increase. Reading may become a problem, as the patient cannot remember what he or she has just read. At this point, the patient may lose or misplace something valuable, not remembering where they put it. Concentration will become very difficult. Most victims will go into denial during this stage, and will tend to have problems with anxiety.
  

• Stage Four: In this stage, some long-term memory loss will be seen. When asked about news headlines or current events, they may have difficulty in recalling what is happening. Travel becomes difficult because of the anxiety it causes. The person may not be able to handle their finances any longer because of confusion.  The victim will usually start to withdraw from anything that presents a challenge. Denial is still prominent.
  

• Stage Five: The patient now has to have assistance with some activities of daily living. They usually need help in selecting the clothes they wear, as during this stage they tend to dress inappropriately. They can still feed themselves and use the restroom without assistance. They may have trouble remembering some family members names, especially grandchildren or siblings, but can usually tell you their own names or the names of their spouse or children. They have trouble recalling such things as their address, or phone number.
  

• Stage Six: The victim may now start forgetting the name of their spouse or children. They usually cannot recall any recent events in their lives. They may be able to recall things that have happened in the past, but cannot go into detail about the events. They are disoriented to time and place. When asked to count from ten, they will   usually not be able to do this. They may even have difficulty in counting from one to ten. They may become incontinent, and will require help with most activities of daily living, such as bathing, toileting, dressing and sometimes eating. Delusions and paranoia may be a problem. They may start having some difficult behavior problems. Anxiety, agitation or violent behavior may occur.
  

• Stage Seven: Most communication skills are lost. Speech is non-existent. The patient is incontinent. They will need help with feeding and toileting. They will become unable to walk or control other motor functions.  During this stage, the person usually becomes bed bound.

Many patients will stay in stage five or six for a long period of time. Some patients that I met several years ago that were in these stages are still in the same stage. Not every patient is the same, so the stages and length of time in each stage will vary. You can help the patient by showing him or her a lot of love.

Jeannette Sheehan RNMS, CS
Board Certified Family Nurse Practitioner
ABC Home Healthcare Professionals

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