Alzheimer's stages: Mild, moderate & severe

When a loved one is diagnosed with Alzheimer's disease, it can be a challenging and emotional journey for the individual and their family.

Understanding the progression of the disease and recognizing the changes in symptoms and behavior accompanying each stage becomes crucial in providing the necessary care and support.

In this comprehensive guide, experts will navigate through the different stages of Alzheimer's, shedding light on the mild, moderate and severe phases.

Alzheimer's stages

When it comes to understanding the progression and stages of Alzheimer's, it's essential to know that there is no universally accepted staging system. However, two widely recognized frameworks outline the progression of this debilitating condition. First, there is the commonly used breakdown of mild, moderate and severe stages outlined by the U.S. National Institute on Aging (NIA).

Then, we will explore Dr. Barry Reisberg's 7 stages model, which offers a more detailed understanding of the cognitive decline experienced by individuals with Alzheimer's. By combining these perspectives, it becomes easier to assess the changes in symptoms and behavior that occur as this illness progresses.

Mild Alzheimer's

In the early stages of Alzheimer's disease, commonly called mild Alzheimer's, individuals may experience subtle but noticeable changes in their thinking. Recognizing these signs and understanding how they manifest is crucial to provide appropriate support and care.

The NIA provides this list of symptoms commonly associated with mild Alzheimer's:

• Disruptive memory loss that affects daily life
• An impaired judgment that leads to poor decisions
• Decreased spontaneity and initiative
• Difficulty keeping track of dates and current location
• Longer time needed to complete regular tasks
• Repetitive questioning and difficulty retaining new information
• Challenges in managing finances and paying bills
• Impaired problem-solving and planning abilities
• Wandering and becoming lost
• Misplacing objects in unusual locations
• Struggles with completing bathing and self-care tasks
• Changes in mood and personality
• Heightened anxiety and potential aggression

In the moderate stage of Alzheimer's disease, the NIA states that significant damage occurs in brain areas responsible for language, reasoning, conscious thought and sensory processing. This leads to a progressive decline in memory and thinking abilities, making it increasingly challenging for individuals to recognize their loved ones and carry out everyday tasks.

"For many, this stage brings noticeable changes, and it will become harder to blame age. It's common to be diagnosed in this stage because this is when a person's daily routine becomes more disrupted," Dr. David Wolk, co-director of the Penn Memory Center in Philadelphia, said in a recent Penn Medicine article.

Common difficulties in this stage go beyond forgetting names and misplacing objects. Symptoms such as hallucinations, delusions, paranoia and impulsive behavior may also emerge in this stage.

Here are some symptoms that the NIA commonly associates with moderate Alzheimer's:

• Increased confusion and memory loss, including forgetting events or personal history
• Social withdrawal
• Inability to learn new information
• Language difficulties, including reading, writing, and working with numbers
• Impaired organization of thoughts and logical thinking
• Shortened attention span
• Difficulty adapting to new situations
• Changes in sleep patterns, such as increased daytime sleepiness and nighttime restlessness
• Struggles with familiar, multistep tasks, such as dressing
• Occasional difficulty recognizing family and friends
• Hallucinations, delusions, and paranoia
• Impulsive behaviors, such as inappropriate undressing or using vulgar language
• Inappropriate emotional outbursts
• Agitation, anxiety, restlessness, tearfulness, and wandering often more pronounced in the late afternoon or evening
• Repetitive statements or movements, occasional muscle twitches

As Alzheimer's disease progresses to its final stage, the symptoms of dementia become incredibly severe. The Alzheimer's Association states that patients reach a point where they lose the ability to interact with their environment, engage in conversations and eventually, even control their own movements. Although they may still utter words or phrases, expressing pain or specific needs becomes increasingly challenging.

Significant personality changes can occur with the ongoing deterioration of memory and thinking abilities, necessitating comprehensive and extensive care for these individuals.

The NIA shares this list of common signs of severe Alzheimer's:

• Complete inability to communicate effectively
• Lack of awareness of recent experiences or surroundings
• Significant weight loss and diminished interest in eating
• Occurrence of seizures
• General physical decline, including issues with dental, skin and foot health
• Difficulty swallowing
• Manifestation of groaning, moaning or grunting sounds
• Increased need for sleep or excessive daytime drowsiness
• Loss of control over bowel and bladder functions

Dr. Barry Reisberg, a renowned researcher and clinician, has developed a widely recognized staging system that helps professionals and caregivers identify and understand the different stages of Alzheimer's disease.

This guideline serves as a valuable tool in assessing the progression of the disease. The stages are divided into pre-dementia (Stages 1 to 3) and dementia (Stages 4 to 7), with Stage 5 marking a critical turning point where individuals require significant assistance for daily living activities.

Stage 1: No impairment

At this stage, individuals exhibit no noticeable thinking declines.

Stage 2: Very mild cognitive decline

Minor memory lapses become evident, such as forgetting familiar words or misplacing objects, but these incidents are often attributed to regular age-related changes.

Stage 3: Mild cognitive decline

Memory and thinking deficits become more noticeable. Individuals may experience difficulty concentrating, struggle to remember recent events, and have trouble finding the right words.

Stage 4: Moderate cognitive decline

In this stage, clear cognitive impairment is observed. Memory gaps are more pronounced, and individuals may struggle with managing finances or organizing daily activities. They may also withdraw from social situations due to thinking challenges.

Stage 5: Moderately severe cognitive decline

This is the point where individuals require significant assistance with daily living activities. Memory loss worsens, and they may become disoriented to time and place. Assistance with dressing, personal care and other routine tasks is necessary.

Stage 6: Severe cognitive decline

Individuals experience a severe decline in cognitive abilities, including difficulty recognizing loved ones, a loss of awareness of their surroundings, and challenges with basic self-care. Behavioral changes, such as agitation or aggression, may become more prominent.

Stage 7: Very severe cognitive decline

A complete loss of verbal and physical abilities characterizes this final stage. Individuals may lose the ability to walk, sit and even hold their heads up. They require round-the-clock care and support for all daily activities.