Stages

Mild Alzheimer’s disease

As Alzheimer’s worsens, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes. People are often diagnosed in this stage.

Moderate Alzheimer’s disease

In this stage, damage occurs in areas of the brain that control language, reasoning, conscious thought, and sensory processing, such as the ability to correctly detect sounds and smells. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multistep tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may behave impulsively.

Severe Alzheimer’s disease

Ultimately, plaques and tangles spread throughout the brain, and brain tissue shrinks significantly. People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end of life, the person may be in bed most or all of the time as the body shuts down.

Signs and symptoms of each stage of Alzheimer’s disease

These are the signs and symptoms of each stage of Alzheimer’s disease. While the symptoms in the initial stages can be mistaken for normal signs of aging, they become more severe with time. 

Pre-clinical Stage

This is the stage before any of the symptoms appear. Though the person may not show any outward signs of the disease, their brain may have started shrinking and declining. These changes within the brain can sometimes begin 10 years before any symptoms become apparent.

Early Stage

Early-stage Alzheimer’s has mild symptoms. The person may appear healthy but can often forget or struggle with some things. In the early stages, they may be aware of their forgetfulness or struggles. Loved ones like friends and family members may notice them too. The sense that something is wrong may come gradually.

These are some of the symptoms of early-stage Alzheimer’s:

  • Forgetfulness, like being unable to remember names, common objects, recent events, or appointments
  • Confusion with time and place
  • Trouble learning or remembering new things
  • Repetitive speech or questions
  • Impaired judgment and questionable decisions
  • Aggressive speech or manner
  • Reduced spontaneity or initiative
  • Delayed reactions
  • Slower speech
  • Difficulty with multistep tasks like cooking
  • Difficulty managing money or finances
  • Trouble with organizing or planning
  • Personality or mood changes

Even as symptoms worsen, the person may retain some skills, like singing, dancing, listening to music, reading, telling stories, reminiscing, or doing arts and crafts. These functions are controlled by parts of the brain that may not be affected in the early stages.

Middle Stage

Middle-stage (mid-stage) Alzheimer’s has moderate symptoms. This stage can sometimes last for many years. The person may gradually be unable to work and require the assistance of a family member or caregiver. 

The symptoms of mid-stage Alzheimer’s can include:

  • Confusion and disorientation
  • Memory loss, like being unable to remember their own name
  • Difficulty recognizing family and friends, even though they may seem familiar
  • Trouble with daily tasks, like getting dressed
  • Difficulty with language and speech
  • Difficulty with reading, writing, and numbers
  • Angry outbursts or vulgar language
  • Illogical thoughts 
  • Reduced attention span
  • Inability to cope with new situations 
  • Tendency to wander or get lost, even in familiar places
  • Unusual behavior, like getting undressed in public or keeping objects in strange places
  • Restlessness or agitation
  • Obsessive or repetitive behavior
  • Mood swings 
  • Social withdrawal
  • Tearfulness 
  • Anxiety 
  • Hallucinations
  • Delusions
  • Paranoia and distrust of family members and caretakers
  • Muscle twitches
  • Repetitive movements
  • Sleep disruptions

Some symptoms, like restlessness, agitation, anxiety, tearfulness, or the tendency to wander, can worsen in the second half of the day, i.e., between late afternoon and night. This is known as sundowning.

Late Stage

Severe symptoms characterize late-stage Alzheimer’s disease. Often, the person is unable to respond or communicate. As a result, they may require full-time care and supervision. Toward the end, they may be in bed all the time.

The symptoms of late-stage Alzheimer’s can include:

  • Difficulty eating and swallowing
  • Severe weight loss
  • Loss of bladder and bowel control
  • Trouble communicating
  • Lack of situational awareness 
  • Difficulty sitting, standing, or walking, which can lead to frequent falls
  • Inability to perform personal hygiene tasks
  • Frequent sleeping
  • Seizures
  • Skin infections
  • Grunting and groaning

The mid and late stages of Alzheimer’s can be particularly distressing for both the patient and the family and caregivers. Therefore, it’s important to practice self-care, develop a support system you can rely on, and seek therapy if you need it.

Complications & Comorbidities 

These are some of the complications and comorbidities associated with Alzheimer’s disease:

  • Mild cognitive impairment (MCI): In the early stages, a person who misplaces things, forgets appointments, or can’t recall words may be diagnosed with MCI. It can be an early warning sign of Alzheimer’s. However, everyone with MCI doesn’t necessarily develop Alzheimer’s disease; many people can take care of themselves and live an independent life with MCI.  
  • Pneumonia: People with Alzheimer’s can get aspiration pneumonia if food or liquids enter their lungs due to difficulties with swallowing. Pneumonia is a common cause of death among Alzheimer’s patients. 
  • Other complications: Stroke, infections, delirium, and certain medications can worsen the symptoms of Alzheimer’s.