Do you know the 7 stages of Alzheimer’s disease?

We’d like to shed some light on the 7 stages of Alzheimer’s disease.

The aim is to help you better understand what people with Alzheimer’s are able to do, or not do, at each of the 7 stages of the disease, and thus better identify the resources and care needed to ensure their well-being.

There is a Global Deterioration Scale (GDS), developed by Dr Barry Reisberg, which provides caregivers and nursing staff with an overview of the different stages of cognitive function in those suffering from degenerative dementia such as Alzheimer’s disease.

Dr. Reisberg’s scale is divided into 7 stages of Alzheimer’s disease; stages 1 to 3 are the pre-dementia stages, while stages 4 to 7 are the actual dementia stages.

It’s important for the families of people with Alzheimer’s, as well as their caregivers and nursing staff, to know that at the beginning of stage 5, the patient can no longer survive without assistance.

Each stage is described with an abbreviated title, followed by a brief list of characteristics for that stage. Caregivers and nursing staff can thus get a rough idea of a person’s state in the disease process by observing their behavioral characteristics.

The 7 stages of Alzheimer’s disease

To have Alzheimer’s disease is first and foremost to have memory problems severe enough to have an impact on daily life.

It doesn’t happen overnight, so it’s important to note the frequency and intensity of symptoms or disorders. There’s a difference between a small, occasional problem and a problem or disorder whose frequency and intensity increase steadily.

Stage 1 – No cognitive decline

Normally, there are no complaints of memory deficit at this stage on the part of the patient; nor is there any memory loss evident during the clinical interview with the patient.

Stage 2 – Very mild cognitive decline (age-related memory impairment)

Some subjective complaints of memory loss appear, with the patient most often concerned about the following situations:

● forget where familiar objects have been placed

● forget the names we once knew.

On the other hand, no objective evidence of memory deficit will be found in a clinical interview. Nor will objective memory deficits be detected, either at work or in social situations. No symptoms of dementia are detected in medical examinations or by friends, family or colleagues.

This is a normal decline in memory, linked to aging, which may give rise to a corresponding, but not alarming, concern.

Stage 3 – Moderate cognitive decline (mild cognitive impairment)

Whereas in the previous stage, both old age and Alzheimer’s disease may have been responsible for the symptoms, here we are witnessing the first clear deficits in mental faculties, albeit still at a moderate stage of cognitive decline.

It is now possible to observe manifestations in the following situations:

● the patient may get lost when moving in unfamiliar surroundings

● co-workers may notice a decline in the patient’s performance, particularly when carrying out complex tasks

● forgetting and searching for words and names become obvious to loved ones

● the patient retains little memory of reading a passage or a book

● the patient may have difficulty remembering names when being introduced to new people

● the patient begins to lose or misplace valuables

● the concentration deficit may be evident on clinical examination by a professional.

We can now obtain objective proof of the memory deficit following an intensive interview. Denial begins to set in, often accompanied by mild anxiety.

It’s usually at stage 3 of Alzheimer’s disease that the family, alerted, will request or suggest a medical diagnosis, which could lead to a prescription for medication accompanied by cognitive therapy and sometimes psychological follow-up.

Stage 4 – Moderate cognitive decline (mild dementia)

A clear cognitive deficit is identified during a careful clinical interview. Cognitive deficits are manifested in the following situations:

● greatly reduced knowledge of recent events and current affairs

● deficit in memory of personal history, past

● difficulty concentrating during serial subtraction tests

● reduced ability to travel and manage finances

However, the following mental abilities are maintained:

● orientation in space and time

● recognition of faces and people around you

● ability to move around familiar places

On the other hand, it has become obvious that sufferers are unable to perform complex tasks, and denial has become a dominant defense mechanism, if not second nature. Emotional reactions have also diminished, with frequent withdrawal in difficult situations.

Considering the impact on daily activities, it would be wise to introduce home care (family caregiver or caregiver assistant) at stage 4 of Alzheimer’s disease to help the sufferer with daily activities, such as preparing meals, grocery shopping, picking up medication from the pharmacy, etc.

It would also be advisable to introduce stimulating activities into daily life, such as making conversation and playing cognitive games, in order to prevent the depression, apathy and isolation that characterize patients at this stage.

Stage 5 – Moderately severe cognitive decline (moderate dementia)

At this stage, it’s clear that the patient can no longer live alone, and caregivers and nursing staff need to be able to recognize this.

For example, during a clinical assessment interview, the patient may not remember an important aspect of his current life, such as his address and telephone number from several years ago, the names of his grandchildren, and so on.

Disorientation in relation to time (date, day of week, season…) and place is also common.

Even a well-educated patient may have difficulty counting from 100 to 50, or from 50 to 5.

However, people in stage 5 retain a good knowledge of many major facts concerning themselves and their loved ones.

As a result, they know their own names and usually those of their spouses and children. They don’t need help with washing and eating, but they may have difficulty choosing the right clothes for the moment.

In stage 5 Alzheimer’s disease, there is a need for permanent care and resources, which would be difficult to provide at home. Serious consideration should therefore be given to moving into a residence with the services ofan assigned caregiver, or into the home of a family member with home care.

Stage 6 – Severe cognitive decline (moderately severe dementia)

We’re at an advanced stage of the disease now, and the impact on cognitive faculties is significant enough to make relationships, even with loved ones, difficult. The following behavioral changes can be observed:

● sufferers can sometimes forget the name of the spouse on whom they are entirely dependent for survival

● they are largely unaware of recent events and experiences in their lives

● they retain some knowledge of their past life, but it’s very sketchy

● they are generally no longer aware of their environment, the year, the season, and so on.

● they may have difficulty counting backwards from 20, for example, and sometimes even just counting to 10.

● they will need assistance with activities of daily living; for example, they may suffer from incontinence, will need help getting around, but will occasionally be able to go to familiar places

● the diurnal rhythm is often disturbed

● they still almost always remember their own name

● they frequently continue to be able to distinguish familiar from unfamiliar people in their environment.

Personality and emotional changes are highly variable and include:

● delusional behavior; patients may accuse their spouse of being an imposter, talk to imaginary characters or their own reflection in the mirror

● obsessive symptoms; a person may often repeat cleaning activities

● symptoms of anxiety; agitation and even violent behavior may occur

● cognitive abulia; i.e. loss of willpower due to the inability to think things through sufficiently to determine and carry out a deliberate action

In stage 6 Alzheimer’s disease, the sufferer needs care 24 hours a day, 7 days a week.

Stage 7 – Very severe cognitive decline (severe dementia)

In stage 7 Alzheimer’s disease, virtually all verbal skills have disappeared, and very often there is no language at all, only unintelligible expressions and the occasional emergence of forgotten words and phrases.

The following behaviours can also be observed:

● urinary incontinence and the need for assistance with washing and eating

● progressive loss of basic psychomotricity such as the ability to walk

● inability of the brain to control the body

● generalized rigidity of neurological reflexes

We hope that this post has enlightened you on the 7 stages of Alzheimer’s disease and helped you to better follow the progression of the disease in your loved one. This will enable you to determine more quickly the resources you’ll need to ensure the well-being of your loved one and your family.

The duration of each of the 7 stages of Alzheimer’s disease can vary greatly from person to person; however, early diagnosis of the disease will enable you to better plan your support strategy and take advantage of available resources such as medication, home care and cognitive therapy.

N.B. The information presented above does not constitute medical or scientific advice; if in doubt, please consult a healthcare professional.

Are you looking for a senior living community in Quebec and want to understand the financial assistance you’re eligible for? Our Visavie housing advisors are here to help you find the right community for your needs and budget—at no cost. Service available 7 days a week.