We would like to provide you with more detailed information about the seven stages of Alzheimer’s disease.
The goal is to help you better understand what people with Alzheimer’s disease are capable of doing or not doing at each of the seven stages of the disease, and thus better identify the resources and care necessary for their well-being.
There is a Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, which provides caregivers and healthcare professionals 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 seven stages of Alzheimer’s disease; stages 1 to 3 are the pre-dementia stages, while stages 4 to 7 are the dementia stages themselves.
It is important for families of people with Alzheimer’s disease, as well as caregivers and healthcare professionals, to understand that at the onset of stage 5, the patient can no longer survive without assistance.
Each stage is described with a short title, followed by a brief list of characteristics for that stage. Caregivers and healthcare professionals can thus get a rough idea of a person’s condition in the disease process by observing their behavioral characteristics.
The 7 stages of Alzheimer’s disease
Having Alzheimer’s disease means, first and foremost, experiencing memory problems that are severe enough to impact daily life.
This does not happen overnight, so it is important to note the frequency and intensity of symptoms or disorders. There is a difference between a minor occasional problem and a problem or disorder whose frequency and intensity are steadily increasing.
Stage 1 – No cognitive decline
Normally, there are no complaints of memory impairment at this stage on the part of the patient, nor is there any obvious memory loss 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 patients most often concerned about the following situations:
● forgetting where familiar objects have been placed
● forgetting names that we once knew.
However, no objective evidence of memory impairment will be found during a clinical interview. Nor will any objective memory impairment be detected, either at work or in social situations. No symptoms of dementia are detected during medical examinations or by friends, family, or colleagues.
This is a normal decline in memory associated with aging, which may cause some concern but is not alarming.
Stage 3 – Moderate cognitive decline (mild cognitive impairment)
While in the previous stage, old age and Alzheimer’s disease could both be the cause of the symptoms, here we are seeing the first clear signs of mental decline, although this is still a moderate stage of cognitive decline.
It is now possible to observe manifestations in the following situations:
● The patient may become lost when moving around in an unfamiliar place.
● coworkers may notice a decline in the patient’s performance, particularly in the execution of complex tasks
● Forgetting and searching for words and names become apparent to loved ones.
● The patient retains little memory of reading a passage or a book.
● The patient may have difficulty remembering names when introduced to new people.
● the patient begins to lose or misplace valuable items
● Concentration deficits may be evident during a clinical examination by a professional.
Objective evidence of memory impairment can now be obtained following an intensive interview. Denial begins to manifest itself in the patient, very often accompanied by mild anxiety.
It is usually at stage 3 of Alzheimer’s disease that the family, alerted to the situation, will request or suggest a medical diagnosis, which could result in a prescription for medication accompanied by cognitive therapy and sometimes psychological follow-up.
Stage 4 – Moderate cognitive decline (mild dementia)
A thorough clinical interview reveals a clear cognitive deficit. The cognitive deficit will manifest itself in the following situations:
● significant decline in knowledge of recent events and current affairs
● lack of memory of one’s personal history, one’s 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 in the surrounding area
● ability to move around familiar places
On the other hand, it has become clear that those affected are unable to perform complex tasks, and denial has become a dominant defense mechanism, even second nature. There is also a decrease in emotional reactions and frequent withdrawal in difficult situations.
Considering the impact on daily activities, it would be wise to introduce home care (family caregiver or nursing assistant) at stage 4 of Alzheimer’s disease to help the person with Alzheimer’s perform daily activities, prepare meals, shop for groceries, pick up medications at the pharmacy, etc.
It would also be beneficial to introduce stimulating activities into their daily routine, such as engaging them in 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 is clear that the patient can no longer live alone; in this regard, family caregivers and healthcare staff must be able to recognize this condition.
Thus, during a clinical assessment interview, the patient may not remember important aspects of their current life, such as their address and phone number from several years ago, the names of their grandchildren, etc.
We also often see disorientation in relation to time (date, day of the week, season, etc.) and place.
Even an 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 important facts about themselves and their loved ones.
They know their own names and usually those of their spouses and children. They do not need help with personal hygiene or eating, but they may have difficulty choosing appropriate clothing for the occasion.
In stage 5 of Alzheimer’s disease, permanent resources and care must be provided, which would be difficult to arrange in the home of the affected loved one. Serious consideration should therefore be given to moving to a residence with the services of an assigned caregiver or to the home of a family member with home care.
Stage 6 – Severe cognitive decline (moderately severe dementia)
We are now at an advanced stage of the disease, and the impact on cognitive abilities is significant enough to make relationships, even with loved ones, difficult. As a result, we are seeing the following behavioral changes:
● People with dementia may sometimes forget the name of their spouse, on whom they are entirely dependent for their survival.
● they are largely unaware of recent events and experiences in their lives
● They retain some knowledge of their past life, but it is very limited.
● They are generally no longer aware of their surroundings, the year, the season, etc.
● They may have difficulty counting down from 20, for example, and sometimes even counting up to 10.
● They will need assistance with activities of daily living; for example, they may suffer from incontinence, need help getting around, but will occasionally be able to visit familiar places.
● the daily rhythm is often disrupted
● they almost always remember their own name
● They often continue to be able to distinguish familiar people from strangers in their environment.
Personality and emotional changes are highly variable and include:
● Delusional behavior; patients may accuse their spouse of being an impostor, talk to imaginary people, or talk to 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; that is, loss of willpower due to an inability to think through a course of action sufficiently to determine and execute a deliberate action
In stage 6 of Alzheimer’s disease, the person affected needs care 24 hours a day, 7 days a week.
Stage 7 – Very severe cognitive decline (severe dementia)
In stage 7 of 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 behaviors have also been observed:
● urinary incontinence and a need for assistance with toileting and feeding
● gradual loss of basic psychomotor skills such as the ability to walk
● inability of the brain to control the body
● generalized rigidity of neurological reflexes
We hope this post has shed some light on the seven stages of Alzheimer’s disease and will help you better monitor the progression of the disease in your loved one. This will enable you to more quickly determine the resources you will need to ensure the well-being of your loved one and your family.
The duration of each of the seven stages of Alzheimer’s disease can vary greatly from one person to another; however, early diagnosis of the disease will allow 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.