The Seven Stages of Alzheimer's

This is the fifth in a series of articles written by Frank S. P. Yacino regarding Alzheimer’s disease. (The Safety for the Patient article printed September 12 was mislabeled as Number 5, it should have been number 6) Mr. Yacino is the husband and caregiver for his wife Barbara who has been struggling with this disease for over fifteen years. (This information was gathered from hand-outs at one of our Support Meetings.)

It is important to keep in mind that stages are general guides, and symptoms vary greatly. Not everyone will experience the same symptoms or progress at the same rate.

These seven-stages are based on a system developed by Barry Reisberg, M.D., the clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Stage 1----No impairment (normal function)

The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptom of dementia.

Stage 2----Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease)

The person may feel as if he/she is having memory lapses by forgetting familiar words or location of everyday objects. But no symptoms of dementia can be detected during medical examination or by family, friends, or co-workers.

Stage 3----Mild cognitive decline (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms.

Family, friends, or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration.

Common Stage 3 difficulties may include the following:

Noticeable problems coming up with the right word or name in a conversation

Trouble remembering names when introduced to new people

Having noticeably greater difficulty performing tasks in social or work settings or forgetting material that one has just read

Losing or misplacing a valuable object

Increased trouble with planning or organizing

Stage 4----Moderate cognitive decline (mild or early-stage Alzheimer’s disease)

At this point, a careful medical interview should be able to detect clear-cut problems in several areas as noted below:

Forgetfulness of recent events

Impaired ability to perform challenging mental arithmetic, i.e. counting backward from 100 by 5’s

Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills, or managing finances

Forgetfulness of ones own personal history

Becoming moody or withdrawn, especially in socially or mentally challenging situations

 

Stage 5----Moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease)

Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this point, those with Alzheimer’s may:

Be unable to recall their home address or telephone number, or the high school or college they graduated from

Become confused about where they are or what day it is

Need help choosing proper clothing for the season or occasion

The person may still remember significant details about themselves and their family

The person may still require no assistance with eating or using the toilet

 

Stage 6----Severe cognitive decline (moderately severe or mid-stage Alzheimer’s disease)

Memories continue to worsen, personality changes may take place and individuals need extensive help with daily activities. (We must remember that it is difficult to place a person with Alzheimer’s in a specific stage as stages may overlap.) At this stage, individuals may:

Lose awareness of recent experiences as well as of their surroundings

Remember their own name but have difficulty with their personal history

Distinguish familiar and unfamiliar faces but have trouble remembering the name of their spouse or caregiver

Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothing or shoes on the wrong feet

Experience major changes in sleep patterns, such as sleeping during the day and becoming restless at night

Need help handling details of toileting, flushing the toilet, wiping, or disposing of tissue properly

Have increasingly frequent trouble controlling their bladder or bowels

Experience major personality and behavioral changes, including suspiciousness and delusions (such as believing that their caregiver is an imposter or trying to steal things from them) or compulsive, repetitive behavior like wringing or shredding paper tissues

Tend to wander or become lost

 

Stage 7----Very severe cognitive decline (severe or late-stage Alzheimer’s disease

In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation, and eventually to control movement, but they may still say words or phrases

At this stage, individuals need help with much of their daily personal care, including eating or using the toilet

They may also lose the ability to smile or sit without support and pick their heads up

Reflexes become abnormal

Muscles grow rigid

Swallowing will become impaired