Understanding the Stages and Symptoms of Alzheimer's Disease

By Dennis Thompson Jr. | Medically reviewed by Pat F. Bass III, MD, MS, MPH
 

Learn about the symptoms of Alzheimer's, and how they change as the disease progresses through three distinctive stages.

 

 

No one experiences Alzheimer's disease in exactly the same way. As memory loss occurs, it affects cognition (the process of knowing and thinking), coordination, personality, and standard of living very differently from person to person. However, researchers have identified some patterns in the way the disease progresses, allowing doctors to group Alzheimer's symptoms into three specific stages. This classification can help people to better understand how symptoms might unfold after an Alzheimer's diagnosis and can assist families in making plans for the future.
It's important to keep in mind, though, that while Alzheimer's symptoms have been clustered into stages, there's no way to tell how long any one stage or symptom will last or how quickly others will progress. People with Alzheimer’s die on average about four to six years after their diagnosis, but the disease can also take its relentless toll for as long as 20 years before death occurs.
Alzheimer's Symptoms: Early Warning Signs
You've forgotten where you've placed your keys. Or you can't remember the name of an actress in a particular movie. Or maybe you are relying more and more on notes to remind yourself you need to do important tasks. Are you suffering from Alzheimer's?
In most cases, the answer is probably not. Most of us experience some “normal” loss of memory, those annoying “senior moments,” as we age. Experts say that misplacing your keys isn’t the issue; forgetting what the keys are used for, however, can be. With this in mind, if you or a loved one is having memory problems that seem to be getting worse more rapidly or happening much more frequently than before, it might be time to pay your doctor a visit.

The following are some early warning signs of Alzheimer's, along with caveats you should keep in mind:

• Forgetfulness. People with early Alzheimer's often find themselves regularly forgetting important information they've just recently learned. On the other hand, there’s probably no need to worry about occasional lapses, such as misplacing your wallet or forgetting names — these types of memory lapses are normal and happen to most people as they get older.

Difficulty completing tasks. People with early Alzheimer's might not be able to remember the steps needed to cook a meal, balance a checkbook, or use a computer program. However, forgetting what you were just going to say or why you went into a particular room isn't unusual when it happens every now and then.

Disorientation. If you've found yourself getting lost in your neighborhood, or ever feel as if you suddenly don't know how to get home because you've forgotten where you are and how you got there, these are signs that could indicate the presence of Alzheimer's. But remember, both of these issues are much different than simply forgetting where you were headed, which can happen to anyone from time to time.

Misplacing objects. Putting objects in strange places — like your car keys in the microwave, or your hair dryer in the washing machine — can be a sign of early Alzheimer's disease. Don't worry if you or your loved one temporarily misplaces keys or a purse, though.

Lapses in judgment. If you notice that you or your loved one has started exhibiting some strange behaviors — like putting on several heavy layers of clothing on a warm day, wearing the same clothes day after day, or giving lots of money away to telemarketers or scam artists, there's reason to suspect Alzheimer's might be present.

Stages of Alzheimer's Symptoms

Once you've been diagnosed with Alzheimer's, researchers say you can expect three phases of symptoms, generally classified as mild, moderate, and severe.

Stage I (Mild) can last two to four years. There will be minor memory loss, as well as mood swings and personality changes. However, relative independence can be maintained. Stage I symptoms can include:

• Getting lost easily
• Difficulty handling money and/or paying bills
• Repeating questions or bits of conversation out of context
• Taking longer to finish routine tasks
• Exercising poor judgment
• Losing or misplacing items

Stage II (Moderate) Alzheimer's causes the brain to begin experiencing significant neural damage. Simple tasks can still be accomplished, but people in stage II will struggle with language, reason, sensory perception, and cognition. Stage II Alzheimer's tends to be the longest, lasting anywhere from two to 10 years. Symptoms may include:

• Trouble completing tasks with multiple steps, such as getting dressed or cooking a meal.
• Increased memory loss, where both recent events as well as personal history are no longer remembered
• Confusion as past memories blend with the present
• Difficulty recognizing familiar people or family
• Loss of ability to read and write
• Impulsive behavior and tendencies to wander

Stage III (Severe) lasts one to three years. People with stage III Alzheimer's generally lose all independence and most of their mental ability. At this stage, you will require constant care. Many people remain homebound or in bed nearly all day. Symptoms can include:

• Inability to recognize anyone, including yourself
• Loss of communication, relying instead on grunts or moans
• Increased vulnerability to other diseases, such as skin or respiratory infections
• Loss of control over bodily functions, such as trouble swallowing or lack of bowel and bladder control
• Further decrease in memory, which becomes nearly nonexistent.

Alzheimer's Disease: Beyond Staging

Some researchers believe that the stages of Alzheimer's now recognized by medical professionals should be modified to reflect the complex nature of the disease, says Malaz Boustani, MD, assistant professor of medicine at the Indiana University School of Medicine and a center scientist with the Indiana University Center for Aging Research. "That kind of staging is decades-old," Dr. Boustani says. "These days, it should be clear that Alzheimer's is more complicated."

Along with ranking cognition as mild, moderate, or severe, Boustani and other doctors think the disease could also be staged by other factors, including:

• Ability to function, ranging from "high level," in which the person can still managing finances and driving, down to "low level," in which they need help with very simple tasks, such as eating and dressing.
• Behavioral and psychological symptoms, such as wandering and pacing, which are more prevalent in later stages of the disease.
• Caregiver burden, taking into account how much a caregiver needs to contribute to the person’s wellbeing and how much they are still able to manage on their own. Because caregivers play such an integral role in the lives of people with Alzheimer's, Boustani says some medical professionals have "started changing the definition of the patient and expanded it to include their caregiver."

If you suspect that you or your loved one might be exhibiting one or more of the symptoms mentioned in these stages, don't hesitate to contact your doctor. While there is no cure for Alzheimer's disease, getting an early diagnosis can help you plan for the future accordingly and a number of treatments are available to help ease problematic Alzheimer's symptoms.