What Are The Stages Of Alzheimer’s And How Is Each Managed
By Julia Thomas
Updated December 18, 2018
Reviewer Erika Schad, LCP, CWLC
Coping with the stages of Alzheimer's can be very difficult for those going through this progressively degenerative disease, as well as for the loved ones who act as their caregivers. According to the Centers for Disease Control and Prevention (CDC), there are over 5 million persons in the United States currently living with Alzheimer's disease. That number is projected to rise to approximately 14 million by 2050 due, in part, to the country's aging population. Furthermore, over 16 million caregivers, many of whom are family members, offer their time and support to people living with Alzheimer's free of charge. It is fair to assume that number will also increase dramatically.
With such a large portion of the population directly affected by Alzheimer's disease, understanding its different phases and how best to care for a loved one who is affected by it has become a priority. In this article, we will look at the various stages of Alzheimer's disease, the signs, and symptoms associated with each stage, how the individual changes in each stage, and the levels of management and care which are required.
How Many Stages Of Alzheimer's Disease Are There?
As a chronic neurodegenerative disease, Alzheimer's results in the deterioration and loss of neurons in the brain. This is manifested in the Alzheimer's patient in several ways including dementia (the progressive decline of memory and cognitive ability). In fact, the most distinguishing characteristic of Alzheimer's is dementia that it causes, with about 50-70% of all dementia cases being Alzheimer's related. This influences how experts identify the stages of Alzheimer's disease.
Furthermore, the stages will show some degree of overlap and can be thought of as a continuum of symptoms rather than distinct stages. So, while you will find that the ever-increasing severity of dementia in Alzheimer's is a common thread among sources, they tend to differ in the number of stages identified. For instance, while some sources break down Alzheimer's progression into as many as seven stages, there are those who choose to only three. We will look at a five:
1. Preclinical Alzheimer's Disease
2. Alzheimer's disease with Mild Cognitive Impairment
3. Alzheimer's disease with Mild Dementia
4. Alzheimer's disease with Moderate Dementia
5. Alzheimer's disease with Severe Dementia
Progression Through The Stages Of Alzheimer's Disease
The general progression of Alzheimer's is the same for each person who goes through the disease, but individual experiences can differ greatly regarding time spent in each stage and the array of symptoms experienced along the way. On average, there is a life expectancy of 8-10 years, with some persons surviving for just three years while others live up to 20 years with the disease.
Some studies have shown that genetics plays a role in the age of onset of Alzheimer's disease as well as the rate of progression. The health of the individual and environment conditions are also cited as contributing factors. In particular, there is believed to be a connection between Alzheimer's and lifestyle choices. Specifically, there appears to be a lower risk of the disease and slower progression through it for individuals who:
- Maintain a nutritious diet
- Engage in regular physical activity
- Are socially active, regularly connecting with family and friends
- Participate in mentally stimulating activities
Treatment for certain conditions the individual may be experiencing, such as diabetes and high blood pressure, is also shown to slow or delay symptoms related to the early stages of Alzheimer's. Reducing risk factors associated with heart disease, diabetes, high blood pressure, obesity, and stroke are also thought to reduce both the risk of developing Alzheimer's, as well as the speed at which the stages progress.
- Preclinical Alzheimer's Disease
The earliest signs of Alzheimer's are usually connected to difficulty with short-term memory, and they tend to go unnoticed by those affected as well as those close to them. Quite often, when the signs are observed, they are mistaken for being a natural part of aging.
Some of the minor cognitive changes which mark the transition from normal aging to Alzheimer's can be detected by certain neuropsychological tests years (sometimes decades) before an individual is diagnosed with the disease. At this stage, the individual is still able to function at a very high level and will most likely still score highly on memory tests.
Symptoms Of The Preclinical Stage
- Increasing apathy (lack of motivation, interest in or concern for what is happening in the surroundings)
- Shortened attention span
- Impaired ability for abstract thinking
- Mild depression
- Subtle changes in mood and personality
- Occasional forgetfulness, for example: misplacing common items, inability to recall names
- Trouble learning new things
- Slight difficulty with complex daily living activities such as grooming and work
Management Of The Preclinical Stage
At this stage, individuals are still very capable of looking after themselves. To cope with short-term memory loss, they may begin to make lists of things to be done and posting reminders that can easily be seen to remember important appointments, etc. Some lifestyle changes such as switching to a more balanced diet, being more physically active and more socially engaged can help.
Since it is generally impossible at this early to tell stage whether the symptoms experienced are Alzheimer's or normal aging, the best approach family and friends can take is to keep seniors engaged by spending more time with them and involving them in regular family activities.
It is prudent for family and friends to keep the risk factors discussed earlier in mind and try to address them where possible. Family members who, for whatever reason, feel the senior is at a heightened risk of developing Alzheimer's should begin learning more about the disease. In fact, it is advisable to keep abreast of any illnesses or significant health issues which seniors are generally affected by.
- Alzheimer's Disease With Mild Cognitive Impairment
In the second stage of Alzheimer's, the changes it causes become more noticeable to the individual and those around them. There is now evidence of the disease affecting functioning both at home and at work. Although still mild, the impairment is sufficient for a diagnosis of Alzheimer's. Someone in this stage may need help with planning activities or handling their finances.
Symptoms Of The Mild Cognitive Impairment Stage
- Further increase in apathy (lack of motivation, interest in or concern for what is happening in the surroundings)
- Difficulty remembering details of some major events from their past
- Trouble recalling recent events and conversations
- Tendency to forget appointments
- Difficulty concentrating
- Slight reduction in some fine motor skills
- Trouble traveling to or finding their way around new places
- Exhibit increasingly poor judgment
- challenging situations
- Struggles to find the right words in a conversation
- Unaware of the extent to which they are affected
- Experiences bouts of depression, aggression, and anxiety
Management Of The Mild Cognitive Impairment Stage
Persons in the second stage are still able to care for themselves, but the above symptoms are now more noticeable to those very close to them. They may still be able to drive but should begin considering not to or be encouraged by family members to consider other forms of transportation.
Family members should have the senior assessed by their primary healthcare provider. The medical professional may be able to say whether this is early-stage Alzheimer's or something else - possibly something reversible. For example, an untrained person might mistake the symptoms of a urinary tract infection as a sign of the onset of dementia. Any treatment administered to the Alzheimer's patient at this stage may be for accompanying conditions such as diabetes or high blood pressure.
Continued physical, mental and social activity should be encouraged. Some individuals at this stage enjoy and benefit greatly from sharing their life story whether by talking with others or by writing it down. Music (or any other activity the senior normally enjoys) may also prove helpful to soothe episodes of anxiety and to keep spirits up. Seniors at this stage may also need to be regularly reminded about taking any medication prescribed to them.
Family and friends should routinely check that seniors are still able to cope with their daily living activities, such as remembering to eat regular meals or cleaning themselves after toileting. At all times, the dignity of the individual should remain a top priority and respect should be shown for their sense of independence. It is a good idea to begin discussions of advance financial planning (e.g., ensuring a will is in place) and the type of long-term care the person would prefer if the need arises.
- Alzheimer's Disease With Mild Dementia
Memory and cognitive ability now show marked signs of decline, and it becomes more apparent that something is amiss with the affected person. All the symptoms highlighted so far continue to get progressively worse. A doctor would be able to make a diagnosis of Alzheimer's at this point.
Symptoms Of The Mild Dementia Stage
- Further increased in apathy (lessened motivation, interest in or concern for what is happening in the surroundings)
- Often confused or forgetful
- Struggles with meal preparation
- Decreasing ability to manage finances and medication
- Unable to recall the sequence of major world events
- Increased anxiety, depression, and delusional behavior
- Repeatedly asks the same questions
- Increased difficulty finding words
- Tends to get lost in unfamiliar settings
Management Of The Mild Dementia Stage
Discuss possible medications with the senior's primary healthcare provider. At this stage, they may recommend FDA-approved drugs which can help with memory loss, reasoning ability, and other cognitive functions. Medication management should not be left to the senior, even if reminders had worked up to this point.
Special care must be taken with the finances of the senior suffering from Alzheimer's, as they are at increased risk of becoming victims of fraud. Losing their life savings at this point can significantly lower the standard of care they can receive as the stages of Alzheimer's progress. The resulting financial burden may be too much for family and loved ones to bear.
For safety, appliances such as the stove may have to be taken out or disabled as a precautionary measure. Sharp kitchen implements may also need to be secured out of sight and out of reach. Another safety issue arises if the senior with Alzheimer's is still driving. If possible, try to explain to them the danger they pose, not just to themselves, but to others on the road.
- Alzheimer's Disease With Moderate Dementia
All symptoms continue to worsen, and daily living activities now pose a challenge with health and hygiene negatively affected. Safety of the senior becomes a major cause for concern in this stage as coordination continues to fade. There is an increased risked for the individual with Alzheimer's to become delusional and to wander off.
Symptoms Of The Moderate Dementia Stage
- Increased signs of apathy (lessened motivation, interest in or concern for what is happening in the surroundings)
- Difficulty selecting clothes appropriate to the occasion or weather
- Confuses the sequence of getting dressed
- Needs help with daily living activities, such as bathing and grooming
- Urinary and fecal incontinence occur occasionally
- Difficulty remembering family members and friends
- Mistakes strangers for family
- Displays unjustified distrust of family and friends
- Prone to becoming restless, agitated and aggressive with physical outbursts
- Suffers from disturbed sleep irregular sleep patterns
- May engage in repetitive behavior, such as hand-wringing
- Trouble recalling important personal information, such as address and telephone number
- The tendency to repeat fond memories
- Substitutes made up stories for facts they cannot remember
- Prone to getting lost even in familiar surroundings
- Tendency to wander
- Disoriented with time, such as which day it is
- Bouts of delusion become more frequent
Management Of The Moderate Dementia Stage
Independent living at this stage, is no longer advisable or possible, in most cases. Wandering off now becomes a greater issue, so apart from increased attentiveness on the part of caregivers, consideration should be given to better-securing locks on outer doors. Behavioral problems might be eased by ensuring the senior is comfortable, their basic needs are met and that they get sufficient rest. An environment which feels safe and secure can also lower the frequency of outburst. Some seniors respond well to having some kind of security object, perhaps something familiar from before the onset of the disease.
It is important to keep appointments with the senior's primary healthcare provider so that they can monitor the effectiveness of prescribed drugs and determine when it is time for a change. Ensure the doctor is aware of all medication the senior is already on and find out about the possible side effects of any newly prescribed medication.
The medications recommended to help improve memory, and a slow cognitive decline in the early-to-moderate stages of Alzheimer's are different from those used in the moderate-to-severe stages. Additionally, there are no FDA-approved drugs for behavior management in Alzheimer's. If the senior is having severe behavioral issues, however, the doctor may draw on medical knowledge and prescribe an appropriate drug to help ease the condition.
Family members who have acted as caregivers up to now may begin to feel overwhelmed and that they are no longer able to offer the level of care required. In these instances, thought should be given to hiring a professional to care for the senior at home or moving them to a senior care facility which specializes in taking care of someone in the latter stages of Alzheimer's disease.
- Alzheimer's Disease With Severe Dementia
The general decline seems more rapid in this stage. The senior may be bedridden in need of round-the-clock care. Keeping the person living with Alzheimer's comfortable is now the main concern, along with ensuring they are cared for in a dignified manner.
Symptoms Of The Severe Dementia Stage
- Extreme apathy without much awareness of what is happening in the surroundings
- Stiff muscles and atypical reflexes often accompanied by significant pain
- Unable to walk or sit down without assistance
- Displays extreme exhaustion
- Vocabulary is decreased to just one or a few words
- Increasing inability to form words and to communicate
- Needs assistance with all daily living activities
- No longer able to smile or hold head up
- Displays infantile reflexes, such as sucking
- Has grim facial movements
- Experiences incontinence frequently
- Suffers muscle mass deterioration and weight loss
- Forgets how to swallow
Management Of The Severe Dementia Stage
During the final stage of Alzheimer's, your loved one will be physically and mentally wasting away. They, however, can still respond to emotions Care given with affection can have positive effects on them. Soothing physical contact, such as a gentle hand massage, can help to keep the senior connected with the world around them. The movement may also be helpful, so try to reduce their immobility by helping them to walk around, providing walk aids where possible.
Gently stimulate their other senses, as well. Consider a daily (short) walk outside, sitting in a quiet garden, or even sitting at a window to the outside. Play relaxing music or let them hear the sound of your voice as you read out loud to them. For instance, you can even try to introduce smells which were once familiar to them - a favorite perfume or flower.
End Of Life Care
Pneumonia is identified as the leading cause of death in seniors with Alzheimer's. It is generally linked to the inability to swallow which creates an increased danger of aspiration - food entering the windpipe and getting into the lungs. This can cause the lungs to become infected and pneumonia to develop.
The inability to swallow can also lead to malnutrition which is one of the common causes of death for those who have Alzheimer's. Make swallowing easier by offering soft foods and be prepared to feed the senior each spoonful as they will eventually lose the ability to feed themselves. Dehydration is another common cause of death in Alzheimer's because the senior is no longer able to detect or indicate thirst. This means caregivers must remember to offer them sips of water routinely.
This stage of Alzheimer's is very demanding on caregivers - mentally, emotionally and physically. It is, therefore, vital for family and friends who act as caregivers to allow themselves time off to recharge and to focus on their wellbeing. If another relative or friend cannot take over, then consider hiring a professional caregiver for a few hours each week.
The final months of your loved one's life will be the most difficult. Some families choose this time to opt for institutionalized care. Hospice care, which also considers the caregiver, is also a good choice. Regardless of where the care is given, the most important thing is that it should be given with the utmost of good intentions for the senior, taking their physical, emotional and spiritual needs into consideration.
There is no known cure for Alzheimer's disease, but understanding it stages, their symptoms and how these are best managed can go a long way in helping you provide your loved one with the very best care. Information and advice on Alzheimer's disease and its effects on the patient, caregiver and family members in general, is widely available. Reach out today so you can get the help you and your loved one need.