What Are The Stages Of Alzheimer’s And How Is Each Managed?
Coping with the stages of Alzheimer's can be difficult for those going through this progressively degenerative disease and for the loved ones who act as their caregivers. The condition impacts millions of people worldwide.
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 affected by it is often a priority. It can be helpful to 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 that may be 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, which influences how experts identify the stages of Alzheimer's disease. According to the Centers for Disease Control and Prevention (CDC), over five million people in the United States currently live with Alzheimer's disease.
The stages of this condition overlap somewhat and can be considered a continuum of symptoms rather than distinct stages. While you may find that the ever-increasing severity of dementia in Alzheimer's is a common thread, some sources break down Alzheimer's progression into as many as seven stages, while some choose only three. Below are five proposed stages:
- Preclinical Alzheimer's disease
- Alzheimer's disease with mild cognitive impairment
- Alzheimer's disease with mild dementia
- Alzheimer's disease with moderate dementia
- Alzheimer's disease with severe dementia
Preclinical Alzheimer's disease
Some minor cognitive changes that mark the transition from normal aging to Alzheimer's can be detected by specific neuropsychological tests years before an individual is diagnosed with the disease. At this stage, the individual can still function at a high level and score highly on memory tests.
Symptoms of the preclinical stage
Below are a few common symptoms of the preclinical stage of Alzheimer's:
- Increased apathy (lack of motivation, interest in, or concern for what is happening in the surroundings)
- Shortened attention span
- The impaired ability for abstract thinking
- Mild depression
- Subtle changes in mood and personality
- Occasional forgetfulness
- Difficulty learning new skills
- Slight difficulty with complex daily living activities such as grooming and work
Management of the preclinical stage
At this stage, individuals are often capable of looking after themselves. To cope with short-term memory loss, they may make lists of tasks to be done and post reminders that can be seen daily to remember necessary appointments. Some lifestyle changes, such as switching to a more balanced diet and being physically active and socially engaged, can help.
Since it may be impossible at this early stage to tell whether the symptoms experienced are Alzheimer's or normal aging, the best approach family and friends can take to keep these individuals engaged by spending more time with them and involving them in regular family activities.
Alzheimer's disease with mild cognitive impairment
In the second stage of Alzheimer's, the changes it causes can become more noticeable to the individual and those around them. There may be little evidence of the disease affecting functioning at home and work. Although still mild, the impairment is sufficient for diagnosing Alzheimer's. Someone in this stage may need help planning activities or handling their finances.
Symptoms of the mild cognitive impairment stage
Below are some of the most common symptoms of this stage:
- A heightened increase in apathy (lack of motivation, interest in, or concern for what is happening in the surroundings)
- Difficulty remembering details of some significant events from their past
- Trouble recalling recent events and conversations
- A tendency to forget appointments
- Difficulty concentrating
- A slight reduction in some fine motor skills
- Difficulty traveling to or finding their way around new places
- Increasingly poor judgment
- Difficulty finding the right words in a conversation
- A lack of awareness of the extent to which they are affected
- Bouts of depression, aggression, and anxiety
Management of the mild cognitive impairment stage
Persons in the second stage may still care for themselves, but the above symptoms are now more noticeable to those close to them. They may still be able to drive but may be encouraged by their family to consider other forms of transportation.
Medical professionals may be able to say whether one is experiencing early-stage Alzheimer's or another condition. For example, a urinary tract infection can cause confusion, which may be confused with dementia. Treatment 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 may enjoy and benefit from telling their life stories, whether by talking with others or by writing them down. People at this stage may also require frequent reminders about taking any medication prescribed to them.
Family and friends may help by routinely checking that seniors can cope with their daily living activities, such as eating regular meals or cleaning themselves after toileting. For caregivers, it is often a priority to ensure the individual's dignity and independence remain respected. Individuals may also start discussions of advanced financial planning and long-term care.
Alzheimer's disease with mild dementia
Memory and cognitive ability show marked signs of decline in the mild dementia stage, and it may become more apparent that the individual is experiencing dementia. All the symptoms highlighted above may get progressively worse. A doctor can often make a confident diagnosis of Alzheimer's at this point.
Symptoms of the mild dementia stage
Below are a few common symptoms noted during the mild dementia stage:
- Further increased apathy
- Confusion or forgetfulness
- Difficulty with meal preparation
- A decreasing ability to manage finances and medication
- Difficulty recalling the sequence of significant world events
- Increased anxiety, depression, and delusions
- Repetitive questions
- Increased difficulty finding words
- Getting lost in unfamiliar settings
Management of the mild dementia stage
At this stage, an individual's doctor may recommend FDA-approved medications to treat memory loss, reasoning ability, and other cognitive functions. A caregiver may best handle medication management, as the individual may not be able to manage their medication, including with reminders.
Take special care with the finances of seniors with Alzheimer's, as they are at increased risk of becoming survivors 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 removed or disabled. Pointed kitchen implements may also need to be stored out of sight and out of reach. Another safety issue arises if the senior with Alzheimer's is still driving. 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
In the moderate dementia stage, symptoms continue to worsen, and daily living activities pose a challenge, with health and hygiene negatively affected. The senior's safety becomes a major cause for concern in this stage as coordination continues to fade. There may be an increased risk for the individual with Alzheimer's to become delusional and wander off.
Symptoms of the moderate dementia stage
Below are the most common signs of moderate dementia:
- Increased signs of apathy
- Difficulty selecting clothes appropriate to the occasion or weather
- Confusing the sequence of getting dressed
- Requiring support with daily living activities, such as bathing and grooming
- Urinary and fecal incontinence
- Difficulty remembering family and friends
- Mistaking strangers for family and friends
- Displaying unjustified distrust of family and friends
- Restlessness, agitation, and aggression
- Disturbed sleep and irregular sleep patterns
- Repetitive behavior, such as handwringing
- Difficulty recalling important information, such as one's address and telephone number
- The tendency to repeat fond memories
- Substituting made-up stories for facts they cannot remember
- Getting lost in familiar and unfamiliar locations
- Wandering
- Disorientation
- Bouts of delusion
Management of the moderate dementia stage
Independent living may not be advisable or possible at this stage. Wandering off becomes a more significant issue, so apart from increased attentiveness on the part of caregivers, consideration is often given to safety. Behavioral problems might be eased by ensuring the individual is comfortable, their basic needs are met, and they get sufficient rest. An environment perceived as safe may also lower the frequency of outbursts. Some seniors respond well to having a safety object, perhaps something familiar from before the onset of the disease.
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 on and find out about the possible side effects of any newly prescribed medication.
The family members who have acted as caregivers may begin to experience being overwhelmed and struggle to offer the level of care required. In these instances, you might consider hiring a professional to care for the individual at home or moving them to a care facility specializing in caring for someone in the latter stages of Alzheimer's disease.
Alzheimer's disease with severe dementia
In the severe and final stage of Alzheimer's, the decline may be more rapid. The adult with this condition may be bedridden and need round-the-clock care. Keeping the person with Alzheimer's comfortable is often the primary concern, along with ensuring they are cared for in a dignified manner.
Symptoms of the severe dementia stage
Below are some of the symptoms of the final dementia stage:
- Extreme apathy without much awareness
- Stiff muscles and atypical reflexes, often accompanied by significant pain
- An inability to walk or sit down without assistance
- Extreme exhaustion
- Decreased vocabulary to one or a few words
- Increased inability to form words and communicate
- Assistance with all daily living activities
- Difficulty smiling or holding up the head
- Infantile reflexes, such as sucking
- Grim facial movements
- Frequent incontinence
- Muscle mass deterioration and weight loss
- Difficulty swallowing
Management of the severe dementia stage
During the final stage of Alzheimer's, your loved one may change physically and mentally, but they 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 keep seniors connected with the world around them. Movement may also be helpful, so try to reduce their immobility by assisting them in walking around and providing walk aids where possible.
Gently stimulate their other senses, as well. Consider a short daily walk outside, sitting in a quiet garden, or sitting at a window to the outside. Play relaxing music or let them hear your voice as you read out loud to them. For instance, you can try to introduce smells that were once familiar to them, such as 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 often linked to the inability to swallow, creating an increased danger of aspiration, which is food entering the windpipe and entering the lungs. Aspiration can cause the lungs to become infected and pneumonia to develop.
The inability to swallow can also lead to malnutrition, another common cause of death for those with Alzheimer's. You may make swallowing easier by offering soft foods and feeding the individual each spoonful. Dehydration can also occur because the individual may no longer detect or indicate thirst. For this reason, caregivers often offer sips of water throughout the day.
The end-of-life stage of Alzheimer's can be demanding on caregivers mentally, emotionally, and physically. It can be vital for family and friends who act as caregivers to allow themselves time off to recharge and focus on their well-being. If another relative or friend cannot take over, consider hiring a professional caregiver for a few hours each week.
The final months of your loved one's life may be challenging. Some families choose this time to opt for institutionalized care. Hospice care, which also considers the caregiver, is also a choice. Regardless of where the care is given, provide care with the utmost positive intentions for the senior, considering their physical, emotional, and spiritual needs.
Navigating Alzheimer’s can be challenging
Therapy for caregivers
Caring for someone with Alzheimer's can be challenging. Providing daily care can be part of one's schedule, but watching a loved one decline can be particularly difficult. Caregivers are often required to care for themselves to continue providing the best care to their loved ones. In these cases, therapy may be beneficial.
If you are busy and struggle to find time for in-person therapy, you might benefit from online therapy through a platform like BetterHelp. With an online platform, you can attend treatment from the comfort of your home, or anywhere you have an internet connection. Because you can message your therapist throughout the week, you can reach out when you experience a challenge, even in the middle of the night, and they will get back to you as soon as they can.
Research shows that online therapy is effective. One review found that online treatment resulted in a 50% improvement in symptoms of anxiety and depression and significantly decreased the impact of chronic fatigue and stress.
Takeaway
How long do the 7 stages of Alzheimer's last?
How long each stage of Alzheimer’s lasts can vary significantly from one person to the next. The second stage, subjective memory loss, can last as long as 15 years. Stage four, moderate cognitive decline, can last about two years, and stage five, moderately severe cognitive decline, can last about 1.5 years. Very severe cognitive decline can last about 6.5 years.
What is the typical progression of Alzheimer's disease?
Alzheimer’s progresses through multiple stages, but everyone moves through them in their own way. During the preclinical stage, changes are happening in the brain cells and nerve cells, but the person may not show any signs of the disease. The first signs that may appear are mild forgetfulness and trouble concentrating. People may have problems remembering the names of people from their personal history and recalling recent events, and they may misplace things or have memory lapses.
The next stage, middle stage Alzheimer's or moderate Alzheimer's disease, can be the longest and last several years. People in this stage of Alzheimer’s may have problems learning new things, trouble remembering events, difficulty planning events, trouble remembering their own names, and issues with writing, reading, and working with numbers. As things progress, they may know the people who are familiar to them but not remember their names. They may need help choosing clothing, getting dressed, and doing things like brushing their teeth. Mood and significant personality changes may occur in this phase, too, including restlessness, agitation, and being tearful. People may become moody or withdrawn or experience paranoia, hallucinations, or delusions.
In late stage Alzheimer's, people may have trouble sitting, walking, and eating and lose control of their bladder and bowel. They may not be able to have a conversation, and they may be unaware of their surroundings.
What are the 4 stages of Alzheimer's?
Alzheimer’s is usually divided into three, five, or seven stages.
When it’s divided into three stages, they are referred to as early, middle, and late or mild Alzheimer's disease, moderate, and severe Alzheimer's disease.
When it’s divided into four stages, they are referred to as preclinical, mild, moderate, and severe.
When it’s divided into seven stages, they may be referred to as before dementia symptoms appear, basic forgetfulness, noticeable memory difficulties, more than memory loss, decreased independence, severe symptoms, and lack of physical control.
How long can a person live with Stage 6 Alzheimer's?
Everyone progresses through Alzheimer's stages differently, so it can be challenging to say how long a person can live in the various stages. A recent review in the Lancet found that the average life expectancy for someone with Alzheimer’s is 5.8 years after diagnosis.
How quickly does Alzheimer's deteriorate?
Everyone is different, and the disease can advance at a different pace for everyone. For some, it can be fast; for others, it can be slow.
How long before Alzheimer's is fatal?
It varies. A recent review found that the average life expectancy after diagnosis is 5.8 years, but everyone progresses differently. Some people may live longer, while others may decline faster.
What makes Alzheimer's progress quickly?
Although Alzheimer’s progresses differently for everyone, researchers have determined that drinking too much might make it progress quickly. Recent research in rats has found that excess alcohol consumption can speed up the progression.
Is Alzheimer's inherited from the mother or father?
Less than 5% of Alzheimer’s cases are considered familial, meaning the disease is caused by a single genetic mutation passed down in families. In this type of Alzheimer’s, the inheritance pattern is autosomal dominant, which means that if one parent has the gene, each child has a 50% chance of inheriting it. If you are at risk of developing this form of Alzheimer’s, talking to a therapist or joining support groups can help.
What is the 5-word memory test?
The five-word memory test is a verbal test meant to evaluate short-term memory. The person giving the test asks the person taking the test to memorize five common works. If the person has difficulty remembering the words, it doesn’t necessarily mean they have Alzheimer’s, but it can indicate cognitive decline. This test evaluates whether someone has delayed recall or short-term memory loss and gives a general state of someone’s cognitive abilities, but it is not a diagnostic tool. If the five-word memory test indicates any mental decline, the doctor may recommend a more comprehensive evaluation.
What is the most common cause of death in Alzheimer's patients?
The most common cause of death in people with Alzheimer’s is aspiration pneumonia. This can happen because, as the disease progresses, people with Alzheimer’s may lose their physical abilities and develop difficulties eating and swallowing, leading to inhaling food particles or liquids. These things are then carried into the lungs, which can lead to a pneumonia infection.
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