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Disease & Conditions >>> Alzheimer's Articles & News

What to Expect: The Stages of Alzheimer's Disease


It's helpful to know where your Alzheimer's patient falls in the stages of the disease in order have some sense of what to expect and how to plan. There are several different lists of stages of Alzheimer's that can be found all over the Internet, but the one I've chosen is the one posted in the Alzheimer's FAQ at the Washington University at St. Louis Alzheimer Page. (The list on that site was adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. "The global deterioration scale for the assessment of primary degenerative dementia." American Journal of Psychiatry, 1982.)

Stage 1 - "No cognitive decline." No memory deficit is evident any clinical interview used for testing the presence of Alzheimer's.

Stage 2 - "Very mild cognitive decline (Forgetfulness)." Some complaints of memory problems. Mostly the patient is forgetful in areas of where an item has been placed, such as car keys, and in forgetting people's names.

Stage 3 - "Mild cognitive decline (Early Confusional)." This is the stage at which there begins to be some memory loss evident in a clinical interview. The problem will affect the person in one or more of these areas: 1) getting lost while traveling, 2) lowered performance at work may be noticed, 3) increased difficulty in finding the needed words or remembering names, 4) reading retention lowered, 5) losing objects of value. The patient may experience both anxiety and denial along with these symptoms.

Stage 4 - "Moderate cognitive decline (Late Confusional)" At this stage there is clearly some memory loss evident in a clinical interview. The problem will be seen in one or more of the following areas: 1) Decreased knowledge of current events, 2) may begin to lose some personal history, 3) inability to concentrate, and 4) inability to travel, handle finances, etc. The person may also begin to be unable to recognize familiar people and may lose orientation to time or place as well as being unable to perform complex tasks. Denial is evidental, and withdrawal from challenging tasks becomes a defense mechanism.

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Stage 5 - "Moderately severe cognitive decline (Early Dementia)" The patient needs assistance in daily living in order to survive. Though the person may require no assistance with toileting and eating, they may need help choosing clothes. They may not be able to recall in a clinical interview important information relavant to their lives as address or telephone number they've had for years, the names of family members, or the high school they attended.

Stage 6 - "Severe cognitive decline (Middle Dementia)." The patient may occasionally forget their spouse's name, and they may be largely unaware of much of their own history as well as of recent events. They may retain some knowledge of their past lives, but this is sketchy. During this stage personality changes may occur, and the person may become obscessive or delusional and may begin having hallucinations. They may begin to have some incontinence as well.

Stage 7 - "Very severe cognitive decline (Late Dementia)" All verbal ability is lost, the person is incontinent, and needs assistance with eating. The person may also lose the ability to walk, and eventually to sit and head control as well.

Looking at the early stages, it is easy to see how a person with Alzheimer's can function for years without others being aware that there is a problem. Some of us might even wonder if we're not in stage one or two ourselves.

Looking back, I think I can safely say that my mother was in stage four before her diagnosis (1993), and in stage five when my sister was her caregiver (1993-1994), stage six when I became her caregiver (1994-1995), and stage seven soon after she entered the nursing home (Jan.-Apr. 1996). Although she was unable to walk or to eat without assistance near the end, and she did pretty much lose her ability to talk, she didn't become unable to sit or to control her head.

I hope this list of stages will be helpful to you who have loved ones with Alzheimer's. The diagnosis isn't the end of the world. If it is caught early, as it often is these days, there can be years of functionality, especially with the aid of new medications that may delay the more advanced symptoms for a long time. There is so much research going on, and perhaps there might even be a cure found before your loved one reaches those advanced stages. There is always that hope!

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