Stages of Alzheimer's Related Changes

Alzheimer's is a form of dementia that causes a steady decline in cognitive, behavioral and emotional processes. A system of stages has been developed to define its progression, but since the length of each stage varies from one person to the next. The stages simply are guidelines to improve understanding and facilitate future planning.

Definition

• No matter how long each phase lasts, there is a common pattern of symptoms that correspond to the progression of nerve damage in the brain. The National Institute of Aging provides a general system broken into four stages: Early, mild, moderate and severe. A system based on research by Barry Reisberg, M.D., at New York University---the Functional Assessment Staging scale---breaks the symptoms into seven more detailed stages.

Stages 1 and 2

• Stage 1 is the time prior to identification of Alzheimer's disease (AD). There isn't enough cell damage to result in symptoms and the issues would not be identified during a physician's examination.

  Stage 2 is considered to be very mild decline. During this stage the signs are there, but they're not noticeable to a medical professional and probably not evident to family. The most common sign is basic forgetfulness---the patient can't remember where he put the keys or can't recall words and names that used to be familiar.

Stage 3

• In Stage 3, it is possible to diagnose early-stage AD. The signs are noticed by friends and family. They can also be discerned by medical professionals during testing. In this stage, the person with AD struggles with some normal daily tasks. This may be seen as disorganization that did not previously exist. Memory loss expands to include people and things that are loved and valued.

Stage 4

• This corresponds to mild or early-stage AD. At this point, the deficiencies are obvious to medical professionals and family. A classic test that the patient fails is counting backwards from 100 by sevens. There is noticeable loss of memory about recent events and an obvious inability to perform complex tasks that were second-nature, such as brewing coffee or doing laundry. To compensate, the patients withdraws from difficult circumstances.

Stage 5

• Corresponding to moderate or mid-stage AD, the disease now causes more deterioration of cells that are vital to controlling movement. Some assistance with activities is needed. Significant loss of memory and cognitive abilities is seen. Some signs include becoming confused about place and time, increasing inability to perform simple math, and forgetting basic information such as a home phone number.

Stage 6

• Stage 6 corresponds to the moderately severe or mid-stage AD. As memory continues to decline, personality changes begin, and help is needed with many daily activities. The patient needs help getting dressed and toileting. Confused about where she is, she may wander and get lost because she has forgotten names and addresses. A difficult new change emerges in personality and behavior. She may become highly suspicious of people (including family members) and delusional. She may have hallucinations---seeing or hearing things that aren't there, for example. She may become angry if told no one is there.

Stage 7

• Stage 7 is severe or late-stage AD. It is the final stage as nerve cell degeneration is so severe that the patient loses the ability to speak, move, or respond to the environment. He can't eat on his own, he's incontinent, and while a few words may be coherent, he can't talk. He loses the ability to sit up or walk without support and eventually can't swallow. Toward the end, he will become confined to bed.