Alzheimer’s is a progressive disease and there are definite stages that have been identified by the Alzheimer’s Association. Knowing what to expect during each of these stages can help you plan the appropriate response as a caregiver.
Keep in mind, however, that the duration of each stage is unknown and unpredictable. Much depends on the overall physical condition and age of the affected individual. Also, some symptoms might not always fit neatly into the “expected” stage. Remember, these are merely guidelines. The journey of the caregiver is one of starts, stops and detours. Still, the description of these stages may provide some structure to determining how your loved one’s care unfolds.
Stage 1: Normal Function
This can be called the invisible stage of Alzheimer’s. At this point, the disease is present in the individual, but there is no evidence of its effects and no way to diagnose it short of sophisticated brain imaging tests. In fact, Alzheimer’s may start years before there are any outward symptoms.
Stage 2: Very Mild Changes
We’ve all experienced some forgetfulness and irritability. These symptoms are also a natural part of aging. When Alzheimer’s is to blame, this stage makes it difficult to separate very mild cognitive deficits from the normal effects of getting older. At this stage, symptoms don’t interfere with the ability to live and work independently and they may be so subtle that even the person’s doctor doesn’t notice anything amiss.
Stage 3: Mild Cognitive Decline
During this stage, the memory lapses become more common, but they still may be undetectable except to those closest to the person. Are questions being asked repeatedly? Are there problems remembering recent events, finding the right word or locating misplaced objects? Is absentmindedness starting to become the rule rather than the exception?
Seeking a diagnosis at this stage is a personal decision and is often avoided in the hope that the problem is something else or will improve on its own. That may not be wise, since early diagnosis could be an opportunity to seek medication or therapies that can help maintain cognitive abilities for longer than would otherwise be possible.
If your loved one exhibits the symptoms common to this stage, it might be a good time to schedule a general physical exam for the person, and possibly a follow-up with a specialist who has experience with diagnosing dementia.
Stage 4: Moderate Decline (Early-Stage Alzheimer’s)
At this stage, there is no longer any doubt that something is wrong. The person might forget things like the month or the season, be unaware of recent events (whether personal or in the world at large), and they could have difficulty with personal tasks such as cooking meals or paying bills. There are now definite cognitive tests that the person’s doctor can use to make an accurate diagnosis.
This is also the stage where reality sets in for the caregiver that they will soon be playing a larger and more active role in the day-to-day life of the person with Alzheimer’s.
Stage 5: Moderately Severe Decline (Mid-Stage Alzheimer’s)
“Moderately severe” may sound like a contradiction, but it’s an accurate description of a stage were symptoms can vary widely. Memory lapses are now more common and more pronounced. A person may lose track of the time of day or the time of year, they may forget their phone number or address, and they may not be able to pick out the right clothes.
The worst part is the realization of the person that their abilities are slipping away, which can cause frustration and anger. Outwardly the person may appear to be still the same —able to feed themselves, use the bathroom, carry on a simple conversation, and so on — but inside they’re becoming increasingly frightened and isolated as the mind they have always relied on seems to be melting away. This is a time when reassurance from caregivers is very important. The person with Alzheimer’s should know that there are still aspects of life that will not leave them feeling abandoned.
Stage 6: Severe Cognitive Decline
This stage is marked by significant personality changes in the person with Alzheimer’s, a Jekyll and Hyde period when a formerly pleasant individual can suddenly become aggressive, abusive and even violent. Among other symptoms:
- Memory deficits become more pronounced and even family members and close friends may not be recognized by the person.
- Help with dressing, hygiene and toileting is usually necessary.
- Wandering can become a problem, as well as delusions, paranoia, hallucinations, sleep disorders and a host of other stressful issues that can make the caregiver’s job extremely difficult.
This stage can seem like a hopeless picture and can cause frustration and anger for even the most dedicated caregiver. At these times, it helps to remember that it is the disease rather than the person that is ultimately to blame for these distressing behaviors. Also keep in mind that the person with Alzheimer’s can still be reached through empathy and kindness, through calming music, and through human contact. As difficult as it may be to understand, even at this stage there are moments left to savor and enjoy together.
Stage 7: Very Severe Decline (Late-Stage Alzheimer’s)
This is the final stage of Alzheimer’s disease, where the person you once knew is essentially gone. Physical abilities have faded along with mental cognition, meaning the person will need assistance with walking, sitting up, eating and toileting. Appetite will decline as the body shuts down. Keeping the person hydrated is important, since they can no longer communicate when they are thirsty. This is the time when many caregivers, if they haven’t already, will seek out a care facility to make the person as comfortable as possible for their remaining days.
Since Alzheimer’s is fatal, there is only one outcome to this stage: the end of the long journey and the celebration of life well lived.