It is well known that Alzheimer’s is a progressive disease, advancing through distinct stages of decline. Every individual will experience the disease differently, but the trajectory of the disease from the beginning to the end is often similar. On average, a person lives for four to eight years after diagnosis. However, changes in the brain related to the disease begin years before any symptoms emerge.
Some doctors use a simple three-phase model (early, moderate and end), while others have found the most recent system that breaks the disease down into seven distinct stages to be more helpful in understanding and treating the disease.
This new criteria, put out by the National Institute on Aging and the American Alzheimer’s Association and developed by Dr. Barry Reisberg of New York University, tracks the disease’s progression from stage 1 (no memory problems or other symptoms) to stage 7 (severe dementia). Following is a summary of the seven stages of Alzheimer’s based on Dr. Reisberg’s system:
PRIOR TO DIAGNOSIS: No Dementia
During the first three stages of the seven-stage model, the individual does not exhibit any symptoms and memory-related issues are associated with typical aging and are not noticeable by doctors or family members. This stage is also called Preclinical Alzheimer’s Disease.
STAGE 1: No Impairment
During this stage, Alzheimer’s is not detectable and no memory problems or other symptoms of dementia are evident. This stage is also called No Cognitive Decline.
STAGE 2: Very Mild Cognitive Decline
At this point, an individual with Alzheimer’s disease begins to experience the typical forgetfulness associated with aging. They may begin to note minor memory problems and / or lose things around the house. Still, these symptoms are usually not noticed by medical professionals or loved ones and the individual will still perform well on memory tests. As discussed previously on this blog, this is the stage where subjective cognitive decline is evident, when the individual is able to recognize a shift in cognitive ability.
STAGE 3: Mild Cognitive Decline
During this stage, the individual will experience increased forgetfulness and have difficulty with concentration. As a result, performance at work will be affected, as well as the ability to carry out basic household tasks like paying bills and cleaning. They will also struggle for the right words during conversations and remembering names of new acquaintances. Because of all of these issues, family will begin to recognize cognitive problems and doctors can identify impaired cognitive function through memory tests.
STAGE 4: Moderate Cognitive Decline
Beginning with stage four, a person is now considered to have Early-Stage Dementia. Discernible symptoms of Alzheimer’s are evident at this stage, such as:
- Difficulty with simple arithmetic
- Poor short-term memory (i.e, no recall for what they ate for breakfast)
- Inability to manage finances and pay bills
- Forget details about their life histories
People in this stage are often in denial about their forgetfulness and other symptoms. As social situations become more fraught, they may begin to withdraw from family and friends. At this point, a health care provider can make a clear cut diagnosis during an interview and examination of the patient. The average duration of Stage Four is approximately two years.
STAGE 5: Moderately Severe Cognitive Decline
Stage five marks the beginning of mid-stage dementia which continues through stage six. During this stage people being to to need help with their day-to-day activities and may experience:
- Difficulty dressing appropriately
- Inability to recall simple details about themselves, such as their phone number
- Significant confusion
- Confusion about place and time
However, people in Stage Five are still able to maintain functionality by being able to bathe and toilet independently. They usually still recognize their family members and some detail about their personal histories, especially their childhood and youth.
Typically, Stage Five lasts for one and half years.
STAGE 6: Severe Cognitive Decline
This stage is also known as Middle Dementia, and signifies a period in which a person requires substantial assistance to carry out day-to-day activities. Symptoms during this stage include:
- Confusion or unawareness of environment and surroundings
- Inability to recognize faces except for the closest friends and relatives
- Inability to remember most details of personal history
- Loss of bladder and bowel control
- Speech ability diminished
- Major personality changes and potential behavior problems, as individuals suffer from delusions, anxiety and agitation
- Need for assistance with activities of daily living such as toileting and bathing
- Wandering
Stage Six lasts an average of about two and a half years.
STAGE 7: Very Severe Cognitive Decline
Also known as Late-Stage Dementia, this is final stage in the progression of the terminal illness and individuals are nearing death. At this point, most individuals have lost their ability to speak or communicate. They require help with all of their activities, including toileting, eating, dressing and bathing. People in Stage Seven also lose their psychomotor abilities, so they may be unable to walk or need significant assistance. This stage lasts an average of two and a half years.
It’s important to note that the progression of the disease will be different for each individual. Family members can familiarize themself with the typical stages throughout the process to prepare for the challenging road ahead. Knowing what to expect can help ease some of the stress and uncertainty that comes with an Alzheimer’s diagnosis.
Did you enjoy learning more about Alzheimer’s Disease? Then read this blog, discussing alternative approaches Dementia caretakers are using to care for patients in the Netherlands! They are finding creative ways to soothe anxious patients and have even created a beach room to simulate a day at the beach!