7 Alzheimer's Disease Stages and Symptoms

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Alzheimer's disease symptoms and stages facts

  • Alzheimer's disease is a generalized deterioration of brain function that progresses in individuals.
  • Depending upon which experts are researched, Alzheimer's disease can have as few as three or as many as seven stages (some stages may include sub stages), but all agree on a gradual and progressive loss of brain functions; the global deterioration scale (GDS) is widely accepted and has seven stages.
  • Stage 1: no symptoms
  • Stage 2: symptoms include mild memory loss, decreased concentration, forgetting names
  • Stage 3: symptoms include forgetting new information, declining work performance, difficulties with future plans and organizational problems, repeating questions
  • Stage 4: symptoms include difficulties with complex actions, can't plan ahead, depression, withdrawn, shun challenging situations
  • Stage 5: symptom include difficulties remembering home address or phone number, need assistance for common tasks such as making a meal, disorientation to time and/or place, a decline in personal hygiene habits
  • Stage 6: symptoms include requiring assistance in getting dressed, forgetting names of close family members, personality changes including paranoia, hallucinations, and delusions, needs assistance with personal hygiene, may require constant monitoring
  • Stage 7: the person may not be able to talk or respond rationally, may not be able to control muscle movements, may not be able to sit upright, and eventually, some individuals will not be able to swallow food or liquids

Quick GuideCaring for Someone With Alzheimer's Disease

Caring for Someone With Alzheimer's Disease
Alzheimer's disease myths

Alzheimer's Disease Symptoms

Alzheimer's disease is a common cause of dementia and its associated symptoms. One of the the main and often the first symptom of Alzheimer's disease is memory problems that develop slowly over time. Symptoms that develop later include

  • personality changes (for example, apathy),
  • withdrawal, and
  • reduced spontaneity.
The cross section of a healthy brain in contrast with a diseased brain.

What is Alzheimer's disease?

Alzheimer's disease (also termed Alzheimer disease) is a progressive mental deterioration that can occur in middle-aged individuals, but usually occurs in individuals that are about 60 to 65 years old or older. Early or younger onset Alzheimer’s can occur in individuals aged about 40 – 65. The disease is due to generalized deterioration of brain function related to plaques that develop in the brain tissue. The cause of Alzheimer's is unknown. Alzheimer's disease is the most common cause of premature senility. About 5.4 million Americans age 65 and older have Alzheimer's and approximately 200,000 individuals have younger or early onset Alzheimer's disease. Statisticians predict by 2050 about 13.8 to 16 million people will have Alzheimer’s disease.

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What are the signs, symptoms, and stages of Alzheimer's disease?

Although the course of Alzheimer's disease varies from person to person, several stages are recognized. How many stages are recognized depends on what expert you consult (described stages may range from 3 to 7). Almost all experts agree that there at least three major stages

  1. mild (early stage),
  2. moderate (middle stage), and
  3. severe (late stage).

Those experts that list up to seven stages do so by breaking the three stages into subsets (for example, the severe stage is broken into severe decline and very severe decline). These stages are defined by certain signs and symptoms. The object of this article is to list those signs and symptoms that usually appear in these stages. Unfortunately, some people with Alzheimer's disease may have some symptoms that may cross over stages.

People with Alzheimer's disease, family members, and others are often told that the affected person has mild, moderate or severe disease. However, others are told they are in one of seven Alzheimer's stages (stages previously used by some physicians and other health-care professionals). This seven stage designation is termed the Global Deterioration Scale (GDS). A few other experts even break down the seven stages into subsets (for example, stage into 6a -6f). Moreover, the stages have various names depending on who is describing them. Consequently, people can be confused if they hear about various "stages" of Alzheimer's disease. In an effort to clarify the situation, all seven Global Deterioration Scale will be presented along with their names (subsets will not be presented) and then each Global Deterioration Scale will then be rated as mild, moderate or severe.

The Alzheimer Association provides a list of 10 "early" signs and symptoms of Alzheimer's disease; they are:

  • Reduced ability in planning or problem-solving
  • Difficulty completing familiar tasks done at home, work or at leisure
  • Confusion due to loss of understanding of dates and time
  • Difficulty understanding visual images and spatial relationships
  • Memory loss that disrupts daily life
  • Problems with speaking or writing
  • Misplacing things in unusual places and not being able to retrace steps to find items
  • Decreasing judgment and/or poor judgment when dealing with finances and/or personal hygiene
  • Avoiding work and/or social activities
  • Changes in personality, behavior, and mood.

Although some of the signs and symptoms may appear occasionally with age-related changes and not be due to Alzheimer’s disease, if the above signs and symptoms cause anyone to worry about a potential diagnosis of Alzheimer’s, the individual should be seen and evaluated by a health-care professional.

Quick Guide to Dementia
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Stage 1: No impairment

Global Deterioration Scale stage 1 of Alzheimer's disease is termed "no impairment," which means that the person has no noticeable symptoms, and is fully independent with no memory or reasoning problems (mild Alzheimer's disease).

  • No noticeable memory problems
  •  No noticeable reasoning problems
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Stage 2: Very mild cognitive decline

Stage 2 of early Global Deterioration Scale of Alzheimer's disease is termed "very mild cognitive decline." The signs and symptoms of the first stage of Alzheimer's disease are:

  • Mild memory loss
  • Forgetting names of known individuals
  • Minor problems with concentration

Usually, these patients can function socially and at work (mild Alzheimer's disease).

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Stage 3: Mild cognitive decline

Deterioration Scale stage 3 of Alzheimer's disease termed "mild cognitive decline," is characterized by worsening of the first and second Global Deterioration Scale stage symptoms and also can include:

  • Forgetting new information
  • Declining work performance
  • Difficulty with making future plans
  • Becoming less able to organize
  • Repeating questions

Family members and co-workers may begin to notice these changes, but many people remain undiagnosed at this stage (mild Alzheimer's disease).

A senior woman struggling to work on finances.

Stage 4: Moderate cognitive decline

Stage 4 of the Global Deterioration Scale of Alzheimer's disease termed "moderate decline," like the third stage, involves worsening of the conditions seen in previous stages. For example, memory loss and memory deficits become more prominent and difficulties with complex actions become more obvious. Other examples of symptoms of the fourth stage of Alzheimer's disease include:

  • Difficulties with complex actions (for example, balancing the checkbook)
  • Cannot plan ahead easily
  • Mood changes and/or mood swings
  • May become depressed
  • May become withdrawn from social contacts
  • May shun challenging situations (for example, family money matters)

Since the above problems become prominent and mood swings are usually out of character for the individual, this is the stage when most of the people have theirs doctors diagnose them with Alzheimer's disease (moderate Alzheimer's disease).

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Stage 5: Moderately severe decline

Stage 5 of Global Deterioration Scale of Alzheimer's disease termed "moderately severe decline," is determined when the individual is no longer able to do routine tasks without some assistance. Typical problems of the previous stages become worse; added to these problems are the patient's inability to remember to do common daily tasks (moderate Alzheimer's disease), for example, the person:

  • May have difficulty remembering common information (for example, home address or phone number)
  • Can no longer do routine tasks such as making a meal without some assistance
  • May become disoriented to time or place
  • Has a noticeable decline in personal hygiene habits, for example, brushing the teeth and/or bathroom hygiene
An elderly woman lost and shivering on a park bench.

Stage 6: Severe decline

In stage 6 of the Global Deterioration Scale of Alzheimer's disease termed "severe decline," all of the problems seen in the other 5 stages considerably worsen, especially memory (severe Alzheimer's disease), for example:

  • Daily activities such as getting dressed are compromised.
  • Affected individuals forget the names of people they should know (for example the names of their spouses and/or children).
  • The personality changes of the person become more pronounced and may include paranoia, hallucinations, and delusions.
  • Affected individuals will require personal help with daily tasks including personal hygiene (for example, they may not be able to take a shower unless assisted).
  • Many people with Alzheimer's disease will need monitoring as some will walk out of their residence and become lost.

Quick GuideCaring for Someone With Alzheimer's Disease

Caring for Someone With Alzheimer's Disease
An elderly man in his pajamas with a caregiver.

Stage 7: Very severe decline

In Global Deterioration Scale stage 7 of Alzheimer's disease termed "very severe decline," affected individuals have declined so much that they require continual assistance to carry out basic activities such as getting out of the chair or feeding themselves (severe Alzheimer's disease). Those people affected:

  • Can decline so far that they may not be able to talk respond to their environment
  • Will not be able to control muscle movement
  • That talk may have only meaningless verbiage
  • May not be able to even sit without support while others may become rigid
  • Eventually will not be able to swallow foods and/or liquids
Quick Guide to Dementia
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Conclusion

  • Individuals usually are diagnosed with Alzheimer's disease during the moderate stages of the disease (stage 2 of 3 in the simplified staging system or Global Deterioration Scale stage 4 to 7).
  • The disease is progressive and progresses at different rates with varying symptoms in each individual diagnosed with this disease.
  • Treatment methods may vary with each individual according to their stage and severity of symptoms.
  • There is no cure for Alzheimer's disease, but treatments may help reduce or slow the development of the signs and symptoms of Alzheimer's disease.
  • Staging may help family, caregivers, and friends to better understand what Alzheimer's disease is doing to the individual.
Reviewed on 5/12/2016
References
REFERENCES:

Alzheimer's Association. Stages of Alzheimer's.
<http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp>

Anderson, H. "Alzheimer Disease." Medscape. Updated May 04, 2016.
<http://emedicine.medscape.com/article/1134817-overview>

Alzheimer's Association. "What is Alzheimer's?"
<http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp>

Reisberg, B. "Clinical stages of Alzheimer's." Fisher Center for Alzheimer's Research Foundation.
<https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/>

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2.Alzheimer's Disease Education and Referral Center, National Institute on Aging

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