What are the 7 stages of Alzheimers

A progressive disease

The discovery that you or a loved one has Alzheimer’s disease can be an emotional experience. Whether you’re a family member or someone with the condition, this progressive disease will slowly affect your daily life. The first step to managing it is to learn more about Alzheimer’s, from how it progresses to treatment options.

Alzheimer’s disease is the most common type of dementia, a general term for a decline in mental abilities. People with Alzheimer’s disease experience a decreased ability to:

• remember
• think
• judge
• speak, or find words
• problem-solve
• express themselves
• move

In the early stages, Alzheimer’s disease can interfere with day-to-day tasks. In the later stages, someone with Alzheimer’s will depend on others to complete basic tasks. There are a total of seven stages associated with this condition.

There’s no cure yet for Alzheimer’s, but treatment and interventions can help slow the progression. Keep reading to learn what to expect from each stage so you can be better prepared for what’s to come.

The general stages of Alzheimer’s disease

The typical progression of Alzheimer’s disease is:

Doctors also use Dr. Barry Reisberg’s seven major clinical stages from the Global Deterioration Scale to help with diagnosis. There’s no universally agreed-upon staging system, so healthcare professionals may use the one that they’re most familiar with.

Read on to learn more about these stages and what you can do to help someone with progressive Alzheimer’s.

Preclinical Alzheimer’s, or no impairment

You may only know about your risk of Alzheimer’s disease due to your family history. Or a doctor may identify biomarkers that indicate your risk.

If you’re at risk of Alzheimer’s, a doctor will interview you about memory difficulties. However, there will be no noticeable symptoms during the first stage, which can last for years or decades.

Abnormal accumulation of a type of protein called tau in the fluid around your brain and spinal cord is associated with the development of Alzheimer’s disease. Changes in the levels of this protein can occur about 15 years before symptoms start.

Caregiver support: Someone in this stage is fully independent. They may not even know they have the disease.

Very mild impairment, or common forgetfulness

Alzheimer’s disease mainly affects older adults over the age of 65. At this age, it’s common to have slight functional difficulties such as forgetfulness.

But for people with stage 2 Alzheimer’s, this decline will happen more quickly than it will for similarly aged people without Alzheimer’s. For example, a person may forget familiar words, a family member’s name, or where they placed something.

Caregiver support: Symptoms at stage 2 won’t interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.

Mild impairment or decline

The symptoms of Alzheimer’s are less clear during stage 3. While the entire stage lasts about 7 years, the symptoms will slowly become clearer over a period of 2 to 4 years. Only people close to someone in this stage may notice the symptoms. Work quality will decline, and they may have trouble learning new skills.

Other examples of stage 3 symptoms and signs include:

• getting lost even when traveling a familiar route
• finding it hard to remember the right words or names
• being unable to remember what you just read
• not remembering new names or people
• misplacing or losing a valuable object
• decreasing concentration during testing

A doctor or clinician may also have to conduct a more intense interview than usual to discover cases of memory loss.

Caregiver support: At this stage, someone with Alzheimer’s may need counseling, especially if they have complex job responsibilities. They may experience mild to moderate anxiety and denial.

Mild Alzheimer’s, or moderate decline

Stage 4 lasts about 2 years and marks the beginning of diagnosable Alzheimer’s disease. You or your loved one will have more trouble with complex but everyday tasks. Mood changes such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in challenging situations.

New symptoms of decline that appear in stage 4 may include:

• decreasing awareness of current or recent events
• losing memory of personal history
• trouble with handling finances and bills
• inability to count backward from 100 by 7s

A clinician will also look for a decline in areas mentioned in stage 3, but there will often have been no change since then.

Caregiver support: It’ll still be possible for someone to recall weather conditions, important events, and addresses. But they may ask for help with other tasks such as writing checks, ordering food, and buying groceries.

Moderate dementia, or moderately severe decline

Stage 5 lasts about 1 1/2 years and requires a lot of support. Those who don’t have enough support often experience feelings of anger and suspicion.

People in this stage will remember their own names and close family members, but major events, weather conditions, or their current address can be difficult to recall. They’ll also show some confusion regarding time or place and have difficulty counting backward.

Caregiver support: People will need assistance with daily tasks and can no longer live independently. Personal hygiene and eating won’t be an issue yet, but they may have trouble picking the right clothing for the weather or taking care of finances.

Moderately severe Alzheimer’s

During stage 6, there are five identifiable characteristics that develop over the course of 2 1/2 years.

6a. Clothes: In addition to being unable to choose their clothes, someone with stage 6 Alzheimer’s will need help putting them on correctly.

6b. Hygiene: A decline in oral hygiene begins, and they’ll need help adjusting the water temperature before baths.

6c through 6e. Toilet: At first, some people will forget to flush or throw tissue paper away. As the disease progresses, they’ll lose control of their bladder and bowels and need help with cleanliness.

By this stage, memory is much worse, especially around current news and life events. Counting backward from 10 will be difficult. Your loved one may also confuse family members with other people and display personality changes. They may experience:

• a fear of being alone
• fidgeting
• frustration
• shame
• suspicions
• paranoia

They may also start stuttering and become frustrated. It’s important to continue counseling for behavioral and psychological symptoms.

Caregiver support: Assistance with personal care, from daily tasks to hygiene, is necessary by this stage. People with stage 6 Alzheimer’s disease may also start to sleep more during the day and wander at night.

Severe Alzheimer’s

There are substages to this final stage, which lasts about 1 1/2 to 2 1/2 years.

7a: Speech is limited to six words or fewer. A doctor will need to repeat questions during the interview.

7b: Speech declines to only one recognizable word.

7c: Speech is lost.

7d: They’ll be unable to sit up independently.

7e: Grim facial movements replace smiles.

7f: They’ll no longer be able to hold their head up.

Body movements will become more rigid and cause severe pain. According to the Alzheimer’s Association, about 40 percent of people with Alzheimer’s also form contractures, or shortening and hardening of muscles, tendons, and other tissues. They’ll also develop reflexes characteristic of infancy, such as sucking.

Caregiver support: At this stage, the person’s ability to respond to the environment is lost. They’ll need help with almost all their daily tasks, including eating or moving. Some people will become immobile during this stage. The most frequent cause of death in someone with stage 7 Alzheimer’s is pneumonia.

Read more about the long-term outlook for Alzheimer’s disease.

A word about progression

Alzheimer’s typically progresses slowly and transitions from mild to severe symptoms. The rate of progression varies widely between people. People with Alzheimer’s live an average of 4 to 8 years after their diagnosis, but some people live more than 20 years.

The risk of progressing to a higher stage increases with age. For example, in a 2018 study, researchers found that a 65-year-old person in the preclinical stage had a 92 percent chance of remaining in normal cognition the next year. They found that a 75-year-old person had a 90 percent chance of remaining in normal cognition.

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Although there’s no cure for Alzheimer’s, treatment can slow each stage of the disease. The goal of treatment is to manage mental function and behavior and slow down symptom progression.

Some factors can have positive impacts on symptoms of the disease, such as:

• dietary changes
• supplements
• exercises for the body and mind
• medication

Medications for Alzheimer’s help regulate neurotransmitters for thinking, memory, and communication skills. But these drugs won’t cure the disease. After a while, they may not work. Someone with Alzheimer’s may also need to be reminded to take their medication.

Learn more about drugs for Alzheimer’s disease.

Treating behavioral symptoms with counseling and therapy may benefit someone with Alzheimer’s disease. It can make them feel more comfortable and ease the process for their caregivers.

Doctors sometimes prescribe antidepressants and anti-anxiety medications to manage mood and behavioral changes.

Moderate exercises such as walking can also improve mood and provide other benefits, such as a healthier heart and healthier joints and muscles. But due to memory difficulties, some people with Alzheimer’s shouldn’t walk or exercise outside the home by themselves.

Read more about alternative remedies for Alzheimer’s disease.

Can you prevent Alzheimer’s?

Researchers are continuing to improve their understanding of Alzheimer’s disease and how to prevent it. Its development is thought to be complex and caused by a combination of:

• genetics
• environmental factors
• age
• lifestyle habits
• other medical conditions

To date, medications have been found to have a limited effect on altering the course of Alzheimer’s once symptoms develop. Research has largely shifted toward preventing symptoms before their onset.

There may be some preventive steps you can take to lower your chances of developing the disease. Modifiable risk factors for the development of Alzheimer’s mostly include improving lifestyle habits and lowering risk factors for cardiovascular disease.

Some autopsy studies have found that up to 80 percent of people with Alzheimer’s also had cardiovascular disease.

Researchers highlighted the following as risk factors for cognitive decline and Alzheimer’s disease:

• diabetes
• depression
• mental inactivity
• physical inactivity
• poor diet
• high blood pressure
• obesity
• low education level

A growing amount of research suggests that regular physical activity can potentially delay the onset of Alzheimer’s disease or slow its progression. It can also help lower your chances of developing conditions such as diabetes, obesity, or high blood pressure.

Finding support

Caring for someone with Alzheimer’s disease is a monumental task. You’ll experience a range of emotions as a caregiver. You need help and support, as well as time off from your duties. Support groups can help you learn and exchange best practices and strategies for coping with difficult situations.

Alzheimer’s is a progressive disease, with people living an average of 4 to 8 years after diagnosis. It can be easier to cope if you know what to expect from each stage of the disease and if you get help from family and friends.