Alzheimer’s disease is a progressive condition that steadily worsens over several years. Because the disease affects everyone differently, experts measure its progress in stages. Most experts reference seven stages, though some simplify it to three: mild, moderate, and severe. It can be difficult to place a person in a specific stage because symptoms often overlap. Still, the breakdown works well as a guideline for an individual's progression through the disease.

Progressing Through the Stages

The pace with which someone with Alzheimer's moves through the stages differs from person to person. Each symptom affects the individual gradually, and not everyone is affected by all of them. On average, an individual with Alzheimer’s lives four to eight years after diagnosis. However, they may live significantly longer, depending on their overall health and various other factors.

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Stage One: Preclinical or No Impairment

Alzheimer’s disease begins before any symptoms become noticeable. People in this stage can function independently and are usually unaware that they have the disease. Individuals can remain here for years or even decades before symptoms become apparent. People with preclinical Alzheimer’s may stay independent if they have no other issues preventing them from doing so.

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Identifying Preclinical Alzheimer’s

Advancements in medical imaging have allowed technicians and researchers to identify preclinical Alzheimer’s, which was previously extremely difficult. Imaging techniques search for deposits of the protein amyloid-beta, which interferes with the brain’s communication system and is an indicator of Alzheimer’s disease. Genetic tests can also determine if a person is likely to develop the condition if it runs in their family.

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Stage Two: Mild Cognitive Impairment or Very Mild Decline

As the disease progresses, people with Alzheimer’s or those close to them may begin to notice mild changes in thinking ability and memory. This may manifest as memory lapses concerning recent events, appointments, or conversations. Other signs that a person is in this stage include forgetting the steps to a task or having difficulty judging how long something will take. While the symptoms are not severe enough to begin affecting daily life, they can be troubling.

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Stage Three: Mild Alzheimer’s and Dementia

Doctors usually diagnose Alzheimer’s once it reaches this stage due to the obvious nature of dementia symptoms. Dementia specifically describes several symptoms that impact memory, social, and thinking abilities and interfere with daily life and relationships. In this stage, people experience:

  • Changes in personality
  • Memory loss
  • Shrinking vocabulary
  • Difficulty performing complex tasks
  • Trouble organizing or expressing thoughts and ideas
  • Getting lost
  • Losing belongings

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Stage Four: Moderate Alzheimer’s and Dementia

When Alzheimer’s and dementia worsen, the individual's ability to care for him or herself steadily declines, and they require help with daily activities. Capability continues to deteriorate, with significant changes to cognitive ability. Notably, it is at this point that Alzheimer’s disease affects long-term memory. People in this stage may even fail to recognize close relatives. Reading and writing skills slowly worsen, along with physical coordination, increasing the likelihood of falls.

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Personality Changes in the Moderate Stage

Perhaps the most noticeable changes in people with Alzheimer’s occur at the moderate stage and involve behavior and personality. Key behavioral signs of this stage include wandering, irritability, and aggression. In many cases, those with Alzheimer’s resist any attempt at caregiving or assistance and may feel that friends, family, or caregivers are stealing from them or trying to harm them. They may also see or hear things that are not there.

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Stage Five: Moderately Severe Stage

As Alzheimer’s progresses from moderate to moderately severe, people with the condition tend to develop signature characteristics over a couple of years:

  • Inability to choose what clothes to wear
  • Deteriorating cleanliness, beginning with oral hygiene
  • Forgetting to flush or wipe

Alongside these key symptoms, memory worsens, and behavior changes continue. There may be signs of frustration, shame, or continued paranoia.

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Stage Six: Severe Decline

Later stages of Alzheimer’s largely feature an inability to care for one’s self, often to the point of needing a full-time caregiver. People who progress to this stage can no longer dress or bathe themselves without help. Because of coordination issues, they may also need assistance navigating their home and using the toilet. Due to poor hygiene, infections become more prevalent. They can still speak, but with a significantly smaller vocabulary, and they may be unable to articulate many thoughts or ideas.

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Stage Seven: Very Severe Decline

This last stage of Alzheimer’s is often the most difficult, not just for the individual with the condition, but for their loved ones, as well. Caring for a person at this stage of Alzheimer’s is extremely challenging, which can lead to family members seeking support services like hospice care. As the individual loses their ability to speak, eat, and drink, these services continue to provide care and comfort. Even as Alzheimer’s diminishes their cognitive ability, people at this stage still benefit from activities like listening to music and having conversations. Support services encourage families to continue interacting with their loved ones, even if they do not seem to respond.

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