Stages of Alzheimers's Disease

There are roughly three different stages with characteristic signs, symptoms and behaviors.
Not all individuals will progress through the disease at the same rate, and not all will display all of the characteristics that will be mentioned.
Each case is individualized.
We do know that the younger a person is when diagnosed with Alzheimer's, the faster the disease progresses.
Divide the three stages into three categories. (Remember, there are no clear-cut divisions.)
1. Cognitive changes - changes in perception and awareness.
2. Affective changes - changes in emotions and feelings.
3. Physical changes - observable changes that we can see in one's physical condition.

FIRST STAGE (EARLY STAGE) -- 2-4 YEARS
- Diagnosis is usually not made at this point - could be one of the 50 to 150 other disorders causing the same signs and symptoms in this first stage.
- Changes are subtle, gradual, and insidious occurring over a period of months or years.
1. Cognitive Changes (perception and awareness)
  1. Memory loss -- especially of recent events and new information.
  2. Uncertainty and hesitancy in initiating behaviors and actions.
  3. Unable to perform simple tasks -- loss of reason, logic, and judgment.
  4. Difficulty focusing attention - decreased attention span.
  5. Motor aphasia (loss for words).
  The changes are very subtle in this first stage of Alzheimer's Disease (AD). The family usually does not recognize anything is wrong, or attributes it to stress, lack of sleep, job, getting older, etc. Patients are very good at compensating for their deficiencies in this first stage. They may do very well in social situations and in a normal nonspecific conversation. It only becomes evident something may not be right when you ask very specific questions such as: "How old are you?" "What year is it?" "What date is it?" "What did you have for dinner?" Persons are very aware in the first stage of AD that they cannot remember. They may display symptoms of depression over their memory loss in this first stage.
2. Affective Changes (changes in emotions and feelings)
  1. Decreased interest in environment and present affairs - social withdrawal.
  2. Indifferent to the normal courtesies of social life.
  3. Loss of initiative and sense of humor, may have a personality change.
  4. Lack of spontaneity (absent-minded, decreased concentration, decreased initiative and decreased drive, dull affect).
  5. Carelessness in appearance and actions.
  6. Emotional instability. The two most common emotions are:
    - Depression, because the person is aware they are forgetful, and
    - Anger/frustration, because they cannot remember or do things the way they used to.
  7. Personality changes / marital problems.
3. Physical Changes (very few) Example - The AD person may look physically fine and may be in perfect cardiovascular health. They will go out, run a mile, come home, and forget where they put their tennis shoes.
  1. May have a slight weakness or slower movements.
  2. May have a small amount of muscular twitching.
By the end of the first stage, people with AD are beginning to perform poorly at work. They might forget to perform tasks that were routine in their daily lives. They may be unable to add and subtract figures correctly, have difficulty organizing times and dates, and may be fired from their job with no explanation and often no retirement or insurance benefits.
SECOND STAGE (2-12 YEARS -- LONGEST OF ALL STAGES)
- Diagnosis is usually made here.
- Families may be relieved to know that the relative has a "disease" and is not mentally ill. Signs and symptoms including behaviors are magnified many times over in the second stage, and the person is usually taken to a doctor, because the family is aware that their memory loss and decreased intellectual function is not a normal process of aging.
1. Cognitive Changes
  1. Obvious defects in memory, retention, and recall. Their recent memory (short-term memory) is the first to go.
  2. Unable to concentrate - loses their train of thought, hesitation in verbal response.
  3. Forgets appointments and socially significant events.
  4. Forgets to initiate or complete normal routines including health and hygiene measures.
  5. Aimless wandering / restlessness (especially at night).
  6. Disorientation to time - confuses day and night.
  7. Misplaces items and then claims they were stolen.
  8. Hallucinations.
  9. Inappropriate social behavior.
  10. Increased dependence on significant others - role reversal, social isolation.
  11. Mirror sign - unable to recognize themselves in a mirror.
    - Example: The Alzheimer's individual may stand in front of a mirror and carry on a conversation with themselves, not realizing it is themselves they are seeing. If they do not recognize themselves, you can see why they would not recognize family, neighbors and friends.
  12. Unable to understand or express language.
  13. Unable to attach meaning to sensory impressions.
  14. Unable to do math calculations.
  15. Unable to carry out purposeful movements.
  16. Unable to read or write.
THIRD STAGE - TERMINAL (1-3 YEARS)
Families usually face the task of making major decisions during this stage regarding nursing home placement since the individual with Alzheimer's requires total physical care.
1. Cognitive Changes
  1. Little or no response to stimuli.
  2. Unable to perform purposeful movements.
  3. Does not recognize others, including family.
2. Affective Changes
  1. Lethargic - no energy.
  2. Expresses little or no emotion.
3. Physical Changes
  1. Mute and unresponsive.
  2. Emaciation - marked weight loss with decreased appetite; choking is common due to the muscles that control swallowing being affected.
  3. Incontinence.
  4. Totally incapable of caring for self.
  5. Seizures - grand mall, approximately 50 percent of the time.
  6. Bedridden.
  7. Extreme psychomotor retardation.
  8. Susceptible to injuries and infections. The most frequent cause of death is pneumonia. Alzheimer's Disease debilitates the body to the point where a secondary infection takes over. Other contributing factors include malnutrition, dehydration, and immobilization.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999. For further information about Alzheimer's Disease or related disorders, contact the Alzheimer's Association at:

Alzheimer's Association of the Great Plains, 402-420-2540 or 1-800-487-2585 (Helpline)
Midlands Chapter, 402-572-3010 or 1-800-309-2112 (Helpline)