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What to expect in the stages of Alzheimer’s

What to expect in the stages of Alzheimer’s

Managing Editor

While most are aware that Alzheimer’s disease progresses in stages, many are still confused about what those stages entail.

This is particularly true in North America, where the American health system recognizes seven stages of Alzheimer’s while the Canadian system is modelled on three.

In order to help you better understand what you and your loved one can expect, here is a short breakdown of the stages of Alzheimer’s in both Canada and the States:

In Canada, according to the Alzheimer Society of Canada, the disease progresses through three official stages: early stage, middle stage and late stage; and end of life.

  1. Early Stage:

The early stage of Alzheimer’s can happen at any age. In the early stage, people experience mild levels of impairment.

Common symptoms at this stage include forgetfulness, confusion, difficulty communicating and mood/behavioral changes. People still retain most of their skills and will require little help from caregivers in performing day-to-day tasks.They may also be aware of the changes they’re experiencing, and will probably be able to tell their loved ones how they are feeling, and help them to plan their own future care.

At the same time, some people may not be aware that they have Alzheimer’s at this stage, and may not get a diagnoses until they have progressed past it.

  1. Middle Stage:

In this stage, the person will have more noticeable decline in cognitive and day-to-day functioning.  They may have more difficulty remembering things or people.

Rambling, confused speech, getting lost in familiar settings, sleep disturbances and changes in mood/behavior are common in this stage. Some people may maintain awareness of their condition. As this stage progresses, more help will be needed for daily tasks. 

  1. Late Stage:

In this stage the person will eventually become unable to communicate verbally and perform tasks for themselves. Physical ability declines and immobility is likely.

It will be necessary to have 24-hour care. As caregivers support their loved ones through this stage, the goal becomes helping them maintain the best quality of life possible.

End of Life:

As the person approaches the end of life, focus shifts from treatment to comfort. During this stage, the physical, spiritual and emotional comfort of the person are important to attend to. Caregivers can be supportive by focusing on their loved ones quality of life and their well-being.

In America, there are seven stages of Alzheimer’s disease. Here’s how they break down:

  1. Stage One: No impairment

According to the Alzheimer’s Association, at this stage the person will show no signs of problems with memory, orientation, judgment, communication skills and daily activities.

  1. Stage Two: Very mild cognitive decline

These could be symptoms of regular aging or of early Alzheimer’s disease. The person may feel like they have lapses in memory — temporarily forgetting names of locations or everyday objects. These changes are likely not noticed by friends, family or coworkers.

  1. Stage Three: Mild cognitive decline

Coworkers and loved ones may start to notice changes in the person. The most common changes include obvious problems coming up with the right word, inability to remember names of people they recently met, losing objects frequently, having increasing difficulty planning and organizing.

  1. Stage Four: Moderate cognitive decline

At this point, a medical exam should be able to identify the symptoms of Alzheimer’s. These symptoms may include forgetting recent events, having difficulty doing complex tasks like planning dinner for friends or doing one’s taxes and becoming moody or withdrawn.  The person will require little or no assistance with day-to-day tasks.

  1. Stage Five: Moderately severe cognitive decline

Memory and thinking is obviously worsening, and individuals need help with some daily tasks. They may forget details such as their address or phone numbers, or the name of the university they attended. They may become confused about what day it is, and might need help choosing weather-appropriate clothing. At this stage, they will probably still be able to eat and use the toilet independently.

  1. Stage Six: Severe cognitive decline

Memory worsens, and the person’s behavior and personality may start to change. They will require help with many daily activities. People may have trouble remembering their personal history, need help dressing properly, have major changes in sleep patterns, forget names of loved ones, require help with toileting (for example flushing, disposing of tissue properly), experience suspiciousness or delusions, compulsive or repetitive behaviours, or anger and agitation. Wandering is also common.

  1. Stage Seven: Very severe cognitive decline

In the final stages of the disease people lose the ability to respond to their environment, to communicate verbally and to be mobile independently. They may still be able to speak some words or short phrases.

People will need help with daily care including eating, dressing and using the bathroom. They may lose the ability to smile, sit upright independently or hold their heads up. Reflexes slow substantially and swallowing becomes difficult.

Megan Jones is a writer for

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Megan Jones

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