The Stages of Alzheimer’s Disease: Pre-Diagnosis to Late-Stage Dementia

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In This Article:

Alzheimer’s Disease: Prior to Diagnosis
Alzheimer’s Disease: Early-Stage Dementia
Alzheimer’s Disease: Mid-Stage Dementia
Alzheimer’s Disease: Late-Stage Dementia
How Do You Know What Stage of Alzheimer’s Disease a Person Is In?
A Roadmap for Care Moving Forward

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Alzheimer’s disease is the most common type of dementia. It’s a progressive disease, developing slowly and gradually worsening, typically over a period of several years. As the disease progresses, it impacts memory, thinking, language, problem-solving, and even personality and movement. Understanding the Alzheimer’s stages timeline is crucial for caregivers to prepare for what lies ahead.

“While one’s experience of Alzheimer’s disease will be unique in a lot of ways, it is important to be aware of and learn about the different stages of the disease process, as there are specific cognitive changes and behaviors that one may likely experience with their loved one at some point in time,” says Careforth Care Coach Nicole McCool. “The disease is progressive and sadly, it is not always easy for a person to shift gears through that progression. In my experience working with our caregivers, they have found that knowledge and awareness is a powerful tool and learning about the disease process is essential to being as prepared as one can be for what may be coming down the line.”

While not everyone will have the same symptoms, and the disease may progress at a different rate for each individual, there is a similar trajectory that most people with Alzheimer’s disease experience. The typical progression of Alzheimer’s disease may be broken down into three phases: early, middle, and late. These phases can be further dissected into seven distinct stages, three of which happen even before a person’s diagnosis. 

Alzheimer’s Disease: Prior to Diagnosis

In the first three stages of the seven-stage model, an individual is not considered to have dementia, as the symptoms are commonly associated with aging and are not typically noticeable by health care providers or family members. This is also known as pre-clinical Alzheimer’s disease, which can begin 10 to 15 years before any symptoms appear.

• Stage One: No Impairment

In the first stage of Alzheimer’s a person with the disease has no memory impairment and no evident symptoms of dementia. At this stage, Alzheimer’s disease is completely undetectable, and is characterized by there being no cognitive decline.

• Stage Two: Very Mild Cognitive Decline

In stage two, a person with Alzheimer’s disease begins to experience forgetfulness – such as forgetting one’s keys or purse. This loss in memory, however, is often assumed to be a symptom of aging and is typically not noticed by the individual’s family members or physician.

• Stage Three: Mild Cognitive Decline

Increased forgetfulness as well as slight difficulty with focus and concentration are common signs of the third stage of dementia. These symptoms may result in decreased engagement and productivity at work. For those who are retired or not in the workforce, they may experience decreased performance in ordinary household tasks such as cleaning or paying bills. They may also get lost or struggle communicating, often finding it difficult to find the right words.

In stage three, increased forgetfulness and decreased performance are likely to be noticed by the person’s family members but isn’t always associated with early-stage Alzheimer’s. The average duration of stage three is approximately seven years prior to the onset of dementia.

Alzheimer’s Disease: Early-Stage Dementia

In the first three stages, an individual is not yet considered to have dementia. At stage four, however, that changes, and a person is considered to have early-stage dementia. It’s important to note that early-stage dementia differs from early-onset dementia or early-onset Alzheimer’s disease, which refers to the onset of clinical symptoms and cognitive decline prior to age 65.

• Stage Four: Moderate Cognitive Decline

Stage four comprises what is clinically described as early-stage dementia. In addition to increased forgetfulness and difficulty concentrating, a person with early-stage dementia will have trouble with problem-solving and managing finances. They may have challenges when traveling to unfamiliar areas alone, and they may have difficulty performing complex tasks or organizing and expressing thoughts.

People in stage four may also be in denial about their forgetfulness and other symptoms, and as socialization becomes increasingly difficult, they may begin to withdraw from family and friends. In stage four, a health care provider can easily identify cognitive decline in an examination and interview with the person. The average duration of stage four is approximately two years

Alzheimer’s Disease: Mid-Stage Dementia

Stage five marks the beginning of mid-stage dementia – also known as middle dementia – which progresses into stage six. The middle stages of the disease are typically the longest phase, often lasting for multiple years. During this phase, a person with Alzheimer’s will become more reliant on their support system, requiring more from their family caregiver.

• Stage Five: Moderately Severe Cognitive Decline

Beginning in stage five, major memory deficiencies are present and people in this stage of the disease may require assistance with activities of daily living, such as bathing, dressing, and preparing meals. Memory deficits in this stage are severe, with individuals often forgetting prominent bits of information that affect their daily lives – such as their home address or phone number. They may also not be able to identify where they are (orientation to place) or what time of day it is (orientation to time).

• Stage Six: Severe Cognitive Decline

Stage six marks a period in which a person requires substantial assistance to carry out day-to-day activities. They may have little memory of recent events and forget the names of close friends or family members. Many people in stage six have limited memory of their earlier lives and will also have difficulty successfully exhibiting cognitive skills.

Commonly, people at this stage of the disease begin to experience incontinence of the bowel or bladder, and speech ability is often diminished. Significant personality changes may also be noticeable at this stage, as individuals may suffer from delusions, anxiety, or agitation.

Alzheimer’s Disease: Late-Stage Dementia

Also referred to as Late Dementia, the seventh and final stage of Alzheimer’s is characterized by very severe cognitive decline and the need for extensive care. People with late-stage dementia often lose awareness of their surroundings and environment, control of their movement, and the ability to communicate with others. During this phase of the disease, it’s also common for a person to experience significant changes in personality and behavior.

• Stage Seven: Very Severe Cognitive Decline

At this stage, most people will have lost their ability to speak or communicate. They often require around-the-clock assistance with most of their activities, including toileting, eating, dressing, bathing, and other daily activities. Because people in stage seven often lose psychomotor capabilities, they may be unable to walk or require significant assistance with ambulation. On average, this stage lasts two and a half years.

Alzheimer’s disease is a progressive disease that gradually worsens over a period of four to 20 years. However, most people live between four to eight years following diagnosis. The progression of the disease may be different for each individual, but family members and caregivers should familiarize themselves with the typical stages that occur throughout progression, as well as the unique challenges and needs of each phase. It’s a difficult road to travel for both the person with Alzheimer’s disease and those who love them, but knowing what to expect can help to ease some stress and uncertainty.

How Do You Know What Stage of Alzheimer’s Disease a Person Is In?

The stages of Alzheimer’s disease can offer a reasonable framework from which to observe symptoms and understand the progression of the disease. However, since there is no medical consensus for Alzheimer’s stages, it is important for caregivers to be aware of the individual symptoms and situations that the person they are caring for is experiencing. While health care providers may refer to a person’s condition as “late” or “early” stage, any specific stage is less important than the understanding of what unique challenges your loved one is experiencing and how this impacts the care you provide.

A Roadmap for Care Moving Forward

Learning about the stages of Alzheimer’s disease can help make it easier to have conversations with doctors about your loved one’s condition and how to approach future treatment options. Understanding the later stages of the disease also helps when planning for lifestyle changes, new equipment, need for additional support, and other considerations that may be needed as the disease progresses.

It’s crucial to plan for the future and follow the progression of the disease through each stage as Alzheimer’s disease first begins with physical changes in the brain. The exact speed of progression is largely based on the inner workings of the brain, and there is little that can be done to influence or predict it.

As caregivers and family members, the most important actions to take are those that improve the person’s quality of life and help them live their life as fully as possible. This can be accomplished by integrating activity into the daily routine of your family member or learning how to improve communication with a person with dementia. With proper preparation and knowledge of the individual stages of Alzheimer’s disease, it is possible to create a roadmap for care that leads to meaningful outcomes and improved quality of life.

“For those who know what stage their loved one is in, it can translate into many different experiences, emotions, and challenges, and often feeling powerless. However, education and knowledge on Alzheimer’s disease does allow for some ability to take that power back,” says McCool. “The stages may look very different and change in severity over time, but the key is acceptance, awareness, and advocacy, for both the person with Alzheimer’s and the caregivers themselves. In a lot of ways, it is like creating a new normal, recreating a different kind of bond that allows your loved one to feel heard and validated – wherever they are in their experience with dementia. Life is ever-changing, but we here at Careforth hope to make an impact by helping our caregivers feel supported at every turn in their journey.”

When it comes to providing care for someone with a chronic illness or disease, you don’t have to do it alone. Careforth provides you with an expert care team and support resources to help you in caring for yourself, so you can feel supported at every turn.