Understanding the Stages

Generally, the stages of dementia are referred to as early, middle, and late stage and we will refer to these stages in our materials.  Many medical professionals use a 7-stage framework and makes reference to “age-related” changes.  Early-onset Alzheimer’s disease occurs outside of “age-related” changes; therefore we use the general stages of early, middle, and late.  We have, however, noted the numbered stages in parenthesis so that you can use that as a guide as well.

It is important to remember that each individual experiences this disease in their own unique way, and there is no set timetable for how long each stage will last for an individual.  Not every person will experience each of these changes and the changes do not necessarily occur in a linear fashion.  For example, an individual may experience behavioral changes that are common in the middle stage before they experience changes that are more common in the early stages.   This information is to be used as a guide of what could be expected throughout the progression of the disease.  One of the most important things to remember about this disease is that it is unpredictable and does not follow a set course.

Early Stage (Stage 3)

The individual may begin to notice problems with their memory or may begin to have difficulty concentrating.  Often times, the first sign of a problem occurs in the work place. 
Initial changes could include:

  • Not remembering appointments
  • Losing train of thought in a conversation
  • Difficulty recognizing familiar faces
  • Losing track of time
  • Difficulty concentrating
  • Difficulty remembering recent information or events
  • Getting lost (especially when driving)
  • Struggles with finding words when having a conversation
  • Misplacing items

As the individual progresses through the early stage (Stage 4), additional changes could include:

  • Difficulty or unable to make decisions or choices
  • Making accusations or showing signs of paranoia
  • Difficulty separating fact from fiction
  • Making mistakes in judgment
  • Difficulty or inability to translate thoughts into actions
  • Withdrawing from social situations
  • Becoming frustrated and/or angry more frequently
  • Misusing familiar words
  • Speaking in rambling sentences
  • Difficulty when writing
  • Losing ability to sequence tasks
  • Difficulty with computing abilities
  • Reacting less quickly

Middle Stage – (Stage 5)

The individual is likely to be experiencing major gaps in their memory, and their cognitive abilities are declining.   They may experience the following changes:

Beginning to have difficulty with activities of daily living (I.e. dressing, grooming, bathing, eating, toileting)

  • Difficulty with knowing the day of the week, month or time of day
  • Losing fine motor skills (i.e. being able to button a shirt)
  • Difficulty understanding the written word
  • Having minimal attention span
  • Possibly displaying more sexual interest
  • Engaging in repetitious speech and actions
  • Having problems with social appropriateness
  • Starting to have hallucinations and/or delusions
    • Hallucinations – seeing things that are not there
    • Delusions – believing that they are being conspired against, etc.
  • Showing frequent changes of emotions
  • Displaying minimal attention span
  • Having outbursts more frequently
  • Showing frustration, anger and/or withdrawal more frequently

As the individual moves to the end of the middle stage (Stage 6), the following changes might be occurring:

  • Needing assistance with all activities of daily living (i.e. dressing, grooming, bathing, eating, toileting)
  • Being incontinent
  • Speech becomes muddled and unintelligible
  • Displaying a downward gaze
  • Hearing may become extremely sensitive
  • Being unable to separate or recognize sounds
  • Walking with a shuffling gait

Late Stage (Stage 7)

This is the final stage of the disease.  The following changes are commonly experienced as the individual progresses to the final stage of the disease:

  • Losing all language abilities
  • Having difficulty in swallowing
  • Losing ability to sit and walk
  • Needing total care