Stages of Alzheimer's

These stages are most valid for people with Alzheimer’s disease, the most common form of dementia.  If your family member has been diagnosed with a different dementia, please consult with your health care provider.

Most dementing illnesses last seven -15 years but people can live as long as 20 years with the illness.  As Arizona's leading provider of Alzheimer's clinical resources, Banner Alzheimer's Institute offers a caregivers guide, including this information about the stages of Alzheimer's.

When comparing the stages below with a person's abilities, select the stage with the highest number where you see changes.  For example, if the person is unable to bathe without direction and has no losses beyond this, we place the person in stage 5. 

The seven approximate stages are:

1. No cognitive decline - Mild Cognitive Impairment
2. Very mild cognitive decline – Forgetful stage
3. Mild cognitive decline - Early confusional
4. Moderate cognitive decline - Late confusional
5. Moderately severe cognitive decline - Early dementia
6. Severe cognitive decline - Middle dementia
7. Very severe cognitive decline - Late dementia

1.  No cognitive decline - Mild Cognitive Impairment

People at this stage may complain of being forgetful or may have difficulty remembering names. It is very difficult to diagnose whether or not this will progress to become a dementia, however, it is extremely important to seek medical attention at this time. 

2. Very mild cognitive decline – Forgetful stage

• The person will have changes in short-term memory or a decreased ability to learn and retain new information
• May have symptoms of depression or apathy, and also may refuse treatment for it
• The person may develop a “short fuse,” becoming angry more easily;  and have new conflicts with others (especially marital conflict)
• There may be an increase in intensity of emotions including sadness or happiness over seemingly minor things. Or becomes more self-involved.

3.  Mild cognitive decline  (Early confused stage)

There will be actual changes in the person’s ability to do the following without direction, supervision (oversight), or modifying the task, or the person may require actual help from another person:

• Manage employment
• Plan for investments, pay bills, balance the checkbook.
• The ability to drive begins to change.  
• There may be a change in the ability to make decisions about purchases or plan trips.
• There may be problems with accessing computer sites, such as not being able to find sites they have used before, or the person may begin to surf risqué sites.
• The person may begin to spend more than before – especially on credit card purchases, magazine subscriptions, telephone calls, or TV or mail order products, and may actually be vulnerable to financial exploitation from these solicitations.
• The person will have difficulty with dialing the phone in an emergency, and  taking messages.
• May have difficulty with power implements (snow blowers, saws, gas tanks) and will become unsafe with firearms.
• Participation in social activities may change such as wanting to leave large social gatherings, not wanting to attend usual social activities.

4.  Moderate cognitive decline (Late confusional stage)

• May obsess over appointment times, getting dressed early for scheduled events, and worrying about when things will occur.
• The person has a general loss of reading comprehension and becomes unable to remember what they have read.
• The person’s ability to remember what is said on the phone and dial the phone declines.
• The person’s ability to determine clean versus dirty in the household may decline. Their cooking abilities may change. 
• The thermostat settings are either too hot or too cold.
• The person begins to withdraw from participating in an organization or preparing for holidays. 
• There is usually a loss of the sense of “risk,” knowing that things are dangerous and/or having “close calls.”
• The person can exhibit increased irritability, frustration with activities, and self-absorption. They may be angry about no longer driving.
• The person may avoid making advanced directives and other complex activities due to difficulty with planning.
• The person may deny the memory problem and become irritated when family tries to discuss it.

5. Moderately severe cognitive decline (Early dementia phase)

This stage starts the losses in basic self care activities which health professionals call “ADL’s,” or activities of daily living. Illness, medications, fatigue and other factors can make the person worse.

• Bathing:  This starts with the person failing to bathe regularly or becoming resistant when bathing is suggested. 
• Grooming: The person may not clean their teeth, comb their hair, shave, or apply makeup as carefully as in the past. 
• Selecting clothing: The person may wear the same clothing day after day, even becoming angry when change is suggested or the clothing is laundered.  
• Dressing: The person may need actual direction to get clothing on correctly. 
• Recognition: The person may begin to have difficulty with recognizing friends or family members.  This is generally intermittent at first.
•  Non-recognition of TV, mirrors, pictures, objects: The person may report extra people or animals in the house because they are misinterpreting these images.
• Clinginess: The person clings to his/her caregiver.
• Repetitive behaviors:  The person may ask the same question repeatedly, despite hearing the answer.  The person may fixate on or endlessly repeat a particular activity.
• Decline in language ability: The person’s ability to hold a conversation is notably poor. Often they do not understand everything that is said.
• Other problem behaviors that once identified may be managed successfully.
  • Pacing 
  • Wandering
  • Sleep disturbances
  • Late day confusion or agitation.
  • Agitation.
  • Aggression – usually related to resisting care.

6. Severe cognitive decline (Advanced Dementia)

• Problem in Toileting: The person may urinate or have a bowel movement in unusual places.  This is often because the person does not recognize who is in the mirror and thinks someone else is in the bathroom and looks for another place to go.
•  Walking:
  • Shuffling.
  • Difficulty rising from chair.
  • Feet getting “glued” to the floor.
  • Falling – Falls while walking are likely   As the person weakens, falling from bed is likely to happen.
• Toddler-like emotions
• Changes in eating including the following:
  • Failing to eat unless served.
  • Eating with fingers.
  • Easily distracted when eating – may need multiple small meals.
  • May put non-food items in mouth.
• Regular non-recognition of family.
• Very poor language ability.

7.  Very Severe cognitive decline (Late dementia to death)

• Loss of ability to move about purposefully, i.e. pushing a wheelchair.
• Loss of regular verbal communication.
• Dependence in all activities of daily living. Severe weight loss.
• Loss of recognition or family members except during moments of clarity.
• Spontaneous behaviors, such as yelling, tapping or banging.
• Contractures – where the joints are “frozen” in a flexed position.
• Fractures. Strong potential for skin breakdown and/or skin tears.
• Repeated infections – especially pneumonia and urinary tract infections.

For more information:

Banner Alzheimer's Institute is offering a free caregiver's guide, "As Memory Fades. . . The Caregiver's Challenge Begins''

• View the entire guide 
• Learn more about the stages of Alzheimer's