The Stages of Alzheimer’s: What to Expect

The Stages of Alzheimer’s: What to Expect

Alzheimer’s is what’s known as a progressive degenerative disease. This means that over time, the signs and symptoms of the disease will get worse. However, not everyone with Alzheimer’s will experience all these stages, and the duration of each stage varies widely between patients.

As a family caregiver, you should also be aware that Alzheimer’s doesn’t progress in a linear fashion. Simply put, you can expect your loved one to have good days and not-so-good days. They may seem to be relatively high-functioning one day and then struggle with basic tasks the next. This unpredictability is one of the reasons why caring for an individual with Alzheimer’s can be so incredibly challenging.

Normal Behavior

Also known as the preclinical stage, this stage lasts for anywhere from 10 to 15 years before any symptoms appear. During this stage, you won’t notice anything unusual about your loved one, despite the fact that a number of neurological changes are occurring. Currently, there are no known medical interventions that can be used at this stage, but researchers are working to develop treatments to delay the onset of issues for those with preclinical Alzheimer’s disease.

Very Mild Changes

During this stage, individuals with Alzheimer’s disease may present with periodic memory lapses or forgetfulness that’s virtually impossible to differentiate from normal age-related memory issues. They may start misplacing small items or occasionally forget familiar names, but they can otherwise maintain their usual daily routines.

Mild Decline

This is the stage of Alzheimer’s when cognitive changes become much more noticeable, both to the affected individual and their family, friends and coworkers.

Common issues associated with this stage include:

  • Difficulty with short-term memory, such as recalling what happened during a movie they just watched
  • Trouble organizing their daily schedule, making plans and remembering important events
  • The emergence of Primary Progressive Aphasia, a language deficit characterized by an impaired ability to use the correct words while speaking and/or writing
  • Avoidance of social settings, such as parties, due to increased anxiety around word searching and memory loss

This is the stage where many individuals seek assistance from their health care provider. Most people with Alzheimer’s are diagnosed when their disease is at this stage.

Moderate Decline

This stage of Alzheimer’s disease involves a marked progression in memory loss, as well as difficulty with organizing thoughts, making plans, and reasoning. Once your loved one reaches this stage, you may notice that:

  • They struggle with their short-term memory on a constant basis
  • They’re able to recall events in the past with clarity, but they might not know what day it is or where they are
  • They have difficulty managing their medications, leading to skipped doses and accidental double-dosing
  • They’ve developed irregular sleep patterns, such as taking excessively long naps during the day and failing to sleep during the night
  • They don’t dress appropriately for the weather
  • They often get lost or have started to wander
  • They may become withdrawn or depressed

Individuals at this stage of Alzheimer’s recognize many of the changes they are experiencing, and that can lead to anger, depression, and anxiety. They may withdraw, lose interest in maintaining contact with family and friends, and become suspicious or fearful of those who they previously trusted. If they previously held a valid driver’s license, by this stage they will no longer be able to safely operate a motor vehicle, and their driver’s license will be suspended by their physician.

Although medications cannot cure or completely prevent the onset of many symptoms of moderate decline, some people with Alzheimer’s may benefit from prescription drugs to treat issues with low mood and sleep.

Moderately Severe Decline

At this stage of the disease, your loved one will likely need significant support with day-to-day activities, such as maintaining their personal hygiene, keeping up with their household chores, and managing their finances. They’re likely to be unable to live independently, so at this stage, most people with Alzheimer’s either require placement in a specialized residential memory care program, or they need to live with a full-time caregiver.

Things you might notice at this stage include:

  • They may have difficulty remembering familiar faces and names
  • They might need some help getting dressed, using the toilet and brushing their teeth
  • They can no longer manage their finances
  • They’re experiencing a wide range of emotions, often without provocation or warning
  • They’ve become fearful and/or paranoid
  • They may experience urinary and/or fecal incontinence, and they might begin relieving themselves outside of the bathroom

Severe Decline

At this stage of the disease, your loved one will no longer be able to manage basic life-sustaining activities, such as dressing themselves, bathing independently, or even remembering to eat or drink. Behaviors and signs of this stage can include:

  • Difficulty speaking
  • Trouble recognizing close family members
  • Inability to orientate themselves to time and place
  • Pacing, fidgeting, and moving objects around repetitively
  • Verbal and/or physical outbursts
  • They likely need hand-over-hand assistance to eat and drink

Very Severe Decline

Once individuals reach the final stage of Alzheimer’s, they require around-the-clock hands-on care. They may become completely mute, or if not, their vocabulary is often limited to just a few words that are difficult to understand and used out of context.

When your loved one enters this stage, you may also notice that:

  • They can no longer control their facial movements, which means they can’t smile or laugh
  • They can’t walk or turn over in bed
  • When in the seated position, they’ll fall over unless the chair has armrests
  • Their joints may become rigid, and they might be unable to bend their legs or arms

Because this stage involves a near-complete lack of physical mobility, it’s common for individuals to suffer from pneumonia, bedsores and other mobility-related problems.

What Is the Life Expectancy of Someone With Alzheimer’s?

The life expectancy for someone diagnosed with Alzheimer’s disease ranges from as little as three years to over 20 years, with the average being 11 years from the date of diagnosis.

Alzheimer’s longevity is influenced by a number of factors, such as:

  • The age of the individual when diagnosed with the disease
  • Their gender, since women tend to live slightly longer than men
  • Any other acute and chronic health conditions the patient may have, such as diabetes, cancer, heart disease and arthritis
  • Genetic predisposition to health issues
  • Whether or not the individual engages in high-risk behaviors, such as wandering, or if they’re prone to falling
  • What kinds of supports the individual receives to help delay the progression of Alzheimer’s related health issues, such as dehydration, poor medication management, malnutrition and lack of activity

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