Understanding the Stages and Symptoms of Alzheimer’s Disease
The National Institutes of Health (NIH) identifies Alzheimer’s disease as having four stages: preclinical, mild (early stage), moderate (middle stage) and advanced (late stage). Below are the symptoms usually experienced in each stage of the disease, as documented by the NIH.
PRECLINICAL STAGE OF ALZHEIMER’S DISEASE
In the preclinical stage of Alzheimer’s disease, changes in the brain begin to occur long before any symptoms are noticeable to the individual or their friends and family. This stage involves the silent accumulation of amyloid plaques and formation of tau tangles without any outward signs of memory loss or cognitive decline. As the NIH states on its website, and as science has demonstrated through assessments of post-mortem brains, not everyone who has plaques and/or tangles in their brains develops Alzheimer’s disease or dementia.
MILD (EARLY-STAGE) ALZHEIMER’S DISEASE
The onset of symptoms marks this stage of Alzheimer’s. The NIH provides the following list of some (or all) of the symptoms that may appear:
- Memory loss that disrupts daily life
- Poor judgment, leading to bad decisions
- Loss of spontaneity and sense of initiative
- Losing track of dates or knowing current location
- Taking longer than normal to complete normal daily tasks
- Repeating questions or forgetting recently learned information
- Trouble handling money and paying bills
- Challenges in planning or solving problems
- Wandering and getting lost
- Losing things or misplacing them in odd places
- Difficulty completing tasks such as bathing
- Mood and personality changes
- Increased anxiety and/or aggression
Often, these symptoms are mild but become noticeable and signal that something is wrong. Providing your medical care provider with symptoms you have noticed may lead to a diagnosis, which will be useful in the management of daily living and care, lifestyle choices and preparing for the future. Despite the challenges that may accompany each of these symptoms, many people in this stage maintain a degree of independence in their daily activities.
MODERATE (MIDDLE-STAGE) ALZHEIMER’S DISEASE
As the disease progresses to the moderate stage, symptoms become more pronounced, and this stage is often the longest in duration. Symptoms may include:
- Increased confusion and memory loss, such as forgetting events or personal history
- Withdrawal from social activities
- Inability to learn new things
- Difficulty with language and problems with reading, writing and working with numbers
- Difficulty organizing thoughts and thinking logically
- Shortened attention span
- Problems coping with new situations
- Changes in sleeping patterns, such as sleeping more during the day and being restless at night
- Difficulty carrying out familiar, multistep tasks, such as getting dressed
- Occasional problems recognizing family and friends
- Hallucinations, delusions and paranoia
- Impulsive behavior, such as undressing at inappropriate times or places, or using vulgar language
- Inappropriate emotional outbursts
- Restlessness, agitation, anxiety, tearfulness, wandering — especially in the late afternoon or evening
- Repetitive statements or movement, occasional muscle twitches
ADVANCED (LATE-STAGE) SEVERE ALZHEIMER’S DISEASE
In the advanced stage of Alzheimer’s disease, individuals are entirely dependent on others, requiring around-the-clock care and support. The degradation of the physical structure of the brain is severe. Symptoms may include:
- Inability to communicate
- No awareness of recent experiences or surroundings
- Weight loss with little interest in eating
- Seizures
- General physical decline, including dental, skin and foot problems
- Difficulty swallowing
- Groaning, moaning or grunting
- Increased sleeping
- Loss of bowel and bladder control
The focus at this stage is on comfort and quality of life, as individuals may spend much of their time in bed and show little interest in eating or interacting with their environment.
