It is important to note that not everyone living with Alzheimer's or a related
dementia will experience the same symptoms or progress at the same rate over
time. As a result, the Seven Stages of Alzheimer's should be look at as
guidelines to expectations.
People with Alzheimer’s typically live an average of 8 years after diagnosis,
but may survive anywhere from 3 to 20 years.
The framework for this section is a
system that outlines key symptoms characterizing seven stages ranging from
unimpaired function to very severe cognitive decline. This framework is based
on a system developed by Barry Reisberg, M.D., Department of Psychiatry at the
New York University Langone Medical Center.
Within this framework, we have noted
which stages correspond to the widely used concepts of mild, moderate,
moderately severe and severe Alzheimer’s disease. We have also noted which
stages fall within the more general divisions of early-stage, mid-stage and
late-stage categories.
Stage 1: No Impairment (Normal Function)
Unimpaired individuals experience no
memory problems and none are evident to a health care professional during a
medical interview.
Stage 2: Very Mild Cognitive Decline (May be normal age-related changes or
earliest signs of Alzheimer's disease.
Individuals may feel as if they have
memory lapses, especially in forgetting familiar words or names or the location
of keys, eyeglasses or other everyday objects. But these problems are not
evident during a medical examination or apparent to friends, family or
co-workers.
Stage 3: Mild Cognitive Decline
Early-stage Alzheimer's can be
diagnosed in some, but not all, individuals with these symptoms:
· Friends, family or
co-workers begin to notice deficiencies. Problems with memory or concentration
may be measurable in clinical testing or discernible during a detailed medical
interview. Common difficulties include:
·
Word- or name-finding
problems noticeable to family or close associates.
·
Decreased ability to
remember names when introduced to new people.
·
Performance issues in
social or work settings noticeable to family, friends or co-workers.
·
Reading a passage and
retaining little material.
·
Losing or misplacing a
valuable object.
·
Decline in ability to
plan or organize.
Stage 4: Moderate Cognitive Decline (Mild or Early-Stage
Alzheimer's Disease)
At this
stage, a careful medical interview detects clear-cut deficiencies in the
following areas:
·
Decreased
knowledge of recent occasions or current events.
·
Impaired
ability to perform challenging mental arithmetic-for example, to count backward
from 75 by 7s.
·
Decreased
capacity to perform complex tasks, such as planning dinner for guests, paying
bills and managing finances.
·
Reduced
memory of personal history.
·
The
affected individual may seem subdued and withdrawn, especially in socially or
mentally challenging situations.
Stage 5: Moderately Severe Cognitive Decline (Moderate or Mid-Stage
Alzheimer's Disease)
Major gaps in memory and deficits in
cognitive function emerge. Some assistance with day-to-day activities becomes
essential. At this stage, individuals may:
· Be unable during a medical
interview to recall such important details as their current address, their
telephone number or the name of the college or high school from which they
graduated.
· Become confused about
where they are or about the date, day of the week or season.
· Have trouble with less
challenging mental arithmetic; for example, counting backward from 40 by 4s or
from 20 by 2s.
· Need help choosing
proper clothing for the season or the occasion.
· Usually retain
substantial knowledge about themselves and know their own name and the names of
their spouse or children.
·
Usually require no
assistance with eating or using the toilet.
Stage 6: Severe Cognitive
Decline (Moderately Severe or Mid-Stage Alzheimer's Disease)
Memory difficulties continue to worsen, significant personality changes may
emerge and affected individuals need extensive help with customary daily
activities. At this stage, individuals may:
·
Lose most awareness of
recent experiences and events as well as of their surroundings.
·
Recollect their personal
history imperfectly, although they generally recall their own name.
· Occasionally forget the
name of their spouse or primary caregiver but generally can distinguish
familiar from unfamiliar faces.
· Need help getting
dressed properly; without supervision, may make such errors as putting pajamas
over daytime clothes or shoes on wrong feet.
·
Experience disruptions
of their normal sleep/waking cycle.
· Need help with handling
details of toileting (flushing toilet, wiping and disposing of tissue properly).
·
Have increasing episodes
of urinary or fecal incontinence.
· Experience significant personality changes and behavioural symptoms, including
suspiciousness and delusions (for example, believing that their caregiver is an
impostor); hallucinations (seeing or hearing things that are not really there);
or compulsive, repetitive behaviours such as hand-wringing or tissue shredding.
·
Tend to wander and
become lost.
Stage 7: Very Severe Cognitive Decline (Severe or Late-Stage Alzheimer's Disease)
This is the final stage of the
disease when individuals lose the ability to respond to their environment, the
ability to speak and, ultimately, the ability to control movement.
· Frequently individuals
lose their capacity for recognizable speech, although words or phrases may occasionally
be uttered.
·
Individuals need help
with eating and toileting and there is general incontinence of urine.
·
Individuals lose the
ability to walk without assistance, then the ability to sit without support,
the ability to smile, and the ability to hold their head up. Reflexes become
abnormal and muscles grow rigid. Swallowing is impaired.
(Source:
Alzheimer’s Reading Room, Update 19 April 2013)
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