Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking about What are the Stages of Alzheimer’s Disease? I’ve taken care of thousands of older adults living with Alzheimer’s disease and ultimately dying either with or from this devastating disease. I hope this podcast’s information will help you be prepared as your loved one moves through each stage of the disease.
There is some variation in what different people think are the Stages of Dementia. I am of the mindset to keep things simple – so I think of this disease in 4 stages: Early-, Middle-, Late- and End-Stage, or Mild, Moderate, Severe, and ultimately the dying process.
The stages help understand the overall picture of what to expect with a person’s ability and should be used as a general guide. I see people trying to peg a loved one into one of the seven stages and want to know if the person is leaving Stage 4 and entering Stage 5. You will have to adapt the care provided to the moment and the person in front of you, regardless of stage or progression. There’s often a lot of overlap, and I recommend you don’t get caught up in the specific stages – even if you’re using these three.
Here’s what we know about Alzheimer’s disease – it’s a progressive, neurodegenerative disease, meaning your brain fails over time. When your brain fails, that means your ability to do anything for yourself will fail by the time you get to the Late-Stage. How quickly a person deteriorates varies – and can range from 4-8 years, and up to 20, depending on how healthy the person is otherwise.
Early-Stage Alzheimer’s – or Mild
In the early stages, a person may be able to function pretty independently. They may be able to drive familiar routes, work, and participate in social activities. The symptoms may not be very apparent at this stage, but family and close friends may notice some changes, such as forgetting familiar words – See my Podcast on the Ten Warning Signs – or where they put things.
Common symptoms or difficulties in this stage include:
- Trouble remembering names when introduced to new people
- Coming up with the right name or word – particularly nouns
- Losing or misplacing valuable or commonly used items
- Have trouble with planning or organizing
- Have difficulty performing tasks at work
Middle-stage Alzheimer’s – or Moderate
The middle stage is the longest stage and can last for many years. During this stage, the symptoms will be much more apparent, and the person will need a greater level of care. The person may get confused or angry or act in unexpected ways – like refusing to bathe. The person will have more trouble expressing thoughts, may confuse words, or have trouble performing routine tasks without assistance.
Common symptoms or difficulties in this stage include:
- Being moody, think mood swings, especially in mentally or socially challenging situations.
- They will have a much easier time recalling information from long ago and have more difficulty with short-term memory – meaning they can remember childhood or young adulthood memories but can’t recall what they had for breakfast.
- They may be more confused about what day it is – or where they are. They will lose orientation to time first, then place, then person, meaning they will know who they are for longer than they know where they are or what year/ season they are in.
- They may need help choosing clothes that are appropriate for the season or the occasion.
- Trouble with bowel or bladder; or may get their days and nights mixed up.
- May wander more and get lost easier.
- May have personality or behavioral changes – such as delusions, compulsiveness, or suspiciousness, or they may have more repetitive behaviors like wringing their hands or shredding tissues.
In the middle stages, the person can still participate in activities of daily living, like bathing, grooming, or getting dressed, but they will need assistance. You should adjust the amount of care you provide based on what the person can do at the moment and simplify tasks if you can. Care will get more intense over time, so know what resources you have in your community like Adult Day Care or Respite Care so you can get a temporary break from caregiving while your loved one is in a safe place.
Alzheimer’s disease makes us all take one day at a time and live in the present. It can be a very long process, so I hope this information and recommendations for finding support have been helpful. Thank you for watching this video or listening to the podcast today.
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer.
I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (2011) ) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities.
Find out more about her work HERE.