Alzheimer’s stages and what to expect 

Alzheimer’s is a progressive disease that consists of the following 3 stages: early stage (mild), middle stage (moderate), and late stage (severe). These stages offer an overview of the changes and symptoms expected as the disease progresses. It’s important to note that these are only guidelines as everyone’s experience is unique. 

Typically, the brain begins experiencing changes long before people exhibit signs and symptoms. This is known as pre-clinical Alzheimer’s disease and can last several years. While disease progression differs from person to person, on average, an individual with the disease lives four to eight years after an Alzheimer’s diagnosis. Many factors, including age and other health conditions, factor into this. In fact, some individuals have lived up to 20 years following a diagnosis.  

Early Stage (Mild)  

Many people with Alzheimer’s still function independently in the early stages. They may still work and be socially engaged. They may begin noticing memory changes in themselves and friends and family may start noticing that they are having trouble remembering things such as familiar words or the location of everyday objects. 

Common symptoms include:  

• Difficulty with word finding 
• Forgetting something she just read 
• Not remembering names of people she recently met 
• Difficulty performing routine tasks at work or socially 
• Losing or misplacing objects 
• Trouble planning or organizing 

It’s important to allow the person to maintain their independence as much as safely possible. Since they are likely still independent in many areas at this stage, your role as a loved one can be to provide support with things such as: 

• Appointments 
• Managing finances 
• Remembering names or words 
• Transportation 
• Planning and organizing 
• Keeping track of medication 

While individuals in this stage are generally more high-functioning and independent, you will want to keep a close eye on your loved one.  You'll want to make eye contact when communicating and do so as clearly and calmly as possible. 

Middle Stage 

The middle stage is typically the longest and can be experienced for several years. In this stage, the dementia symptoms will start to become more obvious – for instance, they may start confusing words, become agitated, or respond in surprising ways.  As the nerve cells in the brain deteriorate, they will experience challenges expressing thoughts and performing routine tasks independently. This likely means they will require more assistance with routine activities.  

Symptoms, which vary by individual, include:  

• Forgetting personal history and events 
• Noticeable personality or mood changes  
• Disorientation regarding date and time 
• Increased need for assistance with personal care 
• Incontinence  
• Wandering and getting lost 
• Changes in sleep patterns 
• Thinking disturbances, such as suspicion and delusions  

Individuals at this stage will require a greater level of care, but this doesn’t mean they can’t participate in their daily care. It’s critical to understand what they can do and help find ways to simplify those tasks. You will most likely have to adjust your loved ones daily routine to include more structure and may want to start looking into care options at this stage as well. 

Late Stage 

In the final stage of Alzheimer’s, the symptoms are severe, and can last from several weeks to several years. They may still use words or phrases but struggle with communicating emotions, pain, and preferences. They will become less tolerant of medical interventions and will require extensive 24/7 care. 

Common characteristics of the late stage include:  

• Changes in physical abilities, including the ability to walk, sit, and eventually, swallow 
• Needing around-the-clock support with personal care 
• Not knowing their surroundings or recalling recent experiences 
• Increased difficulty communicating 
• Vulnerability to infections, particularly pneumonia 

During this stage, you will want to reevaluate the goals of care and may want to use support services, such as hospice, which focuses on providing comfort and maintaining quality of life.  

Though they may not engage in the same way during the late stage, you are encouraged to find new ways to communicate with them. Using your voice can offer comfort even if your loved one isn’t fully comprehending the message. Be advised to never underestimate the power of touch – such as a gentle hand massage or even holding a hand. You can also play music or read to your loved one. There are so many ways to make meaningful connections. 

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For more caregiving assistance, you can find live expert help by reaching out to a Care Guide via message or by scheduling a phone call.