Alzheimer’s Disease Stages

Alzheimer’s disease (AD) causes a progressive cognitive decline. That means it damages your brain over time and causes dementia. Healthcare providers use stages to say where you are in the disease progression. These are loose groupings that refer to how advanced the AD is.

Some providers group Alzheimer’s disease into five stages based on the severity of dementia you have:

• Preclinical Alzheimer’s disease (you have no noticeable symptoms)
• Mild cognitive impairment (MCI) that causes some symptoms (but isn’t enough to be considered dementia)
• Mild dementia
• Moderate dementia
• Severe dementia

Mild cognitive impairment means that you have more memory difficulties than usual for your age. But you’ll still be able to do everyday tasks without help. You’ll still be able to shop for yourself, do tasks around home and manage your own finances without trouble.

Dementia means cognitive issues affect your day-to-day life. You might have trouble managing everything at home, paying bills on time or doing everyday tasks.

Many providers use a broader set of stages, including:

• Preclinical Alzheimer’s disease
• Mild Alzheimer’s (early)
• Moderate Alzheimer’s (middle)
• Late Alzheimer’s (severe)

Don’t be afraid to ask your healthcare provider what they mean when they use certain words to describe the stages of Alzheimer’s. No matter which type of staging your provider uses, they’ll help you adjust to changes in your brain and body.

How can you tell which stage of Alzheimer’s disease someone is in?

Your provider will diagnose which stage you’re in based on a few factors, including:

• The symptoms you’re experiencing
• How much Alzheimer’s disease has damaged your brain
• How much it impacts your day-to-day routine

Remember, AD affects everyone differently. And it can sometimes be hard to tell the difference between normal aging and changes that should be concerning. Talk to your healthcare provider about any changes you feel or notice.

Alzheimer’s symptoms are more noticeable and affect your brain and body the further it progresses. Using the four-stage system, the most common symptoms in each stage include:

Preclinical Alzheimer’s disease

People who go on to develop AD often experience a preclinical stage. You might feel like your thinking or mental abilities are changing. Everyday tasks may feel more difficult. And you may feel like you need to change how you do some things to compensate for them feeling harder.

This stage can be impossible to distinguish from normal aging. Loved ones, coworkers or friends probably won’t notice any changes in how you act at this point.

Mild Alzheimer’s symptoms

Memory loss is the most common early Alzheimer’s symptom. It usually affects your memory for recent events. You may forget facts you just learned, especially recent events, places and names.

You’ll still recognize familiar faces and loved ones. You’ll probably still be able to drive, get around familiar places and take care of yourself without issues. Many people aren’t diagnosed until they start experiencing mild Alzheimer’s symptoms.

Other signs and symptoms of early Alzheimer’s include:

• Struggling to find the right words or express your thoughts
• Having trouble making plans or organizing a schedule
• Losing or misplacing objects more than usual
• Difficulties with problem-solving, reasoning or decision making
• Taking longer than usual to complete routine daily tasks
• Increased agitation, anxiety or changes in your sleeping habits
• Knowing your memory has changed, but not being able to understand how much

Moderate Alzheimer’s symptoms

You’ll probably need extra care and assistance when you enter the moderate stage of Alzheimer’s. You might struggle to recognize people, especially acquaintances or relatives you don’t see often. It’s common to live longer in this stage than any other.

Common symptoms include:

• Confusion: You may have a hard time keeping track of what day it is or where you are. It might be hard to do simple math, even if you’re usually good at it.
• Increased memory loss: Issues with your short-term memory will become more severe. AD will start to affect your long-term memory, too. You might forget events or details about your life, like your phone number or where you went to school.
• Needing help with self-care: You might not be able to bathe or shower, use the bathroom or groom yourself safely. It’s common to start losing control of your pee (urinary incontinence) and poop (fecal incontinence).
• Language problems: It will be harder for you to speak and write. You might have a hard time saying the right word or idea when you’re talking. If you speak more than one language, you may mix and match words, or default to discussing stories from when you were growing up. You might have a hard time understanding what others are telling you.
• Personality changes: You may become more agitated or aggressive. It’s common for people in the moderate stage to feel suspicious of others, even loved ones. You might experience mental health issues like depression or anxiety. You might experience hallucinations, paranoia and delusions.
• Wandering from home: You might start to wander without knowing it. Some people walk around their home. Others leave the house entirely. You might need a loved one or another caregiver to check on you to make sure you’re staying safe throughout the day.

Severe Alzheimer’s symptoms

The severe stage of Alzheimer’s is the last stage. Providers sometimes call it end-stage Alzheimer’s or terminal stage. That’s because this is the stage people are in when they die. Your provider might suggest hospice care during this stage.

You’ll experience severe dementia symptoms and will probably need constant care. Severe Alzheimer’s symptoms include:

• Complete (or almost complete) memory loss
• Losing the ability to speak or use language to communicate
• More frequent complications like infections, bedsores and trouble swallowing
• Not knowing where you are or being unaware of what’s going on around you
• Needing help with many or all daily activities, including eating, walking or sitting up

How can I prepare for each stage of Alzheimer’s disease?

Learning how Alzheimer’s disease progresses can be scary. It’s probably overwhelming to read a list of symptoms you haven’t experienced yet, but need to plan for.

But knowing what comes next can help you get ready.

You’ll need to:

• Manage symptoms: Your healthcare providers will help you prepare for each stage of Alzheimer’s disease. They’ll suggest medications, clinical trials and other ways to help you manage the symptoms. There’s currently no cure, but you may be able to slow down AD’s progression with treatment. Everyone’s brain and body respond differently to Alzheimer’s disease. Your providers will help you understand what you can expect.
• Plan for the future: You can start planning ahead now before you experience more severe symptoms. You might want to think about things like advanced directives and legal and financial plans.
• Talk to your loved ones: People who care for you now will still love you in the future. Having Alzheimer’s disease won’t change that.
• Caregiver support: Loved ones who will help care for you need support, too. It can be hard for them to process all of their own feelings on top of learning everything they need to know to help you. That’s OK. Your healthcare provider can suggest resources or support groups that can help them connect with other people in similar situations.

How long do stages of Alzheimer’s last?

It can sometimes be difficult for providers to place a person with AD in a specific stage. The stages can overlap and there’s not always a set time you leave one and enter another. You can expect to spend the longest in the moderate stage:

• The preclinical stage can last several years.
• The mild stage usually lasts a year or two.
• The moderate stage can last anywhere from a few years to 10 or more.
• The severe stage typically lasts for fewer than two years.

No two people experience Alzheimer’s in the same way. Everyone progresses through the stages at different speeds. How quickly the condition progresses depends on a few factors, like:

• If you have early-onset Alzheimer’s (it usually progresses faster)
• Your age at diagnosis
• Your overall health

How do you know when someone enters the terminal stage of Alzheimer’s?

Your provider will tell you and your loved ones when you enter the severe or terminal stage of Alzheimer’s. They’ll make that diagnosis based on your symptoms and imaging tests of your brain.

Being in the terminal stage doesn’t mean you’re going to die right away, or even soon. You may live in this stage for years. You might not be able to think or remember by the time you have severe dementia. Your provider will work with your loved ones to make sure you get the treatment and support you need.