Stages of Alzheimer's Disease – Seven Stage Model

The seven stages of Alzheimer's disease reflects the step-by-step progression of damage as Alzheimer's disease travels through the brain. The disease first affects the hippocampus, the area in the center of the brain in which new memories are formed. This corresponds to the memory problems, particularly problems with recent memories, that is one of the earliest signs of Alzheimer's. The last stages of Alzheimer's disease are manifested by decreasing coordination and balance, and complications with vital functions such as blood pressure and breathing. These are functions controlled by the cerebellum and the brain stem, the last (approximately seventh) areas of the brain to be affected.

Stage One Alzheimer's – Normal

In the first stage of Alzheimer's disease there is no noticeable declination in cognitive ability. The plaques and tangles associated with the disease can exist in the brain for several years before having any discernable affect.

Stage Two Alzheimer's – Very Mild Impairment

The individual may begin to feel that she is having memory problems. This is especially evident with more recent memories. The hypothalamus, that part of the brain responsible for converting experiences into memories, is the first part of the brain attacked by Alzheimer's disease.

In this early stage, a word needed to complete a sentence might be hard to remember, or common items like glasses or car keys might get misplaced frequently. These changes are generally not recognized by family or friends at this stage, and will likely not even be identified in a medical examination. These symptoms are generally associated with normal aging, but will be more pronounced and advance more rapidly in the person with Alzheimer's disease.

Stage Three Alzheimer's – Mild Impairment

The cognitive deficits of the previous stage become more pronounced in the third stage of Alzheimer's, and may become evident to others. Alzheimer's disease is moving forward, into the temporal lobe of the brain, an area responsible for memory and language. Damage to the temporal lobe is responsible for the difficulty finding the right word that is a common symptom in this stage.

In this stage of Alzheimer's, memory problems may become measurable, and medical diagnosis is often first made during this stage, Very often, as the individual begins to realize that something is not right, he becomes good at hiding or covering up his impairment. For example, many people will develop an intricate note-writing system that will include reminders, dates, etc. to compensate for their cognitive decline.

Other behavioral symptoms and resulting outcomes include:

  • Problems finding the right word or name becomes noticeable to others
  • Job performance may begin to suffer, and behavior in social situations might become increasingly difficult or inappropriate
  • Retention and comprehension of reading material declines
  • Planning and organizing becomes more difficult
  • Becomes unresponsive to stimuli

Stage Four Alzheimer's – Moderate Impairment

Other functions of the frontal lobe include planning and organizing, regulating behavior including

Cognitive impairment at this stage is severe enough to be evident to friends, family, and co-workers. A medical diagnosis can be made with a relatively high degree of certainty. Even major events that are recent, like holiday parties or a vacation, may not now be processed into memory. Older memories may start to fade away, including details of personal history. The affected individual may become more withdrawn, socially inactive, and emotionally unresponsive. Conversation becomes more difficult and less frequent.

Other behavioral symptoms and resulting outcomes include:

  • Forget the day of the week, the month, or even the season. The person with Alzheimer's might put on a winter coat to go outdoors in July
  • Decreased ability to work math or arithmetic problems, especially mental math
  • Complex tasks like paying bills, planning a shopping list, and other Instrumental Activities of Daily Living (Instrumental ADLs) become increasingly difficult
  • Trouble handling household finances

Stage Five Alzheimer's – Moderately Severe Impairment

It becomes very difficult if not impossible for the affected individuals to live independently and carry out the Independent ADLs. Major events of their current lives become obscure or forgotten altogether, including where they live, their current phone number, or the presiding president. When asked they may give an old address, a place they lived ten or twenty years ago, or the name of the president who was in office when they were thirty years old. They will probably remember their own name and the names of close family members. These cognitive deficits are often irregular; something forgotten on one occasion may be remembered later, or certain things from a time period might be remembered and others not.

The memory problems, disorientation, and increasing difficulty with Independent ADLs associated with this stage of Alzheimer's disease make living independently unfeasible and potentially dangerous. It is during this stage that alternative living arrangements are made: in home caregivers, moving in with a family member - a son or daughter for example - or a long term care facility are all appropriate solutions.

Other behavioral symptoms and resulting outcomes include:

  • Simple mental arithmetic becomes challenging
  • Major gaps in memory become apparent as memory problems increase
  • May need help choosing season appropriate clothing, or putting clothes on in the right order
  • Personal car and hygiene may become a problem
  • Personality changes and behavioral problems become increasingly troublesome

Stage Six Alzheimer's – Severe Impairment

This stage of Alzheimer's disease is characterized, in part, by an increase in the severity of many of the problems first seen in earlier stages. The individual sometimes won't remember what happened just minutes ago, and older memories continue to be lost, including details of personal history. Personality changes and behavioral disorders become more pronounced and more disturbing.

An increasing amount of help is required with the Independent ADLs, and the Basic Activities of Daily Living (Basic ADLs) begin to suffer. If inappropriate dressing or other problems with dressing were seen in an earlier stage, they will be more obvious and pronounced, and help will be increasingly necessary. The individual might put her clothes on backward, put underwear on over everything else, or just have difficulty with sleeves, buttons, zippers, etc.

Behavioral and emotional problems can become disturbing for both the individual and the caregiver, especially if that caregiver is family. These changes are probably based as much in the psychological reaction to their condition as to the neurological affects of the disease. The person in this stage of Alzheimer's is aware that he is no longer independent, that his cognitive ability and many of his physical abilities are declining, and that he is no longer a productive member of his family and of society. These realizations can cause a range of emotional behavior from withdrawal to loud and even violent outbursts.

Furthermore, because of these limitations he cannot channel his energies into productive and creative activities. This can cause fidgeting and repetitive behavior, wandering, and other inappropriate behaviors.

Other behavioral symptoms and resulting outcomes include:

  • Might occasionally forget the names of spouse and children
  • Sleep disorders may become evident or worse, including disruption of the normal wake-sleep cycle and sundowning
  • May experience urinary and fecal incontinence - may need help with toileting
  • Hallucinations, sometimes experienced in earlier stages, will likely become more common and more severe
  • Wandering, with the very real danger of becoming lost
  • Paranoid and suspicious behavior - the individual might think that someone is stealing his things, or poisoning him
  • Poor hygiene

Stage Seven Alzheimer's – Very Severe Impairment

The last stage of Alzheimer's disease is characterized by a need for constant care and assistance with ADLs, almost total loss of speech, and the eventual loss of control of the muscles and of motion. Eventually even the organs shut down, and if the individual has survived this long, death follows shortly.

For the person in this stage, walking becomes increasingly difficult, even with help, and then impossible. He progressively looses the ability to sit up unsupported, to hold his head up, then to smile and even to swallow. During this time, as during the entire progression of the disease, proper or extraordinary care can extend the period of time that the individual can use his muscles to walk, feed himself, and carry out many of the other Activities of Daily Living.

As this last stage progresses, joint deformities become increasingly problematic. A joint deformity is a condition in which the range of motion of a major joint can be severely restricted, making movement painful.

Other behavioral symptoms and resulting outcomes include:

  • The capacity for speech can be lost almost entirely
  • Physical rigidity and, eventually, deformities caused by muscular contractures
  • Re-emergence of some of the "infantile" reflexes that occur in infancy but disappear shortly thereafter. The sucking reflex is an example of this
  • Incontinence, especially urinary incontinence, which may have been noticed in an earlier stage, is very common in the last stage of Alzheimer's disease


Death results from the shutdown of organs if Alzheimer's disease progresses to the final stages. However, death often occurs earlier as an indirect result of Alzheimer's disease before the final stage is reached. Infections from bedsores, and pneumonia, which the body is unable to combat normally, are two of the most frequent causes.






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