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What are the "stages" of Alzheimer's?

You might be surprised to learn that there’s no single definition of the “stages of Alzheimer’s.” Several different staging approaches are variously used; all reflect the fact that Alzheimer’s is a degenerative disease (it gets gradually worse) that progresses along a spectrum.

Depending who you talk to, you might encounter any of the following three most common ways of staging Alzheimer’s dementia. The first one is the most useful to caregivers, I think, because of its practicality and ease of understanding. It’s also fairly applicable to any type of progressive dementia.

1. Mild-Moderate-Severe dementia staging

Probably the most widely used staging system due to its simplicity, this approach refers to three main phases: mild (early), moderate (middle) and severe (advanced or late). Because they chart degeneration, they’re sometimes further subdivided (early mild, mid-mild, late mild, early moderate, and so on).

A key insight: Skills and abilities are lost in the reverse order of which they’re learned. So more advanced skills gained during adolescence, like paying bills, disappear well before basic skills mastered in infancy, like self-feeding.

Mild-stage Alzheimer’s

The person can still manage basic self-care and communicate well, but memory changes are interfering with independent activities of daily living (IADLs), higher-order thinking skills, such as driving, shopping, preparing meals, and managing money or medications.

Think of mild-stage dementia as: Losing the skills that had been gained in the teenage years.

Someone with mild-stage Alzheimer’s may:

  • Repeat questions and comments

  • Show poor judgment or an inability to plan or make decisions

  • Get lost on familiar routes (walking or driving)

  • Seem preoccupied or irritable, or show other personality changes

  • Have trouble with basic finances, transportation, and medications.

Moderate-stage Alzheimer’s

The person begins to have trouble with the so-called “activities of daily living” (ADLs), which are such basic skills as getting dressed, grooming, self-feeding, walking, and toileting.

Think of moderate-stage dementia as: Losing the skills that were gained during childhood.

Someone with moderate-stage Alzheimer’s may:

  • Remember the distant past better than more recent events

  • Need help choosing clothes or dressing, brushing teeth, or bathing.

  • Fidget restlessly, pace, wander away from home, shadow a caregiver

  • Have delusions (fixed false beliefs), make false accusations

  • Experience evening agitation known as sundowning

Severe-stage Alzheimer’s

The person becomes unable to perform the activities of daily living without significant help. Basic life skills (speaking, sitting up, continence) are also affected.

Think of severe-stage dementia as: Losing essential skills that were