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It is difficult to place a patient with Alzheimer's disease in a specific stage. However, symptoms seem to progress in a recognizable pattern and these stages provide a framework for understanding the disease. It is important to remember they are not uniform in every patient and the stages often overlap.
First Stage - 2 to 4 years leading up to and including diagnosis
Symptoms
- Recent memory loss begins to affect job performance
- What was he or she just told to do?
- Confusion about places - gets lost on way to work
- Loses spontaneity, the spark or zest for life.
- Loses initiative - can't start anything.
- Mood/personality changes - patient becomes anxious about symptoms, avoids people.
- Poor judgment - makes bad decisions.
- Takes longer with routine chores.
- Trouble handling money, paying bills.
Examples
- Forgets which bills are paid. Can't remember phone numbers.
- Loses things. Can't remember grocery list.
- Arrives at wrong time or place, or constantly rechecks calendar.
- Not the same personality - withdrawn, disinterested.
- Spends all day making dinner and forgets to serve several courses.
- Pays the bills three times over, or doesn't pay for three months.
Second Stage - 2 to 10 years after diagnosis (longest stage)
Symptoms
- Increasing memory loss and confusion
- Shorter attention span.
- Problems recognizing close friends and/or family.
- Repetitive statements and /or movements.
- Restless, especially in late afternoon and at night.
- Occasional muscle twitches or jerking.
- Perceptual motor problems.
- Difficulty organizing thoughts, thinking logically.
- Can't find right words - makes up stories to fill in blanks.
- Problems with reading, writing and numbers.
- May be suspicious. irritable, fidgety, teary or silly.
- Loss of impulse control - sloppy - won't bathe or afraid to bathe - trouble dressing.
- Gains and then loses weight.
- May see or hear things that are not there.
- Needs full-time supervision.
Examples
- Can't remember visits immediately after you leave.
- Repetitive movements or statements.
- Sleeps often; awakens frequently at night and may get up and wander.
- Perceptual motor problems - Can't follow written signs, write name, add or subtract.
- Suspicious - May accuse spouse of hiding things, infidelity; may act childish.
- Loss of impulse control - Sloppier table manners. May undress at inappropriate times or in the wrong place.
- Huge appetite for junk food and other people's food; forgets when last meal was eaten, then gradually loses interest in food.
Terminal Stage - 1 to 3 years
Symptoms
- Can't recognize family or image of self in mirror.
- Loses weight even with good diet.
- Little capacity for self care.
- Can't communicate with words.
- May put everything in mouth or touch everything.
- Can't control bowels, bladder.
- May have seizures, experience difficulty with swallowing, skin infections.
Examples
- Looks in mirror and talks to own image
- Needs help with bathing, dressing, eating and toileting.
- May groan, scream or make grunting sounds.
- Sleeps more.
Source: Care of Alzheimer's Patients: A Manual for Nursing Home Staff, by Lisa P. Gwyther, ACSW. American Health Care Association and Alzheimer�s Disease and Related Disorders Association, 1985.
 © 1997 - 2001 Alzheimer's Association, National Capital Area. All rights reserved.
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