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What are the 7 stages of Alzheimer's?

The progression of Alzheimer's can be broken down into seven stages: (1) No Impairment, (2) Very Mild Decline, (3) Mild Decline, (4) Moderate Decline, (5) Moderately Severe Decline, (6) Severe Decline, (7) Very Severe Decline. This system was developed by Dr. Barry Reisberg.

Before we start, please remember that the progression of Alzheimer's varies from person to person.

How Alzheimer’s develops in your case can not be predicted by this article.

Your general practitioner may not use this model to diagnose Alzheimer’s. You can read more on the other model in “Alzheimer’s Disease - All You Need to Know Guide (2021)”.

Table of Content
1. No Impairment
2. Very Mild Decline
3. Mild Decline
4. Moderate Decline
5. Moderately Severe Decline
6. Severe Decline
7. Very Severe Decline.
8. Conclusion
List of Resources
About the Author

1. No Impairment

The beloved person has no memory problems or other symptoms like loss of cognitive function.

Alzheimer's is not yet detectable by memory test.

But, a microscopic evaluation, which searches for amyloid plaques and neurofibrillary tangles in the brain, can give the first hint.

Herein, modern brain imaging techniques like MRI or PET scans are used for evaluation.

2. Very Mild Decline

In this stage, your beloved one might start losing things. For example, it is typical to lose a wallet or a book.

These minor memory problems are being noticed by the Alzheimer-affected person.

However, these memory problems might be difficult to distinguish from normal age-related memory problems.

Thus, the progression is not detectable by the general practitioner because the individual still scores well enough on a memory test.

Remember this

A common test used to assess memory is the Mini-Mental-Status-Test.

Besides, the changes are not yet noticeable by family members.

3. Mild Decline

Now, the first cognitive problems are noticeable to friends and family members.

The score on a Mini-Mental-Status-Test shows proof for impaired cognitive function.

The beloved one will have difficulties in the following areas:

What are Symptoms of Mild Decline in Alzheimer's?
4 Symptoms
Organizing and planning: Following a simple step-by-step recipe is difficult.
Difficulties with finding the right words: For example, a watch is suddenly a hand clock.
Arithmetic problems: Counting down (e. g. 100 - 9) becomes increasingly challenging.
Misplacing things: Steps to retrace a lost item are not found.

As you can see, the individual starts to struggle with normal cognitive tasks.

Family members can help by using communication techniques to make the individual feel safe and protected.

I wrote an entire article on "How to talk to someone with Alzheimer's", which I warmly recommend any family member to read.

4. Moderate Decline

A person in this stage experiences the first symptoms of Alzheimer's in day-to-day activities.

Such symptoms include:

What are Symptoms of Moderate Decline in Alzheimer's?
3 Symptoms
Having trouble with short-term memory: For example, struggling to recall a list of three words (e.g. "Ball", "School", "Bird") after one minute.
Inability to manage finances and paying bills: Family members should overtake these tasks like paying the water and gas bills.
Arithmetic troubles: Summing up numbers in the head does not work anymore.

Arrangements for a nursing home should be set in place. From here on the disease rapidly progresses.

5. Moderately Severe Decline

As mentioned in stage four, the disease progresses rapidly. Therefore, the beloved person begins to need help with daily activities.

Commonly, individuals experience:

What are Symptoms of Moderately Severe Decline in Alzheimer's?
2 Symptoms
Significant confusion with time and place: For example, telling what date or what time of the year it is, is complicated.
Recalling details about oneself: Forgetting one's phone number is normal at this stage.

Your beloved one should still be capable of showering and going to the toilet alone.

Just be careful with the toothbrush. I know cases first hand, where individuals brushed their eyes with a toothbrush.

6. Severe Decline

At this point, the individual needs 24/7 care. There is a high risk of self-harm.

This is due to a new set of symptoms:

What are Symptoms of Severe Decline in Alzheimer's?
3 Symptoms
Behavior changes: The personality can change and the behavior becomes increasingly mean and aggressive.
Need for assistance: Going to the toilet alone is not anymore possible. The same accounts for taking a shower. Help can be required with eating breakfast, lunch, and dinner.
Wandering: One might just start walking away without aim and reason.

At this stage, the beloved person should be placed in a nursing home.

This way the self-harm risk can be reduced and one can live with basic human decency.

7. Very Severe Decline.

It is the final stage of Alzheimer's. The progression of Alzheimer's has reached so far that preparations for death and funeral can be set in motion.

The person is bed-bound. Needs feeding through a tube, because swallowing does not anymore work.

The ability to communicate is about to be lost. Uttering words might be still possible.

Please read the Alzheimer's guide, in case you want to know in detail what most cases of death look like.

8. Conclusion

Whether you have a beloved person affected by Alzheimer's or you are someone with the condition, the disease will slowly impact your day-to-day life.

Knowing about the stages helps to prepare for the worst.

However, a psychologist or therapist can serve with professional advice, too.

Alzheimer's can have various psychological effects on family members and someone with the condition.

The behavioral changes make it difficult for family members to adapt.

The psychologist can support them with communication techniques like seen in my article "How to talk to someone with Alzheimer's".

The therapist can help prevent psychological effects like depression.

List of Resources

Patric Pförtner

B. Sc. Psychology

Hi, my name is Patric Pfoertner and I graduated 2020 from the NBU. Currently, I work and study in Germany. My specialisations are Cognitive Psychology paired with a good slack of Clinical Psychology. Just this year I started publishing my research in the CBB Journal. Feel free to read about it at ResearchGate. Otherwise, click the other button to read my full CV.

About Author ResearchGate

P.S.: I am available for psychological consultation, too.