Stages of Symptom Progression in Alzheimer's Disease

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.

1. Early Stage:

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 routines 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 times or place, or constantly rechecks calendar.
"Mother's not the same -- she's withdrawn, disinterested."
She spent all day making dinner and forgot to serve several courses.
She paid the bills three times over, or didn't pay them for three months.

2. Middle 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 -- difficulty getting into a chair, setting the table for a meal.
Can't find the right words.
Problems with reading, numbers -- 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.

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3. Late Stage:

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, Member, Committee on Patient and Family Services, Alzheimer's Association.

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