Memory lossInability to problem-solveLack of judgment
While no two cases of Alzheimer’s follow the same path, the progression of AD generally falls into three primary stages based on signs and symptoms.
This article looks at the three stages of Alzheimer’s disease recognized by the National Institutes of Health (NIH), how they interfere with activities of daily living (ADL), and what stage 3 of Alzheimer’s is like depending on the severity of dementia.
Stages and Activities of Daily Living
Alzheimer’s staging involves activities of daily living and how much the disease interferes with them.
ADLs are the routines you go through every day, such as:
EatingDressingBathing/showeringHygiene and grooming (e. g. , brushing your teeth and hair)
As AD progresses through the stages, ADLs become more and more difficult.
Stage 1: Preclinical Alzheimer’s
In stage 1, your brain may have begun to change. For example, imaging studies may reveal changes in nerve cells and the build-up of amyloid-ß (beta), an abnormal protein that forms masses in the brain called plaques.
During this stage, you may have no symptoms or symptoms that are too mild to notice. Your ADLs remain unimpaired. Stage 1 can last for many years or even decades.
This stage is most often diagnosed in research studies, not in clinical practice.
Stage 2: Mild Cognitive Impairment
Stage 2 is called mild cognitive impairment (MCI). It’s defined as:
More memory problems than are normal for your ageSymptoms still don’t have a significant impact on ADL
Symptoms of MCI are usually mild and involve problems in cognition—brain-based abilities required to learn, form and retrieve memories, problem-solve, and pay attention.
The first symptoms of Alzheimer’s vary from person to person. You may experience:
Memory loss Difficulty recalling known words Vision problems Impaired reasoning or judgment
These problems may lead to behaviors such as:
Wandering and getting lostForgetting to pay billsMissing appointmentsLosing thingsRepeatedly asking the same questions
Most people are diagnosed during this stage. Symptoms necessary for a diagnosis of MCI include:
Concern about a change in cognition (compared to your previous level of function)Impairment of one or more cognitive functions, such as problem-solving or memory, that’s greater than expected for your age and education levelAbility to perform ADLs, although they may have started becoming more difficult
Stage 3: Alzheimer’s Dementia
Not everyone with MCI will go on to develop the third and most severe stage of Alzheimer’s disease—Alzheimer’s dementia. This stage involves problems with the brain, including:
Loss of normal neuron (brain cell) connections Death of nerve cells due to amyloid plaques and other factors
Alzheimer’s dementia is classified by its severity.
Mild Dementia
In mild Alzheimer’s dementia, symptoms are severe enough to interfere with ADLs. They include:
Worsening memory loss, when compared to MCIPoor judgmentMaking bad decisionsDeclines in motivation and spontaneityTaking longer than normal to perform daily tasks
This leads to problems and behaviors such as:
Repeating the same questions or stories over and overHaving difficulty balancing the checkbook, managing money, and/or paying billsGetting lost in familiar placesWandering away from homeLosing things and finding them in very odd places (such as the cell phone in the refrigerator)
Moderate Dementia
The hallmark sign of moderate Alzheimer’s dementia is that supervision becomes increasingly necessary. Symptoms interfere more with ADLs and involve:
Worsening memory loss and confusionAn inability to learn anything newWorsening language problems (reading, writing, remembering words)Trouble calculating numbersProblems thinking logicallyHeightened problems with focusDeclining attention spanTrouble organizing thoughtsAn inability to cope with stress or new situations
In addition, the following symptoms are notable in the moderate Alzheimer’s dementia stage:
Difficulty with multi-step tasks (such as following a recipe) Trouble recognizing people (including close friends and family members) Symptoms of paranoia (severe fear), delusions (believing things that are untrue), and hallucinations (seeing things that aren’t there) Angry outbursts Impulsive behavior Inappropriate language Restlessness, anxiety, and agitation Wandering/getting lost in familiar places (such as a person’s own neighborhood) Impulsive behavior such as undressing at inappropriate times or places or using vulgar language Inappropriate outbursts of anger Repetitive movements or muscle twitches
Severe Dementia
People with severe Alzheimer’s dementia are completely dependent on others for care and require 24/7 supervision. Symptoms from the moderate stage grow worse.
Additional symptoms may be:
Trouble eating and swallowing Weight loss Inability to communicate Skin infections Loss of bowel and bladder control Constant sleeping or being bedridden Inability to walk Seizures
Eventually, the body shuts down and death occurs.
New Understanding
Alzheimer’s didn’t used to be diagnosable until memory loss and other symptoms became apparent. Now, studies have found changes in the brain may start 20 or even 30 years before the first symptoms begin.
With the early stages better recognized, people are getting an earlier diagnosis. That means they can start treatments and preventive measures that may stave off symptoms and the progression to later stages.
The NIH has funded research aimed at even earlier detection of preclinical Alzheimer’s disease.
Summary
Alzheimer’s disease involves three stages: preclinical disease, mild cognitive impairment, and dementia. The dementia stage is divided into mild, moderate, and severe categories.
As the disease advances, symptoms of memory loss and other cognitive declines become more apparent and more likely to impair activities of daily living. The people who progress to the final stage need around-the-clock care and supervision.
With advances in diagnosis, treatment, and prevention, fewer people advance to the dementia stage.
A Word From Verywell
When you or a loved one is diagnosed with Alzheimer’s disease, it can be frightening. It’s normal to go through a grieving process as you adjust to living with the disease.
Rest assured, though, that treatments are always improving. Fewer people are now progressing out of the earlier stages and into dementia. And future research is likely to improve the situation even more.
