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Support & Insight for the Autumn of Life

7 Stages of Alzheimer’s

THE SEVEN STAGES OF ALZHEIMER'S are helpful in finding the words to discuss Alzheimer's. Caregivers find them particularly useful in support groups, as well as in conversations with doctors, family and care professionals.

Although the progression of Alzheimer’s disease can be slowed down today thanks to today’s medications, it cannot as of yet be stopped. The process is described in general terms as going through 3 steps:

  1. Mild Alzheimer’s
  2. Moderate Alzheimer’s
  3. Severe Alzheimer’s.

For more meaningful terms between professionals, caregivers and patients, a more detailed process has been characterized in seven stages. The seven stages are based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Stage 1 – Normal

This system calls a mentally healthy person at any age “Stage 1”.

  • No memory problems
  • No problems with orientation

    • person – your name, who you are;
    • place – what country, state, city you live in, where you are;
    • time – what day, date, season it is
  • No problems with judgment
  • No difficulties with communication skills
  • No problems with daily activities

Stage 2 – Normal Aged Forgetfulness

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More than half of all people ages 65 and older complain of cognitive difficulties. This is considered a normal part of aging.

  • Occasional lapses in memory, usually undetectable to family and friends
  • Slight cognitive problems, also undetectable to friends and family, might also not be visible on medical exam

Stage 3 – Mild Cognitive Impairment

At this point, there are mild changes in memory, communication skills and/or behavior, noticeable to family members and friends. Symptoms might be picked up by an alert physician. Many people will not decline further than this point. Notwithstanding, a majority do progress to Mild Alzheimer’s within two to four years.

  • Problems remembering names, words for objects
  • Difficulties functioning at work and in social settings
  • Problems remembering newly-read material
  • Misplacing important items with increasing frequency
  • Decline in organizational skills and the ability to plan
  • Repeating questions and evident anxiety

Stage 4 – Mild Alzheimer’s

Cognitive symptoms are more obvious now. A neurologist can confidently diagnose Alzheimer’s disease and treat it with medications that have been proven effective in slowing it down.

  • Difficulty remembering personal details, recent events
  • Some confusion possible (ie: might put towel in fridge)
  • Impaired mathematical ability, financial management (trouble managing a checkbook – for those who did not have trouble managing one before)
  • Social withdrawal
  • Moodiness, depression

Stage 5 – Moderate Alzheimer’s

This is the stage at which it is not possible for a person with Alzheimer’s to live alone.

  • Severe memory loss, e.g., may not remember basic personal contact information such as current address or phone number
  • Disorientation (not knowing the day/date/season, and/or location/country/state/city)
  • No longer safe to cook, even if the sufferer can manage or remember the logistics of the process, due to severe short-term memory difficulties and confusion
  • Wandering risk; might get lost once leaving the home
  • Decreased personal hygiene skills
  • Increased desire to sleep is common

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Stage 6 – Moderately Severe Alzheimer’s

It is at this stage that family members often suffer the most, because the loved one with Alzheimer’s loses much of the ability to recognize those around him or her, even a spouse, sibling, parent or child. Personality changes are common as well.

  • Severe memory loss continues to intensify
  • Withdrawal from surroundings
  • Wandering
  • Reduced awareness of recent events
  • Problems recognizing loved ones, although it is still possible to differentiate between those who are familiar and those who are not
  • “Sundowning”, if it has not yet begun, makes its appearance at this point – this is the phenomenon of increased restlessness and agitation toward sundown (hence the name), in the late afternoon and evening hours
  • Bathroom management becomes difficult; at this stage it often is necessary to switch to diapers due to incontinence, wetting and other such problems using the bathroom independently
  • Paranoia, suspiciousness
  • Shadowing, extreme anxiety, following a loved one around the house due to fears of being alone
  • Repetitive, compulsive behavior (verbal and/or nonverbal)

Stage 7 – Severe Alzheimer’s

This is the final stage of Alzheimer’s disease, at which the long goodbye comes to an end. Even though the Alzheimer’s person may somewhere inside really hear and understand what is being said, he or she can no longer respond, other than possibly to speak a word or phrase.

  • Communication is very limited
  • Physical systems begin to deteriorate
  • Gross motor coordination shuts down, may not be able to sit
  • Swallowing may become difficult, choking is a risk

The last stage of Alzheimer’s disease, as with any other illness, is a very individual matter and no two journeys end the same way. People with Alzheimer’s seem to experience little physical pain. What is certain, however, is that every Alzheimer’s journey ends – as does every other. May they all be peaceful and pain free.

A Fresh Perspective

For a new, insight-filled perspective on the stages of Alzheimer’s, check out the video:

Teepa Uses Gems To Illustrate The Stages Of Alzheimer’s

In this video, Teepa Snow shows what to expect, while keeping the focus on the person, not the disease.

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June 1, 2016 12:01 am

This is so sad 🙁

I pray that there can be a cure for both Alzheimer's and Dementia. No one should have to go through something like this, whether it is the patient or caregiver. No one deserves to go through so much pain and suffering. It's just so wrong.

—K. Z.

August 25, 2016 1:38 pm

my dad is not able to talk at all. any idea how to communicate with him?

September 4, 2016 9:02 am

My Granddad died in June because of dementia.
The doctor said he wasn't in pain but
Not convinced?
Also, as he was no longer able to communicate, was he lost in his head or did the dementia shut any thoughts down?
I also feel guilty because I cried in front of him.
Horrible death. He was a legend. Worked for the queen and flew Lancaster bombers in ww2. RIP Granddad

December 14, 2016 6:47 pm

My mother went through all stages of Alzheimer's over a period of almost 8 years. I used to hear that Alzheimers can have a very early onset that is hardly diagnosable. Would that be right ?. I can remember her doing occasional strange things. I do have a memory of her coming to my graduation – as a mature student – and seeing her walking with her handbag hanging from her hand almost touching the ground. Her bag was wide open for anyone in the crowds to help themselves to take anything from it! This was so not what my mother normally would do. I let it go.
There then was my father's pride. As the years past, gradually more seemed to be 'not right' in their little bungalow and there was a distinct smell more and more. Getting through the pride of their generation is very very difficult I my belief. Eventually I was able to 'prise' my mother away from dad for a day or two so that she could spend time at a day centre where she was bathed and enjoyed company and was cared for and it gave him a break. The impossible situation grew and grew for dad. One night he collapsed ……..she would hit him, scream at him furiously, want to go out to look for her two cats in the night but of course dad had had to lock her in and endure the stress on his own. I lived and worked almost 90 miles away. I only found out much more later on. When dad collapsed he managed to crawl to their wall phone and call an ambulance. They took him to hospital and he was diagnosed with pneumonia caused by stress. The consultant made it clear that although he recovered well, he was not to return home until my mother was placed in a care home. Only at that point did things speed up.The first Christmas she was at the dare home, I had visited dad too in the bungalow and brought him a small indoor plant as a present. He muttered that it wasn't really his 'thing' to look after and said it was more the sort of thing mum would be able to care for WHEN SHE IS BETTER and when she comes out of there…..meaning the care home of course. So much of this story is full of details I have not expressed. It is a hugely destructive thing is Alzheimer's to partners, families and friends. So sad. I know everyone who has written their stories will understand mine. Dad died of lung cancer in 2010 aged 91 though he had stopped smoking in his early forties. He obviously developed the cancer through my mother's smoking heavily all her married life . Mum died of Alzheimer's and vascular dementia in 2012 . Did the smoking play a part? Reading others words gives me some strength . I just wish the very great lack of support any of us had from the NHS could have been better for longer and not only there for the crisis.

January 24, 2017 3:03 am

my dad has had alzheimers for almost 20 years now his brother had it and was in the hospital for 20 years with tubes and all so my dad made me promise to never do that to him and let him die,he is at the last level and is too tired to walk ,has air all the time and sleeps most of the day.He also wont go to washroom but will take it out of his diaper and pee on the bed or the he seems a bit scared and I am wondering if he is having a hard time swallowing.he holds my hand tight and tells me not to go any where ,rthen hes ok or switches and tells me I can go because hes tired,is that the signs of him dying ,because I would really like everyone to take the time to come see him before he goes so that they dont feel bad that they were to busy to say goodbye

Reply to  Anonymous
February 19, 2018 7:42 am

You know, I've heard other people report that type of behavior many times, with alzheimer's (the thing with begging you not to leave, then spontaneously switching gears and saying you can leave). My grandmother, whom I take care of, likes to follow me around and literally every time I go to use the bathroom, she will be knocking on the door 30 seconds after I close it. There's never a good reason either. It's always "just checking" or "just saying hi". She does the same thing with constantly ringing my phone, then saying she "just wants to say hi", etc. (even if I was just physically in the room with her minutes ago). Point is, I'm not sure why but this constant needy behavior is apparently typical.

February 7, 2018 8:05 am

my mummy is at stage 6. so cruel this awful disease

February 19, 2018 7:38 am

My grandmother is between 5-6. She believes there is nothing wrong with her, and if you bring up the fact that she just asked you the same question 8 times in 2 minutes, she becomes hostile and flips out. I've had to switch her aspirin with lactose tablets, because she takes about 20 a day and was poisoning herself with aspirin (at one point, she had bruises all over her body). She also pathologically hides things; including things that aren't even hers. She's called the police on me numerous times for nebulously-described non-existent "abuse" and also for "cutting up her cats" and hiding their bodies in the garbage. Any time she sees me take the trash out, she will sneak outside to go through it, expecting to find her cats from 20 years ago. Oh yeah, and recently she spontaneously tried to give away her elderly cat, who sleeps at the foot of her bed every night. When questioned, she was unable to articulate any sort of answer. Lately, she likes to ring my phone 30 times a day (especially in the middle of the night) because she perpetually believes she is having a heart attack (hence the aspirin consumption). This is despite her being in remarkably excellent health, aside from her brain.

Thankfully, she can still use the bathroom unaided. However, she has no capacity for memory whatsoever. That is to say, she will immediately forget what just happened minutes ago 100% of the time.

November 29, 2018 12:34 am

I wish I could get my mother into a neurologist it is a 6 month wait list to see the nearest neuro and the next city is 50 miles away. Her GP is doing his best to give her comfort I believe she is entering stage 7 … it’s been a rough year I lost my Dad In January and my husband in March…it seems like her dementia accelerated at a rapid pace. She is healthy as a horse but her mind is gone. The sundowners and hallucinations are the worst. Finally got her on an antipsychotic medicine that helped slow the agitation and hallucinating episodes. I might get some sleep tonight.

Reply to  Marydd1959
August 7, 2020 9:11 pm

you are brave..keep it up!!!wish you best of luck…

Edmond G. Belanger
Edmond G. Belanger
December 27, 2018 3:36 pm


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December 28, 2018 3:23 pm

This is a great reminder that alzheimers has taken so many loved ones. I really wish there was a cure for this horrible disease!

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Creative Peptides
January 9, 2019 3:48 am

I really hope the day come sooner when this disease can be cured.

August 2, 2020 4:11 pm

Thanks for creating this article. It is a very strong reminder of how much Alzheimer's can affect us all.

August 7, 2020 9:08 pm

My Father has been dignosed with he hardly speaks..often just few words..he do able t lo eat but with someone help..any home.remedy etc which helps along with doctor medicine?

August 7, 2020 9:15 pm

My Father has been dignosed with he hardly speaks..often just few words..he do able t lo eat but with someone help..any home.remedy etc which helps along with doctor medicine?

Brian Coyne, MD
Brian Coyne, MD
December 28, 2020 12:45 pm

Alzimer is a serious disease. Its early diagnosis and treatment is very important. Thanks for sharing a great content about it. Beautifully presented!

June 3, 2021 7:37 pm

Mom will be 92 this July. She has terrible ST memory loss but can yell u everything from years ago. She knows her SS number and birthdate. She walks with a cane and in wi ter usesWalker. I watch her for when she needs pain med. She will say she hurts or shows signs of pain but does not ask for med. She is not taking meds like she use to so cut out her supplements so she wouldnt complain of taking so many but still gets important ones. Shes in briefs and pads but takes self to bathroom and I have to check her for inzcontinence at times. She feeds self but was eating 3 squares a day I fix to now maybe doing g one and half. She does hydrate well with ice water which I keep fluids at her side at all times. She was getting up in am and staying up all day then naps in between now she wants to sleep all the time. She is getting weaker a d color more pale. Have a dr appt for her for blood work for lab and a check up.She gets into paranoia and a ger stages and usually last about 1 to 2 weeks then she comes back and throws her arms around me and thanks me and tells me she loves me and to never forget it with years in her eyes. I always look forward to when she comes back to me. . I know it's coming… but I will never be ready. I love her so much. .

B. Berger

B. Berger

This site was inspired by my Mom’s autoimmune dementia.

It is a place where we separate out the wheat from the chaffe, the important articles & videos from each week’s river of news. With a new post on Alzheimer’s or dementia appearing on the internet every 7 minutes, the site’s focus on the best information has been a help to many over the past 15 years. Thanks to our many subscribers for your supportive feedback.

The site is dedicated to all those preserving the dignity of the community of people living with dementia.

Peter Berger, Editor

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This site was inspired by my Mom’s autoimmune dementia.

It is a place where we separate out the wheat from the chaffe, the important articles & videos from each week’s river of news. With a new post on Alzheimer’s or dementia appearing on the internet every 7 minutes, the site’s focus on the best information has been a help to many over the past 15 years. Thanks to our many subscribers for your supportive feedback.

The site is dedicated to all those preserving the dignity of the community of people living with dementia.

Peter Berger, Editor

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