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The Ribbon - Care for Caregivers

The Three Stages of 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.

Alzheimer's Disease (pronounced altz-hi-merz) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking, and behavior. It is the most common form of dementing illness. More than 100,000 die of Alzheimer's disease annually, which makes it the fourth leading cause of death in adults, after heart disease, cancer, and stroke.

First Stage
2 to 4 years leading up to and including diagnosis


  • 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.
  • 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.


  • Forgets which bills are paid and phone numbers that are called frequently.
  • Loses things. Forgets grocery list.
  • Arrives at wrong time 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  • "Mother's not the same---she's withdrawn, disinterested"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 for three months.

Second Stage
2 to 10 years after diagnosis (longest stage)


  • 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, or thinking logically.
  • Can't find right words--makes up stories to fill in the 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.


  • Memory loss--can't remember visits even though the visitor just left.
  • 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 peoples food; forgets when last meal was eaten, then gradually loses interest in food.

Terminal Stage
1 to 3 years


  • Can't recognize family or self in mirror.
  • Loses weight even with good diet.
  • Little capacity for self care.
  • Can't communicate with words.
  • May put anything in mouth or touch anything.
  • Can't control bowels or bladder.
  • May have seizures, experience difficulty with swallowing, skin infections.


  • Looks in mirror and talks to own image.
  • Needs help with bathing, dressing, eating, and going to the bathroom.
  • May groan, scream, or make grunting sounds.
  • May try to suck on everything.
  • Sleeps more.

Taken from Care of Alzheimer's Patients: a Manual for Nursing Home Staff, by Lisa P. Gwysher ACSW, Member, Committee on Patient and Family Services Alzheimer's association, pp. 25-27. The book is published by the Alzheimer's association and the American Health Care Association in 1985.

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