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Alzheimer's Disease - Stages of Dementia

By the Alzheimer's Association

Use your browsers back button to navigate this "Stages of Dementia" menu.

• Stage 1: No impairment
• Stage 2: Very mild decline
• Stage 3: Mild decline
• Stage 4: Moderate decline (mild or early stage Alzheimer's Disease)
• Stage 5: Moderately severe decline (moderate or mid-stage Alzheimer's Disease)
• Stage 6: Severe decline (moderately severe or mid-stage Alzheimer's Disease)
• Stage 7: Very severe decline (severe or late stage Alzheimer's Disease)
• Alzheimer's Related Resources

Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer's disease and developed several methods of staging based on these patterns. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer's disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control every aspect of thinking, judgment, and behavior. The damage eventually affects cells that control and coordinate movement.

Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that all stages are artificial benchmarks in a continuous process that can vary greatly from one person to another. Not everyone will experience every symptom and symptoms may occur at different times in different individuals. People with Alzheimer's live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.

The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe, and severe Alzheimer's disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage, and late-stage categories.

Stage 1: No cognitive impairment

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

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Stage 2: Very mild cognitive decline

Individuals at this stage feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses, or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family, or co-workers.

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Stage 3: Mild cognitive decline

Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms

Friends, family, or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

• Word- or name-finding problems noticeable to family or close associates

• Decreased ability to remember names when introduced to new people

• Performance issues in social or work settings noticeable to family, friends, or co-workers

• Reading a passage and retaining little material

• Losing or misplacing a valuable object

• Decline in ability to plan or organize

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Stage 4:Moderate cognitive decline (Mild or early-stage Alzheimer's disease)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

• Decreased knowledge of recent occasions or current events

• Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s

• Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances

• Reduced memory of personal history

• The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations

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Stage 5:Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

• Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated

• Become confused about where they are or about the date, day of the week, or season

• Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s

• Need help choosing proper clothing for the season or the occasion

• Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children

• Usually require no assistance with eating or using the toilet

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Stage 6:Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease)

Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

• Lose most awareness of recent experiences and events as well as of their surroundings

• Recollect their personal history imperfectly, although they generally recall their own name

• Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces

• Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet

• Experience disruption of their normal sleep/waking cycle

• Need help with handling details of toileting (flushing toilet, wiping, and disposing of tissue properly)

• Have increasing episodes of urinary or fecal incontinence

• Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding

• Tend to wander and become lost

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Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement.

• Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered

• Individuals need help with eating and toileting and there is general incontinence of urine

• Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

Alzheimer's Related resources

Alzheimer's Disease Basic Facts and Statistics

Cognitive Decline Delayed by Fish Oils

By HealthDay News 4-10-2007

Omega-3 fatty acids from fish may help prevent age-related cognitive decline, according to two new studies.

In one study, Dutch researchers examined the diet and cognitive function of 210 men, ages 70 to 89, who did not have Alzheimer's disease. The men were assessed in 1990 and again in 1995.

The researchers concluded that consumption of approximately 400 milligrams of omega-3 fatty acids per day (equivalent to eating six servings of lean fish per week or one serving of fatty fish per week) protects against cognitive decline.

In the other study, American researchers looked at omega-3 consumption and cognitive decline in 2,251 white males, ages 50 to 65, who were initially assessed between 1987 and 1989. The men were checked again three and nine years later.

The study found no association between baseline levels of omega-3 fatty acids in the men and overall cognitive decline. However, an analysis of specific types of cognitive decline did find that higher levels of omega-3 fatty acids were associated with protection against loss of verbal fluency.

This association was particularly strong in men with high blood pressure and dyslipidemia (disruption in the amount of lipids in the blood) but was not evident in men with major depression.

The studies were published in this month's American Journal of Clinical Nutrition. The authors of an accompanying editorial recommended that clinical trials be conducted to determine the effect of dietary fish, fish oil or both in elderly people at risk of cognitive decline and Alzheimer's disease.

Curcumin, the active constituent of the curry spice, turmeric, inhibits Alzheimer's

"Curcumin has been used for thousands of years as a safe anti-inflammatory in a variety of ailments as part of Indian traditional medicine," Cole said. Recent animal studies "support a growing interest in its possible use for diseases of aging involving oxidative damage and inflammation like Alzheimer's, cancer and heart disease." Continue

Homocysteine and B vitamins relate to brain volume and white-matter changes in geriatric patients with psychiatric disorders

Elevated homocysteine and low folate were associated with radiological markers of neuropathology. Since no patient had clinically deficient folate, it may be important to rethink what defines functionally significant micronutrient deficiency and explore what this means in different age- and health-status groups. PMID:15545331

Am J Geriatr Psychiatry. 2004 Nov-Dec

Can cognitive deterioration associated with Down syndrome be reduced?

This paper suggests that essential nutrients such as folate, vitamin B6, vitamin C, vitamin E, selenium, and zinc, as well as alpha-lipoic acid and carnosine may be partially preventive. Continue

Nutraceutical Research

A growing body of evidence shows how nutraceuticals may offer many advantages for the future of medicine.

• Carotenoids
• Colostrum
• Cranberry
• Elderberry Extract
• Fucoidans, Alginates, Laminarines
• Glyconutrients
• Lo Han Kuo
• Lotus Seed
• Polyphenols