There are many models used to explain the disease process, some using only 3 stages with others using 7 or more stages.  Each is useful in it’s own way.  We will present a model with 4 stages indicated.

As with all models, this information is provided for instructional purposes only.  Persons with Alzheimer’s disease or dementia may exhibit symptoms from more than one stage at any given time.  For clarification about the progression of the disease, please contact our toll-free Helpline at 888-303-0180.

Stage 1 – Forgetfulness

Symptoms

• Memory loss of recent events begins to affect job performance
• Vague complaints
• Less tolerant
• Angry
• Less energy
• Slow to react and learn
• Forgets what he/she was just told to do
• Loss of spontaneity, spark or zest for life
• Loss of initiative – can’t start anything
• Mood/personality changes – anxious about symptoms – keeps to self
• Poor judgment – makes bad decisions
• Takes longer with routine chores
• Trouble handling money or paying bills

Examples

• Forgets which bills are paid
• Forgets which cards are played in bridge
• Forgets phone numbers and grocery list
• Difficulty driving a car
• Difficulty cooking or following recipes
• Difficulty maintaining a checkbook
• Loses things
• Arrives at wrong time or place, or constantly rechecks calendar
• “Mother’s not the same – she’s withdrawn, disinterested”
• Appears less outgoing, hides things, gets upset easily
• Spends all day making dinner and forgets three courses
• Pays the bills three times over or doesn’t pay for three months

Care

• Try to understand the person’s anger and confusion (and your own)
• Offer support in times of frustration
• Begin to organize and simplify daily routines; structure the home environment for safety

How We Can Help

• Helpline 888-303-0180
• Memory loss forum
• Community referral lists (day care, geriatric assessment, etc.)
• Caregiver Orientation Series
• Support groups
• Website

Community Services Available

• Area Agency on Aging
• Council on Aging

Stage 2 – Confused

Symptoms

• Needs assistance to manage affairs
• Can’t calculate, understand, concentrate, plan or decide
• Slow to react or overreacts
• Can’t cope with failure
• Self-absorbed
• Increasing memory loss and confusion
• Shorter attention span

Examples

• Not performing activities of daily living such as bathing and cooking
• Giving money to strangers

Care

• Be prepared to offer supervision
• Provide help, but treat as an adult
• Give one-step directions
• Limit choices and set routines
• Remind and repeat gently
• Encourage strengths but accept some withdrawal

How We Can Help

• Helpline, toll-free at 888-303-0180
• Caregiver Orientation Program
• Family care planning
• Community referral lists (care, geriatric assessment, etc.)
• Support groups
• Website

Community Services Available

• Respite and time-out opportunities
• Adult day services and other community resources
• Area Agency on Aging
• Council on Aging

Stage 3 – Disorientation

Symptoms

• Obviously disabled
• Lethargic
• Disoriented to time and place
• Uncertain how to react
• Poor recent memory
• Inappropriate behavior problems
• 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
• Problems organizing thoughts
• Can’t find right word – makes up stories to fill in
• 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 or may see or hear things that are not there:  “My daddy is waiting for me outside.  I’m going home.”
• May have fixed ideas that are not real (delusions)
• Needs full-time supervision

 Examples

• Can’t remember visits immediately after you leave
• Repetitive movements, statements, tapping or folding
• Sleeps often and awakens frequently at night and may try to jump up and “go to work”
• Perceptual motor problems, such as having difficulty getting into a chair or setting a table
• Can’t find right words:  “I used to be a boss big man and now I”m an big old dummy? …”
• Problems with reading numbers –  can’t follow  written signs, write name, add or subtract
• Suspicious – may accuse spouse of hiding things or infidelity
• Loss of impulse control such as forgetting table manners
• May forget proper place to dress/undress
• Huge appetite for junk food or other people’s food
• Forgets when last meal occurred, then gradually loses interest in food
• Samples of perceptual losses or hallucinations: “There are babies in this house.” “The police are after me.” “I want to go home.”

Care

• Devise and use memory aids
• Offer reassurance
• Approach slowly
• Explain before doing a task
• Decipher meanings
• Relate to feelings, not to words
• Use touch to communicate

How  We Can Help

• Helpline 888-303-0180
• Family care planning
• Support groups
• Caregiver Training program
• Advanced disease program

Community Services Available

• Respite, in-home, special residential or nursing home care
• Council on Aging
• Area Agency on Aging

Stage 4 – Dependency

Symptoms

• Can’t recognize family or self in mirror
• Needs assistance with simple tasks
• Appears apathetic
• Perception is distorted
• Physical disabilities
  • Loss of coordination
  • Inability to feed himself or to swallow
  • Greater immobility (may be unable to walk)
  • Seizures
  • Skin breakdown
  • Loss of bowel and bladder control
• Loses weight even with an adequate diet
• Little capacity for self care
• Can’t communicate with words
• May put everything into mouth or touch everything

Examples

• Looks in the mirror and talks to own imiage
• Needs help with bathing, dressing, eating or toileting
• May groan, scream or make grunting sounds

Care

• Assist with daily needs
• Remember that the behavior is not intentional
• Understand the disease is affecting the patient
• Ask for support in both practical and emotional matters
• Look to the community for resources/respite care
• Nursing home placement may need to be considered

How We Can Help

• Helpline 888-303-0180
• Family care meeting
• Support groups
• Advanced Disease program

Community Services Available

• Hospice and nursing home options as appropriate