7 Stages of Dementia

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.

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 not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s die an average of four to six years after diagnosis, but the duration of the disease can vary from three 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. This framework is 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.

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 impairment (normal function)

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

Stage 2:

Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)

Individuals may feel as if they have memory loss and 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.

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

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 75 by 7s
Decreased capacity to perform complex tasks, such as planning dinner for guests, 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

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

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

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.

Source: Alzheimer's Association