Understanding The 7 Alzheimer’s Stages

Everyone experiences Alzheimer’s differently. There is no one path everyone with the disease follows.

Yet, for caregivers, it’s common to want to have an idea of what to expect. To understand how the disease progresses.

In this article, we’ve broken that progression down into 7 stages. As you read about each, keep this in mind:

The stages and how long they last varies from individual from individual.  Some individuals may live with the disease for 25 years or more. Many of them with no outward symptoms.

Others may jump to Stage 4 or 5 seemingly overnight.

And the stages may not go in order. Someone in say, Stage 3, may progress to Stage 4 or, they could go back to Stage 2 for a while.

Again, it varies from person to person. But whatever the specifics for your loved one, understanding these stages will help you prepare for the road ahead.

The 7 Stages of Alzheimer’s Disease

Stage 1: “Business As Usual”

Here’s something most people don’t realize:

Medical evidence shows that Alzheimer’s may start damaging the brain almost 2 decades before symptoms appear.

This is the period we refer to as Stage 1. There are no outward signs of the disease. A person’s cognitive function is totally normal at this stage. It’s “business as usual” for the individual.

Stage 2 – “Just Getting a Little Forgetful”

We all get forgetful from time to time. Especially as we age.

In fact, at least half of those 65 and over report they occasionally have difficulty remembering someone’s name or remembering where they left things like keys or eyeglasses.

Forgetfulness can be caused by a number of factors. Many unrelated to Alzheimer’s Disease. In confirmed cases of Alzheimer’s, however, it’s often discovered that the individual had previously exhibited “Stage 2” symptoms.

Stage 3 – “Symptoms Becoming Noticeable”

Stage 3 is where family members and close associates start to notice a person is having trouble performing certain mental tasks. Maybe they can’t find the right word when speaking. Or they have trouble remembering something they just read.

If the person is still employed, supervisors and/or co-workers may notice a decline in job performance. Especially for tasks involving complex planning or organizational skills. The person may also find it increasingly difficult to master new job skills, understand technical information or follow detailed instructions.

Concentration becomes a problem at this stage. And the inability to concentrate will often cause anxiety. When this happens, professional counselors may recommend retirement. Or they may suggest withdrawing from demanding activities to ease the psychological stress.

For the majority of people in Stage 3, obvious signs of dementia appear within two to four years.

Stage 4: “Diagnosis: Alzheimer’s”

Stage 4 is there the diagnosis of Alzheimer’s disease can be made with considerable certainty. In this Stage some of the symptoms include:

  • Increased difficulty with numbers, often apparent in their inability to manage finances (i.e., they frequently write the wrong date or wrong amount on checks or payment slips).
  • Trouble remembering the day of the week or month of the year.
  • Forgetting details from their own past.

As their personal frustration with these previously simple tasks increases, they become more reserved and less responsive to others. Rather than acknowledge the pain of their decreased mental capacity, they attempt to deny it or hide it (even from themselves). Often this is done by withdrawing from conversations and social interaction.

This Stage tends to last for an average of about 2 years.

Stage 5 – “Memory Gaps and Confusion”

This is when cognitive decline interferes with basic day to day activities.

It’s at this stage when it’s unlikely an individual will be able to live alone safely. Without help, the individual may not be able to prepare their own foods. Their ability to recall vital information such as their age, address or the current year is sporadic. They may wear the same clothes day after day – unable to choose appropriate clothes for current weather conditions.

Because they can’t make reasonable choices, they can become vulnerable to strangers and scam artists.  Loved ones and close associates will notice a marked change in the individual’s behavior, with increasing instances of unprovoked anger and suspicion.

Stage 5 lasts an average of one-and-a-half years (though this depends on other non-related health conditions).

Stage 6 – “Severe Mental and Physical Decline”

It’s at this stage where the symptoms of Alzheimer’s are severe enough to jeopardize the individual’s well-being.  Early signs of Stage 6 include:

  • An inability to dress without assistance (i.e., dressing backwards or putting street clothes over night clothes).
  • Issues with hygiene and cleanliness.
  • An inability to adjust the temperature of bathwater or brush their teeth.

As this stage progresses, they may become incontinent and require assistance with all aspects of toileting.  Because of the severity of cognitive decline, they may display little or no knowledge of their current circumstances. They may confuse loved ones with deceased relatives and/or forget the names of their parents or spouse. They exhibit difficulty in speaking. Their building fear and frustration can trigger emotional outbursts and aggressive behavior.

Again, based on other non-related health conditions, Stage 6 lasts an average of two-and-a-half years.

Stage 7 – “Functional Failure and Death”

Stage 7 is often referred to as “late-stage Alzheimer’s.” This is when individuals require continuous assistance in order to survive.

At this stage, speech is limited to a handful of intelligible words… at most. This is soon followed by a decrease in their ability to walk. Eventually movement itself is limited and the person becomes unable to sit or even hold their head up without assistance. The diminished functioning also affects their ability to smile, with the only observable facial expression being a grimace.

Victims of late-stage Alzheimer’s may live on in this tragic condition indefinitely, although because of other contributing factors such as pneumonia, aspiration, severe flu, infection, cancer, COPD, CHF, etc., this last stage rarely lasts more than two years. Those who do live on are likely to exhibit increased rigidity as well as “primitive” or “infantile” reflexes such as sucking before ultimately passing away.


    • That’s an excellent question Linda. It’s believed that Alzheimer’s does not cause pain itself. However, there may be other medical conditions that cause pain in someone suffering from Alzheimer’s. Research has shown that those with Alzheimer’s do experience pain. However, they may not be able to communicate it to their caregivers, especially in the final stage of the disease.

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