Understanding Stages and Symptoms of Alzheimer's Disease/Dementia
Alzheimer's disease develops slowly over many years, and initially causes changes in a person's memory, thinking, and use of words or behavior. Later in the illness there are changes in physical ability. While every person has a unique path through the illness, and each person progresses at a different speed, there are some common symptoms. The collection of symptoms has been grouped into stages to describe the degree of disease progression.
How is the Stage of Alzheimer’s disease determined?
Unlike many illnesses where a blood test or x-ray determines the status of the illness, for Alzheimer’s disease the best guide as to the disease’s progression is the ability of the individual to use their mind for typical activities, as we all do to engage in the world and/or care for ourselves. Because of this, the family caregiver is typically the best person to identify what stage the loved one is in. We have created this worksheet to assist in this process.
How to know what stage of illness your loved one is in:
As you read each item, determine if it describes your loved one on most days of each week; if so, circle the bullet. When you stop circling the bullets you will find the stage of illness your loved one is in.
A commonly referred to system is the FAST system with Stages 1-7.
Other times the stages are more generally referred to as “Early, Middle, Late”.
We have included both below along with the typical time frame for disease progression.
Common Changes in Early (FAST 2) - Early (FAST 3) (Typically lasts 3-10 years)
Loses recent memory without a change in appearance or casual conversation
Loses spark or zest for life - does not start anything
Loses judgment about money.
Has difficulty with new learning and making new memories.
Has trouble finding words - may substitute or make up words that sound like or mean something like the forgotten word.
May stop talking to avoid making mistakes.
Has a shorter attention span and less motivation to stay with an activity.
Easily loses the way going to familiar places.
Resists change or new things.
Has trouble organizing and thinking logically.
Asks repetitive questions.
Withdraws, loses interest, and is irritable, not as sensitive to others' feelings, uncharacteristically angry when frustrated or tired.
Won't make decisions. For example, when asked what she wants to eat, says "I'll have what she's having."
Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens.
Forgets to pay, pays too much, or forgets how to pay - may hand the checkout person a wallet instead of the correct amount of money.
Forgets to eat, eats only one kind of food, or eats constantly.
Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
Constantly checks, searches, or hoards things of no value.
Common Changes in Mild (FAST 4) – Moderate (FAST 5 and 6) (Typically lasts from 5-10 years)
Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
Mixes up the identity of people, such as thinking a son is a brother or that a wife is a stranger.
Poor judgment, creating safety issues when left alone; may wander and risk exposure, poisoning, falls, self-neglect or exploitation.
Has trouble recognizing familiar people and their own objects; may take things that belong to others.
Continuously repeats stories, favorite words, statements, or motions like tearing tissues.
Has restless, repetitive movements in late afternoon or evening, such as pacing, trying doorknobs, fingering draperies.
Cannot organize thoughts or follow logical explanations.
Has trouble following written notes or completing tasks.
Makes up stories to fill in gaps in memory. For example, might say, "Mama will come for me when she gets off work."
May be able to read but cannot formulate the correct response to a written request.
May accuse, threaten, curse, fidget or behave inappropriately, such as kicking, hitting, biting, screaming or grabbing.
May become sloppy or forget manners.
May see, hear, smell, or taste things that are not there.
May accuse spouse of an affair or family members of stealing.
Naps frequently or awakens at night believing it is time to go to work.
Has more difficulty positioning the body to use the toilet or sit in a chair.
May think the mirror image is following him or a television story is happening to her.
Needs help finding the toilet, using the shower, remembering to drink, and dressing for the weather or occasion.
Exhibits inappropriate sexual behavior, such as mistaking another individual for a spouse. Forgets what private behavior is and may disrobe or masturbate in public.
Common Changes in Severe – Late (FAST 7) Typically lasts from 1-2 years
Doesn't recognize self or close family.
Speaks in gibberish, is mute, or is difficult to understand.
May refuse to eat, chokes, or forgets to swallow.
May repetitively cry out, pat or touch everything.
Loses control of bowel and bladder.
Loses weight, and skin becomes thin and tears easily.
May look uncomfortable or cry out when transferred or touched.
Forgets how to walk or is too unsteady or weak to stand alone.
May have seizures, frequent infections, falls.
May groan, scream, or mumble loudly.
Sleeps more.
Needs total assistance for all activities of daily living.
Typical symptom progression adapted from Caring for People with Alzheimer's Disease: A Manual for Facility Staff (2nd edition), by Lisa P. Gwyther, 2001. Published by the American Health Care Association (1201 L Street, NW, Washington, DC 20005) and the Alzheimer's Association (919 N. Michigan Ave., Suite 1100, Chicago, IL 60611).
Please talk with your own healthcare provider before using any of this information.
