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> Stage
1: No impairment
> Stage 2: Very mild
decline
> Stage 3:
Mild decline
> Stage 4:
Moderate decline (mild or early stage AD)
> Stage 5:
Moderately severe decline (moderate or mid-stage
AD)
> Stage 6:
Severe decline (moderately severe or mid-stage
AD)
> Stage 7: Very severe decline (severe
or late stage AD)
> 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:
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No cognitive impairment
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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:
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Very mild cognitive decline
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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:
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Mild cognitive decline
Early-stage Alzheimer's can be diagnosed in some, but not
all, individuals with these symptoms
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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:
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Word- or name-finding problems noticeable to family or close
associates
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Decreased ability to remember names when introduced to new
people
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Performance issues in social or work settings noticeable to
family, friends, or co-workers
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Reading a passage and retaining little material
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Losing or misplacing a valuable object
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Decline in ability to plan or organize
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Stage 4:
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Moderate cognitive decline
(Mild or early-stage Alzheimer's disease)
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At this stage, a careful medical interview detects clear-cut deficiencies
in the following areas:
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Decreased knowledge of recent occasions or current events
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Impaired ability to perform challenging mental arithmetic-for
example, to count backward from 100 by 7s
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Decreased capacity to perform complex tasks, such as marketing,
planning dinner for guests, or paying bills and managing finances
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Reduced memory of personal history
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The affected individual may seem subdued and withdrawn, especially
in socially or mentally challenging situations
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Stage 5:
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Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer's disease)
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Major gaps in memory and deficits in cognitive function emerge.
Some assistance with day-to-day activities becomes essential. At
this stage, individuals may:
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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
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Become confused about where they are or about the date, day
of the week, or season
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Have trouble with less challenging mental arithmetic; for example,
counting backward from 40 by 4s or from 20 by 2s
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Need help choosing proper clothing for the season or the occasion
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Usually retain substantial knowledge about themselves and know
their own name and the names of their spouse or children
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Usually require no assistance with eating or using the toilet
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Stage 6:
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Severe cognitive decline
(Moderately severe or mid-stage Alzheimer's
disease)
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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:
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Lose most awareness of recent experiences and events as well
as of their surroundings
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Recollect their personal history imperfectly, although they
generally recall their own name
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Occasionally forget the name of their spouse or primary caregiver
but generally can distinguish familiar from unfamiliar faces
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Need help getting dressed properly; without supervision, may
make such errors as putting pajamas over daytime clothes or
shoes on wrong feet
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Experience disruption of their normal sleep/waking cycle
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Need help with handling details of toileting (flushing toilet,
wiping, and disposing of tissue properly)
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Have increasing episodes of urinary or fecal incontinence
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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
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Tend to wander and become lost
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Stage 7:
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Very severe cognitive decline
(Severe or late-stage Alzheimer's
disease)
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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.
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Frequently individuals lose their capacity for recognizable
speech, although words or phrases may occasionally be uttered
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Individuals need help with eating and toileting and there is
general incontinence of urine
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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.
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Related resources
Basic Facts
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