It is difficult to place a patient with Alzheimer's disease in a specific stage. However, symptoms seem to progress in a recognizable pattern and these stages provide a framework for understanding the disease. It is important to remember they are not uniform in every patient and the stages often overlap.

1. First stage - 2 to 4 years leading up to and including diagnosis.


-Recent memory loss begins to affect job performance.

-What was he or she just told to do?

-Confusion about places

- gets lost on way to work.

-Loses initiative -can't start anything.

-Loses spontaneity, the spark or zest for life.

-Mood/personality changes

- patient becomes anxious about symptoms, avoids people.

-Poor judgment - makes bad decisions.

-Takes longer with routine chores

-Trouble handling money, paying bills.


-Forgets which bills are paid. Can't remember phone numbers.

-Loses things; can't remember grocery list.

-Arrives at wrong time or place, or constantly rechecks calendar.

-"Mother's not the same - she's withdrawn, disinterested".

-She spent all day making dinner and forgot to serve several courses.

-She paid the bills three times over, or didn't pay for three months.

2. Second Stage - 2 to 10 years after diagnosis [longest stage]


-Increasing memory loss and confusion.

-Shorter attention span.

-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.

-Difficulty organizing thoughts, thinking logically.

-Can't find right words - makes up stories to fill in blanks.

-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.

-May see or hear things that are not there.

-Needs full-time supervision.


-Can't remember visits immediately after you leave.

-Repetitive movements or statements.

-Sleeps often; awakens frequently at night and may get up and wander.

-Perceptual motor problems - difficulty getting into a chair, setting the table.

-Can't find the right words.

-Problems with reading, numbers - can't follow written signs, write name, add or subtract.

-Suspicious - may accuse spouse of hiding things, infidelity, may act childish.

-Loss of impulse control - sloppier table manners. May undress at inappropriate times or in the wrong place.

-Huge appetite for junk food and other people's food; forgets when last meal was eaten, then gradually loses all interest in food.

3. Terminal Stage - 1 to 3 years.


-Can't recognize family or image of self in mirror.

-Loses weight even with good diet.

-Little capacity for self care.

-Can't communicate with words.

-May put everything in mouth or touch everything.

-Can't control bowels or bladder.

-May have seizures, experience difficultly with swallowing, skin infections.


-Looks in mirror and talks to own image.

-Needs help with bathing, dressing, eating, and toileting.

-May groan, scream or make grunting sounds.

-Sleeps more.

(c) copyright 1994

Greater San Antonio Chapter



STIBack to Stages Index