Progressive Phases of Alzheimer's Disease
Memory Disorders and Alzheimer's Center, Lincoln General Hospital

Families often ask about the course of Alzheimer's disease and some of the behaviors they can expect to encounter along the way.

It might be helpful to list four progressive phases. Remember as you read them that some of symptoms will overlap, vary in sequence and in the rate at which they progress.

The symptoms reflect a continuous decline, yet some may be absent in individual patients, depending on the area of the brain affected, the extent of the disease and the victim's previous personality.

Phase One:

The onset is subtle, and usually the family is unsure anything is wrong.

Cognitive Changes: Short-term memory loss. Unable to find the right word, especially nouns. May forget familiar names, telephone numbers and may write many reminder notes...and then lose the notes. May show a preference for familiar things [wear the same clothes, avoid going out]. Judgment may be impaired early, [dress inappropriately for the weather]. Adept at covering up by using family members to fill memory gaps / or blame problems on fatigue, stress, grief, overwork -- even people. Often able to use simple judgment and logic to overcome memory gaps.

Personality Changes: Less sparkle, spontaneity, ambition. May appear passive or easily angered and restless. Indifferent to ceremonies and courtesies of social life. Decreased interest in environment and present affairs...more and more interested in fewer things. Family may be hurt because victim "doesn't seem to care."

Functional Changes: Vague, uncertain, hesitant in initiating action. Can function without direction only in familiar surroundings. Forgetfulness is disruptive to activities of daily living.

Phase Two:

Cognitive Changes: Greater difficulty with memory, retention of new information, recall, calculations, decision-making, planning and following a storyline. Forgetful -- may not pay bills, take medication, turn off the stove. Increased loss of learned behavior, manners, etc. Can talk about familiar topics [weather, etc.].

Personality Changes: Increased self-absorption, lack of interest in or concern for family. Social withdrawl. May resent interference by younger people.

Functional Changes: Deterioration of ability to initiate purposeful activity [bathing, etc.] and to sequence events [e.g., driving]. Sleep disturbance with restlessness at night. Begins to neglect health and hygiene. Moderately impaired. Needs direction to function in familiar surrounding. Can respond to instruction.

Phase Three:

Cognitive Changes: Judgment impaired [learned behavior from experience]. May eat spoiled, smelling food, etc. Disoriented to time and place. Unable to attach meaning to sensory stimuli [smoke-filled room...danger of fire etc.]. Invents words. May be unable to express themselves in speech or writing but ask questions over and over because can't remember answers given. Confused. May be unable to understand spoken or written words.

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