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

Three or four different stages and characteristic signs, symptoms, and behaviors.

Not all will progress through the disease at the same rate, and not all will display all of the characteristics that will be mentioned. Each case is individualized.

We do know that the younger a person diagnosed with Alzheimer's, the faster the disease goes.

Try to divide the three stages into three categories [no clear-cut divisions].

1. Cognitive changes - changes in perception and awareness.

2. Affective changes - changes in emotions and feelings.

3. Physical changes - observable changes that we can see in ones physical condition

First Stage [Early Stage] - two to four years

Diagnosis is usually not made here - could be one of the fifty to one hundred other disorders causing the same signs and symptoms in the first stage. Subtle, gradual, insidious changes that occur over a period of months or years.

A. Cognitive Changes [changes in perception and awareness]

1. Memory loss - especially of recent events and new information.

2. Uncertainty and hesitancy in initiating behaviors and actions.

3. Unable to perform simple tasks. Loss of reason, logic, and judgment.

4. Difficulty focusing attention - decreased attention span.

5. Motor aphasia [loss of words].

Very subtle changes in the first stage of Alzheimer's disease. The family usually does not recognize anything is wrong or attributes it to stress, lack of sleep, job, getting older, etc. Patients are very good at compensation for their deficiencies in the first stage. They may do very well is social situations and in a normal nonspecific conversation. It is only when you ask them a very specific question, such as how old they are, what year it is, what date it is, what did you have for dinner, etc., that you can tell something might not be right.

Persons are very aware in the first stage of Alzheimer's disease that they cannot remember. They may display symptoms of depression over their memory loss in the first stage.

B. Affective Changes [changes in emotions and feelings]

1. Decreased interest in environment and present affairs - social withdrawl.

2. Indifference to normal courtesies of social life.

3. Loss of initiative and sense of humor, may have a personality change.

4. Lack of spontaneity [absent minded, decreased concentration, slower, decreased initiative and decreased drive, dull affect.]

5. Begins to become careless in appearance and actions.

6. Emotional instability. The two most common emotions are depression because the person is aware they are forgetful and anger and frustration because they cannot remember or do the things the way they use to.

7. Personality changes / marital problems.

C. Physical Changes - very few. They look physically fine. May be in perfect health and go out and run a mile, come home, and forget where they put their tennis shoes.

1. May have slight weakness or slower movements.

2. May have a small amount of muscle twitching.

By the end of the first stage, the person is beginning to perform poorly at work. They might forget to perform tasks that were routine in their daily lives. They may be unable to add or subtract a figure correctly, difficulty organizing times and dates, and may be fired from their jobs with no explanation and often no retirement or insurance benefits.

Second Stage [several years, two to twelve years] longest of all stages

Diagnosis is usually made here. Families may be relieved to know that the relative has a "disease" and is not crazy. Signs and symptoms and behaviors are magnified many times in the second stage, and the person is usually taken to a doctor because the family is aware of their memory loss and decline in intellectual functioning is not normal process of aging.

A. Cognitive Changes

1. Obvious defects in memory, retention, and recall. Their recent memory is the first to go.

2. Unable to concentrate - loses their train of thought - hesitation in verbal response.

3. Forgets appointments and socially significant events.

4. Forgets to initiate or complete normal routines including health and hygiene measures.

5. Aimless wandering / restlessness [especially at night].

6. Disorientation to time - confuses day and night.

7. Loses items and claims they are stolen.

8. Hallucinations

9. Inappropriate social behaviors.

10. Increased dependence on significant others / role reversal / social isolation.

11. Mirror sign - this is when the Alzheimer's victim is unable to recognize themselves in the mirror. They may stand in front of a mirror in the bathroom or bedroom and talk to themselves [carry on a conversation] and not realize it is them that they are seeing. If they do not recognize themselves, you can see how they would not recognize family, neighbors, friends, etc.

12. Unable to understand or express language.

13. Unable to attach meaning to sensory impression.

14. Unable to do math calculations.

15. Unable to carry out purposeful movements.

16. Unable to read or write.

Third Stage - Terminal [one, two, three years]

Families usually face the task of decision making during this stage regarding nursing home placement since the victim requires total physical care.

A. Cognitive Changes

1. Little or no response to stimuli.

2. Unable to perform purposeful movements.

3. Does not recognize others - even family.

B. Affective Changes

1. Lethargic - no energy.

2. Expresses little or no emotion.

C. Physical Changes

1. Mute and unresponsive.

2. Emaciation - weight loss, they have an increased appetite and marked weight loss. This is due to muscles eventually being effected that control the swallowing and choking is common.

3. Incontinence.

4. Totally incapable of caring for oneself.

5. Seizures - grand mall approximately 50 percent of the time.

6.. Bedridden.

7. Extremely psychomotor retardation

8. Susceptible to injuries and infections.

The most frequent cause of death is pneumonia. Alzheimer's disease debilitates the body to the point when a secondary infection takes over.

Other contributing factors are malnutrition, dehydration, immobilization, decreased ability for the body to fight off infections.

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Alzheimer's Outreach

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