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Understanding Stages and Symptoms of Alzheimer's Disease

Alzheimer's disease develops slowly and causes changes in the brain long before there are obvious changes in a person's memory, thinking, use of words or behavior. Stages and changes the person will go through are outlined below.

Common Changes in Mild AD

  • Loses spark or zest for life - does not start anything.
  • Loses recent memory without a change in appearance or casual conversation.
  • 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 shorter attention span and less motivation to stay with an activity.
  • Easily loses way going to familiar places.
  • Resists change or new things.
  • Has trouble organizing and thinking logically.
  • Asks repetitive questions.
  • Withdraws, loses interest, 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 is 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 Moderate AD

  • Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
  • Mixes up identity of people, such as thinking a son is a brother or that a wife is a stranger.
  • Poor judgment creates safety issues when left alone - may wander and risk exposure, poisoning, falls, self-neglect or exploitation.
  • Has trouble recognizing familiar people and 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 mirror image is following him or 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 is private behavior, and may disrobe or masturbate in public.


Common Changes in Severe AD

  • 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.

*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)

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