Alzheimer’s disease typically has three general stages:

• Mild: Referred to as the early stage with subtle symptoms, such as occasional memory lapses, trouble recalling specific words and challenges with organising or planning.

• Moderate:  Referred to as the middle stage, memory problems become more obvious, and individuals may need increased assistance with everyday activities.

• Severe:  Referred to as the late stage, significant cognitive and physical decline occurs, including an inability to communicate effectively and a loss of control over many voluntary movements.

As Alzheimer’s affects people in different ways, each person may progress through the stages differently and even experience different symptoms. Similarly, it’s important to note that it may be difficult to place a person with Alzheimer’s into a specific stage, as stages can overlap.

In this article, we will provide an idea of the changes individuals experience once symptoms appear, and how family members can recognise mild Alzheimer’s disease from moderate Alzheimer’s disease

Preclinical Alzheimer’s Disease

Preclinical Alzheimer’s disease is the earliest stage of the condition. During this phase, changes begin to happen in the brain long before symptoms appear. This period can last many years. Experts, including those from the Alzheimer’s Association, use the term “preclinical” to describe these early biological changes. Understanding this stage is important because it can support earlier diagnosis and more effective treatment options.

During the preclinical stage, there may be mild cases of cognitive decline, but symptoms affecting memory, thinking or behaviour will not take hold until the later Alzheimer’s stages. Preclinical Alzheimer’s disease can be difficult to recognise and diagnose, but the Alzheimer’s Research Foundation and other groups identifying key signs across all clinical stages of Alzheimer’s are working towards understanding the full scope of symptoms.

You may learn about your Alzheimer’s disease risk because the condition appears in your family or after a doctor identifies biological markers that suggest a higher chance of developing the disease.

When someone is considered at risk, healthcare providers often ask about any recent memory changes or cognitive difficulties. However, during the earliest phase of Alzheimer’s, most people do not notice clear symptoms. This stage can remain silent for many years, and in some cases, even decades.

The Early Stages of Alzheimer’s Disease

In the early stage of Alzheimer’s disease, a person may still be able to function and live independently. They may still drive, work, communicate and be part of social activities. Despite this, the person may feel as if they are having difficulties with their memory. Memory lapses or memory loss at this early stage may include things like forgetting familiar locations of everyday objects, or familiar words.

During this phase, symptoms can be mild and easy to overlook. While the individual may recognise that something feels “off,” it is often close friends or family who notice the first signs of cognitive difficulty. These early clues may reflect mild cognitive impairment (MCI), a condition that can occur before more noticeable Alzheimer’s symptoms develop.

Common difficulties in early Alzheimer’s Disease

 People in the early stage may experience:

• Trouble articulating the right word or name
• Difficulty remembering the names of new people
• Having difficulty performing tasks in a social or work setting
• Forgetting a conversation that has just been had
• Forgetting material that has just been read
• Losing or misplacing objects
• Finding it more difficult to plan and organise

These issues often come and go, which can make them easy to dismiss as stress or normal ageing. Over time, however, the pattern of forgetfulness or confusion becomes more noticeable.

Understanding early-onset Alzheimer’s (Before Age 65)

Early-onset Alzheimer’s, which develops before age 65, shares many of the same early symptoms but may progress more quickly. Memory lapses such as forgetting recent discussions, losing items, or struggling to recall familiar words, are often among the first warning signs. Some individuals may also experience confusion in new environments, difficulty making decisions, or changes in mood such as anxiety or irritability.

A small proportion of early-onset cases are caused by inherited gene mutations. These genetic forms of Alzheimer’s tend to run strongly in families and may appear across generations.

Causes and risk factors

Factors that may increase the likelihood of early-stage or early-onset Alzheimer’s include:

• Genetic mutations (responsible for a small percentage of early-onset cases)
• Family history, especially when close relatives developed symptoms at a younger age
• Lifestyle and environmental influences, such as cardiovascular health, smoking, and long-term health habits

As Alzheimer’s advances, memory problems typically become more pronounced and may be joined by other symptoms, such as changes in judgement, difficulty navigating familiar places, or challenges managing daily tasks.

The Middle Stages of Alzheimer’s Disease

Middle-stage Alzheimer’s disease is typically the longest stage of the disease, and can last for many years in some cases. As Alzheimer’s disease progresses, the individual will require a greater level of support and care. This could be administered via close family members, support groups or hospice care at this stage.

In this stage, symptoms of dementia become more noticeable and can affect communication, behaviour, and the ability to perform routine tasks. Brain cell damage interferes with memory, language, and reasoning, which may lead to frustration, mood changes, and behaviours that seem unusual or out of character.

Common symptoms in the middle stage

SSymptoms can vary between individuals but often include:

• Memory loss and forgetting recent events, important personal details, or familiar names
• Confusion and difficulty recognising familiar places, misjudging time, or getting lost
• Language problems such as struggling to find words or follow conversations
• Changes in behaviour or personality such as increased anxiety, agitation, irritability, suspicion, or delusions
• Compulsive or repetitive actions such as repeating questions, hand-wringing, or other repetitive movements
• Disrupted sleep patterns and restlessness at night
• Withdrawal from social situations, frustration in challenging situations
• Physical control issues such as difficulty with bowel or bladder control

While there are some more severe symptoms during this stage, the person living with Alzheimer’s will still be able to participate in daily activities as long as assistance is provided. Risk factors will need to be assessed, but with mild dementia there are ways that caregivers can simplify tasks in the individual’s daily life to make symptom management easier.

Supporting someone in the middle stage

The need for more intensive care will likely increase as this stage progresses, therefore caregivers may want to consider seeking support/respite from specialists so that they avoid caregiver stress and burnout.

Below are some practical strategies to maintain quality of care:

• Breaking down tasks: Simplifying activities into smaller, manageable steps
• Using memory aids: Visual cues such as photos or written reminders to support orientation
• Engaging in meaningful activities: Familiar hobbies like listening to music, gardening, or crafts can improve well-being
• Creating a safe environment: Monitoring for wandering and ensuring safe spaces for daily living
• Seeking professional support: Community services, adult day care, respite care, or assisted living can provide both safety and caregiver relief

By understanding these middle-stage symptoms and challenges, caregivers can better support their loved ones and improve their quality of life while managing the practical and emotional demands of Alzheimer’s disease.

The Late Stages of Alzheimer’s Disease

The late stage of Alzheimer’s disease, also called advanced or severe Alzheimer’s, is when symptoms become most pronounced. Individuals lose the ability to respond to their environment, engage in conversation and, eventually, control movement. They may still say words or phrases, but communicating pain and other emotions becomes difficult for them.

As mental function, including memory and cognitive skills, continue to worsen, significant personality changes may take place and individuals will likely need extensive care.

Common symptoms in the late stage

 During this stage, individuals may:

• Total dependence for personal care: Assistance with eating, dressing, bathing, and toileting is required
• Severe memory loss: Inability to recognize family members or recall recent events
• Disorientation: Limited awareness of surroundings or the current situation
• Communication difficulties: Trouble speaking, understanding, or expressing needs
• Physical decline: Difficulty walking, sitting, swallowing, and maintaining balance
• Increased vulnerability to illness: Higher risk of infections, such as pneumonia
• Behavioural changes: Withdrawal, agitation, restlessness, or emotional outbursts

Even in this stage, individuals can benefit from gentle, supportive interaction. Listening to calming music, receiving reassuring touch, or engaging in familiar routines can provide comfort and emotional connection.

Caring for someone in the late stage

Providing care in the late stage of Alzheimer’s focuses on comfort, safety, and maintaining quality of life. Strategies include:

• The use of non-verbal communication such as using touch, music, facial expressions, or simple gestures to connect
• Prioritising pain management, gentle handling and emotional support
• Paying attention to nutrition, hydration, infection prevention and safe mobility
• Professional support such as accessing hospice, palliative care or multidisciplinary teams for guidance and assistance

With the right approach, caregivers can help maintain dignity and comfort while supporting individuals through the challenges of advanced Alzheimer’s disease.

Are you concerned about a family member or loved one who may be experiencing symptoms of Alzheimer’s disease? Contact us today if you have any questions or concerns, or if you would like to speak to a specialist neurologist. At Dementech, we can provide various treatment options, and we offer a multidisciplinary approach to treat the full spectrum of Alzheimer’s disease symptoms.

Frequently asked questions about the stages of Alzheimer’s Disease

What is the life expectancy of a person with late?stage Alzheimer’s disease?

 Life expectancy for someone with late-stage Alzheimer’s can vary widely, depending on their age at diagnosis, overall health, and other medical conditions. The Alzheimer’s Society reports that people with Alzheimer’s tend to live around 8 to 10 years after diagnosis on average. However, some individuals live much longer, in rare cases up to 15 or even 20 years, particularly if they are younger when first diagnosed.

What stage of Alzheimer’s disease causes people to sleep a lot?

Excessive sleeping is most common in the later stages of Alzheimer’s. As the disease progresses, brain damage becomes more severe, and individuals often feel more fatigued. According to the Alzheimer’s Association, people with advanced Alzheimer’s may sleep more during the day, and their nighttime sleep patterns can also become reversed.  Other factors, such as medications (antipsychotics, antihistamines) or coexisting health issues like sleep apnea, can also contribute to increased drowsiness. 

How does Alzheimer’s disease differ from dementia?

Alzheimer’s disease and dementia are related, but they are not the same thing. Dementia is a syndrome, a set of symptoms that affect memory, thinking and behaviour, rather than a specific disease. Alzheimer’s is the most common cause of dementia; it is a progressive brain disease that eventually leads to the symptoms identified as dementia.

When should someone with Alzheimer’s go into a care home or residential care?

Deciding to move someone with Alzheimer’s into formal care depends on their individual needs. Key considerations include:

• Safety concerns: Are they at risk of falls, wandering, or forgetting to eat/take medication?
• Care burden: Is the caregiver becoming overwhelmed or unable to meet all their needs?
• Daily functioning: Is the person struggling with personal care tasks like bathing, dressing, and toileting?
• Sleep and rest: If they spend increasing amounts of time in bed or sleep excessively (a possible late-stage sign), this might signal the need for more structured care. 
• Health complications: Difficulty swallowing, frequent infections, or frailty may point to the need for care with medical support.

There’s no fixed right time, but it often becomes necessary when the person’s independence declines significantly, or when caregiving at home becomes unsafe or unsustainable.

What are the main symptoms in the final (late) stages of Alzheimer’s disease?

In the late stage of Alzheimer’s, symptoms become severe and life-limiting. Common features include:

• Full reliance on others for daily personal care (e.g., washing, feeding, toileting)
• Loss of awareness of time, place, or even familiar faces
• Very limited verbal communication or non-verbal expression
• Physical decline: difficulty walking, swallowing, sitting up, or controlling bodily functions
• Increased risk of infections such as pneumonia, due to weakened immunity and swallowing difficulties 
• Pronounced behavioural and personality changes, including withdrawal, agitation, or repeated motions

Comfort-focused care such as soothing music, gentle touch, and careful pain management becomes a central part of daily support in these final stages.