Alzheimer’s disease typically has three general stages: mild, moderate and severe (also referred to as early, middle and late). 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.

Although the rate at which Alzheimer’s disease progresses varies between different individuals, it is often the case that the symptoms of the disease worsen over time. But what are the key differences between the very early stages of Alzheimer’s disease and the later stages as the disease progresses? 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

The changes in the brain related to Alzheimer’s disease start years before there are any signs or symptoms of the disease. This time period can last for several years, and is referred to as ‘Preclinical Alzheimer’s disease’, as defined by members of the Alzheimer’s Association. Understanding how Alzheimer’s disease affects the brain at preclinical or early stages is key to supporting earlier and more helpful treatment interventions.

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. 

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 stage, symptoms may not always be apparent, but family and close friends may begin to notice mild cognitive impairment and other small difficulties their loved one may be experiencing. 

Some common difficulties during early stage Alzheimer’s mostly include examples of mild cognitive impairment:

• Being unable to articulate the right word or name 
• Being unable to remember 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

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.

During this stage of Alzheimer’s disease, symptoms of dementia become more pronounced. You may find that the person is confusing their words, becoming more frustrated and angry, and can even act in ways that are out of character. Due to the damage to the nerve cells in the brain, they may also find it difficult to express their thoughts and perform routine, basic tasks without assistance.

Some common symptoms in this stage include the following, but please be aware that these symptoms can vary significantly from person to person:

• Being forgetful of major events
• Feeling moody or withdrawn, especially in challenging situations
• Memory problems: being unable to recall information about themselves like their telephone number, address or personal history
• Frequently experiencing confusion about where they are or what day it is
• Trouble with bowel and bladder control
• Changes in sleep patterns; sleeping during the day and feeling restless at night.
• A growing tendency to wander off and get lost
• Personality and behavioural changes, including delusions and suspiciousness 
• Compulsive and/or repetitive behaviour such as hand-wringing

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.

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.

The Late Stages of Alzheimer’s Disease

In the final stage of Alzheimer’s disease, symptoms of dementia are severe. 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. During this stage, individuals may:

• Require constant assistance with daily personal care
• Lose awareness of their surroundings
• Forget recent events and experiences
• Confuse family members
• Experience changes in their physical abilities, including walking, sitting and swallowing
• Have difficulty communicating
• Become more vulnerable to infections, especially pneumonia

Although the person living with Alzheimer’s disease will have a decreased ability to initiate engagement during the late stage, they can still benefit from interaction such as listening to relaxing music, or if appropriate, receiving reassurance through gentle touch from a loved one.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.