Alzheimer’s Disease: Stages and Treatments

Table of Contents

Stages of Alzheimer’s Disease
Alzheimer’s Prevention and Treatment
Outlook

Alzheimer’s disease is the most common form of dementia. Dementia is a condition that causes a continuous decline in thinking, memory, and reasoning as well as behavioral and social skills that interferes with a person’s ability to function independently.

Alzheimer’s disease accounts for 60 to 80 percent of cases of dementia. The symptoms of Alzheimer’s come on slowly and gradually worsen over time. An individual can progress from no symptoms or innocent memory loss to being unable to care for themselves in as little as 3 to 11 years after their diagnosis.

Stages of Alzheimer’s Disease

There are seven stages of Alzheimer’s disease, all developed by researchers and doctors to describe how you or your loved one will change over time. 

Typically, the Clinical Dementia Rating Scale is used to define the various stages of this disease – but this requires a considerable amount of data to be collected both from the patient and an informant. Recently, the Mini-Mental State Exam (MMSE), which has been used in the past for screening and diagnosis, has gained traction as a stand-in for the rating scale for the staging of dementia in Alzheimer’s disease. 

The following are the 7 stages of Alzheimer’s disease. 

Stage 1: No Impairment

Some also refer to this stage as “preclinical”, as there are no noticeable symptoms during this stage of Alzheimer’s disease. 

You may be aware of your risk for Alzheimer’s as a result of family history. Your doctor may choose to screen you with the MMSE, which will be normal. At this stage, you’re fully independent and have no impairment. And this stage may last years or decades. 

Stage 2: Very Mild Impairment

This stage is often dismissed as “normal forgetfulness”, as the majority of patients diagnosed with Alzheimer’s disease are over the age of 65. But, Alzheimer’s disease is not a normal part of aging. 

You may find that you occasionally forget familiar words, a family member’s name, or misplace objects. Your troubles will most likely go unnoticed by family and friends, as your symptoms won’t interfere with work or social activities. Furthermore, a medical exam will most likely not detect any abnormalities at this stage.

Stage 3: Mild Decline

Symptoms at this stage may include:

  • Getting lost, even when traveling a familiar route 
  • Finding it hard to remember the right words or names
  • Forgetting material that you just read
  • Misplacing or losing valuable objects
  • Asking the same question over and over.

Family and friends may notice these subtle changes in memory and even comment on them. These symptoms may induce mild to moderate anxiety. If you have complex job responsibilities, it may be time to contemplate retirement.

A  doctor’s evaluation may result in the diagnosis of early/mild Alzheimer’s disease, but not always. 

Stage 4: Moderate Decline

Symptoms at this stage may include:

  • Forgetting personal information, such as address, phone number, and education history
  • Impaired mathematical ability (e.g., difficulty counting backwards from 100 by 9s)
  • Having trouble cooking meals or even ordering from a menu
  • Difficulty handling finances and bills (e.g., inability to put the right date and amount on a check)
  • Moodiness and social withdrawal.

You will become increasingly confused and forgetful and may need help with daily tasks. It may be time to stop driving. You may want to consider appointing someone you trust implicitly with power of attorney to manage your finances. Also, you may want to consider appointing a healthcare proxy to make healthcare decisions for you if you’re no longer able to make them yourself. 

Stage 5: Moderately Severe Decline

Symptoms at this stage may include:

  • Disorientation to time and/or place
  • Decreased judgment and skills in regard to personal care
  • Confusion as to what are the appropriate clothes to wear for the day, season, or occasion.

At this point, you’ll definitely need assistance with daily tasks. You’ll no longer be able to live independently. The ability to eat and use the bathroom without assistance may still be preserved at this stage.

Stage 6: Severe Decline

Symptoms at this stage may include:

  • Problems recognizing one’s spouse and other close family members
  • Sundowning, which is increased restlessness and agitation in the late afternoon and evening
  • Difficulty using the bathroom independently
  • Bowel and bladder incontinence
  • Suspicion and paranoia.

This is often the most difficult stage for caregivers because it’s characterized by personality and behavior changes. In addition, assistance is required for most daily activities. 

Stage 7: Very Severe Decline

During this stage, speech becomes extremely limited (6 words or fewer). Many basic abilities, such as eating, walking, swallowing, and sitting up, fade during this stage. Your ability to respond to the environment disappears in this final stage, and many become immobile. 

Total care is required around the clock, and you’ll most likely reside in a facility like a nursing home. The most frequent cause of death for individuals with end-stage Alzheimer’s is pneumonia.

Alzheimer’s Prevention and Treatment

Unfortunately, Alzheimer’s disease is not a preventable condition. However, research shows that you can reduce your risk of Alzheimer’s through a combination of simple but effective lifestyle changes. 

The “six pillars” for prevention of the disease are:

  • Regular exercise
  • Social engagement
  • A healthy, balanced diet
  • Mental stimulation
  • Quality sleep
  • Stress management.

Currently, there is no cure for Alzheimer’s disease. But early diagnosis and treatment can slow progression of the disease and improve your quality of life. The following treatments for Alzheimer’s disease target memory loss and include:

  • Cholinesterase inhibitors (donepezil [Aricept], rivastigmine [Exelon], and galantamine [Razadyne])
  • A partial N-methyl-D-aspartate (NMDA) antagonist (memantine [Namenda])
  • Combination cholinesterase inhibitor and NMDA antagonist (memantine/donepezil [Namzaric])

Secondary symptoms, such as depression, anxiety, agitation, psychotic behavior, and sleep problems, can benefit from treatment with antidepressant or antianxiety medications, neuroleptic agents, mood modulators, and trazodone.

Outlook

Today, Alzheimer’s disease is the sixth leading cause of death in the United States. This makes finding a cure, treatment, or even more whole understanding of Alzheimer’s disease a priority for medical professionals. 

However, this also makes it a very active area of research looking to find better treatments for its stages. More and more research is unveiling facts and details about Alzheimer’s disease to scientists, giving the medical community more understanding and knowledge. And the future may hold new treatments and innovations that can help those who develop it.

Alzheimer's Disease Stages and Treatments

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Jul 5, 2019