Alzheimer's is a heartbreaking and serious form of dementia that gradually robs a person of his or her ability to function normally. Someone with advanced Alzheimer's probably can't live on their own, may have aggressive emotions, likely suffers from confusion, and is unable to connect with others. Sadly, there is no cure, only medications that slow the progression of the symptoms. Early diagnosis can give you or a loved one a better quality of life until the disease ultimately takes its toll.

There is no single test for Alzheimer's disease. Before making a diagnosis, a physician should conduct a complete physical and neurological exam, take a thorough medical history as genetics often plays a roll, perform mental status testing and order blood and brain imaging tests to rule out other forms of dementia. Certain drug interactions, vitamin deficiencies and thyroid problems can also cause dementia-like symptoms which are treatable.

Stages of Disease Progression

Because the specific symptoms of Alzheimer's can vary from person to person, and the disease progresses at different rates, doctors use a system of stages to help determine the level of impairment and need for further care.

Some experts label as many as seven different stages of Alzheimer's disease, ranging from normal to very severe, often with overlapping symptoms that could make it difficult for the average person to distinguish one stage from another. Other experts break the progression of disease down into just three or four distinct stages.

Paul Rosenberg, MD, Associate Director of the Memory and Alzheimer's Treatment Center at Johns Hopkins Bayview Medical Center, says it is much less confusing for family members to understand these four distinct stages, beginning with mild cognitive impairment, which may or may not indicate Alzheimer's disease, followed by mild, moderate, and severe dementia, if Alzheimer's disease is present.

Stage 1: Mild Cognitive Impairment (MCI)

During this first stage of minimal impairment, patients are still functioning normally and performing conceptual activities of daily living, such as driving, shopping, housekeeping, and paying bills. Patients (as well as friends and family) notice symptoms associated with loss of short-term memory, such as difficult remembering something that happened a week ago or even just minutes ago and repeating themselves. "You start to forget what to do next, and what you already did," says Rosenberg. "Maybe you forgot an ingredient in a familiar recipe, or to take medication or pay a bill." A doctor who is made aware of these signs and symptoms will mostly likely do some office testing.

"Showing signs of MCI puts you in a higher risk group for developing Alzheimer's disease," the expert points out. "But it doesn't mean you have the disease." It is a significant risk factor, however, since more than 50 percent of people with MCI go on to develop Alzheimer's disease.

Stage 2: Mild Alzheimer's Dementia

In this stage, although they appear fine, patients start having problems with executive functions and need support to maintain a good quality of life, especially if they live alone. Symptoms include forgetting how to organize their bills to pay them and getting lost while driving.

Frustrated patients often show resistance to help from friends and family. At this point, Rosenberg recommends consulting a doctor. The family can follow up on the doctor's instructions and check to make sure the patient is using a medicine box, eating properly and perhaps set up an auto-pay system for the patient's bills.

Stage 3: Moderate Alzheimer's Dementia

Patients with moderate dementia can often "fake it" briefly, so that friends and family members may not fully recognize the level of decline. But at this stage, there is loss of awareness of one's own environment, trouble remembering the name of close companions such as a spouse or caregiver, change in sleep patterns, loss of judgment, communication skills and coordination, tendency to wander and get lost, mood changes associated with anxiety and depression, and trouble tending to or controlling bladder and bowel functions. The patient can no longer live alone and the primary caregiver such as a spouse or adult child may need assistance from an aide or adult daycare center.

Stage 4: Severe Alzheimer's Dementia

"You don't need a medical degree to recognize the severity of this stage," Rosenberg admits.  In this final stage of Alzheimer's disease, there is loss of most ability to hold a conversation, perform personal care such as eating, dressing and using the toilet, and even sitting properly or holding up the head.  The patient may no longer remember how to walk. At this point, muscles become rigid, reflexes slow down, and it may be difficult to swallow. Patients need help with all activities of daily living, and usually need to be moved to an assisted living facility or nursing home with a dementia unit.

Paul Rosenberg, MD, reviewed this article.




Alzheimer's Association. "Seven Stages of Alzheimer's," Web. Accessed 9 January 2014.

National Institute on Aging. "About Alzheimer's Disease: Symptoms," Web. Accessed 9 January 2014.