An individual's abilities and capabilities change during the course of the disease and Alzheimer's symptoms vary as the disease attacks each individual very uniquely.

However, individuals with the disease tend to experience a similar path from the beginning to the end, and most healthcare professionals use the seven-stage framework that was developed and outlined by Dr. Barry Reisberg, clinical director of the New York University School of Medicine's Silberstein Aging and Dementia Research Center. A summary of the seven stages is as follows:

Stage 1 is no impairment. The person performs normal functions and is free of cognition and functional decline as well as associated behavioral and mood changes. The individual is a mentally healthy person.

Stage 2 shows normal aged forgetfulness. The person may feel he/she is having some memory lapses and forgets familiar words, has difficulty recalling names or remembering the location of everyday objects. Additionally, they may experience difficulties in concentration as well as finding the right words when speaking. In this stage, no symptoms of Alzheimer's or dementia can be detected during a medical examination or by friends or family members or co-workers.

Stage 3 is characterized by mild cognitive impairment. Friends, family members or co-workers begin to notice difficulties, such as the person is having problems coming up with the right words or names, having noticeably greater difficulty in performing daily tasks and/or responsibilities, losing and misplacing valuable objects, and having increased trouble with planning and organizing. For those still employed, job performance declines and executive functions become compromised. Doctors can usually detect problems in memory or concentration when performing an assessment.

Stage 4 is considered mild or early-stage Alzheimer's disease. A careful medical assessment should be able to identify clear-cut symptoms in areas such as forgetfulness of recent events, impaired ability to perform challenging mental arithmetic, greater difficulty performing complex tasks, forgetfulness about personal history and becoming moody and withdrawn. The person in Stage 4 begins to withdraw and typically has difficulty writing the correct date and the correct amount on a check, as well as mistakes in recalling the day of week, month of year and current season.

Stage 5 includes those at a moderately severe cognitive decline or moderate or mid-stage Alzheimer's disease. Individuals in this stage can no longer manage on their own and need help with daily activities, have gaps in memory and thinking, cannot recall personal address or phone number, are confused about days and dates, and need help in choosing proper clothing (begin to wear same clothing everyday unless reminded to change). However, he/she can still remember significant details about themselves and their family and he/she usually requires no assistance with eating or using the toilet.

Stage 6 is severe cognitive decline, or moderately severe/mid-stage Alzheimer's disease. The person's memory continues to worsen and he/she needs extensive help with daily activities. The earliest deficit marked in this stage is the decreased ability to put on clothing correctly without assistance. Personality changes may take place and the person loses awareness of recent experiences as well as surroundings. The individual also encounters major changes in sleep patterns, needs assistance with toileting, has frequent issues with incontinence, goes through major personality and behavioral changes, tends to wander or become lost, and has trouble remembering the name of a spouse or caregiver.

The final stage of the disease, Stage 7, is marked by severe cognitive decline (severe or late-stage Alzheimer's disease). Individuals are usually non-verbal, lose the ability to respond to their environment and to control movement, need assistance with all activities of daily living, and they may lose the ability to smile or sit without support or hold their heads up. Reflexes become abnormal in this final stage and muscles grow rigid and swallowing is impaired.

Though historically there are seven stages of Alzheimer's disease, it is important to keep in mind that it is difficult to put the affected individual in a specific stage as stages overlap and the disease affects each person differently.


Questions about Alzheimer's disease or a related disorder can be sent to Dana Territo, the Memory Whisperer, director of services at Alzheimer's Services of the Capital Area at advice@alzbr.org or visit the the organization at 3772 North Blvd., Baton Rouge.