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The Three Stages of Alzheimer's
  It is difficult to place a patient with Alzheimer's disease in a specific stage. However, symptoms seem to progress in a recognizable pattern and these stages provide a framework for understanding the disease. It is important to remember they are not uniform in every patient and the stages often overlap.  

First Stage - 2 to 4 years leading up to and including diagnosis


  • Recent memory loss begins to affect job performance.
  • What was he or she just told to do?
  • Confusion about places - gets lost on way to work.
  • Loses spontaneity, the spark or zest for life.
  • Loses initiative - can't start anything.
  • Mood/personality changes - patient becomes anxious about symptoms, avoids people.
  • Poor judgement - makes bad decisions.
  • Takes longer with routine chores.
  • Trouble handling money, paying bills.


  • Forgets which bills are paid. Can't remember phone numbers.
  • Loses things; can't remember grocery list.
  • Arrives at wrong time or place, or constantly rechecks calendar.
  • "Mother's not the same - she's withdrawn, disinterested."
  • She spent all day making dinner and forgot to serve several courses.
  • She paid the bills three times over, or didn't pay for three months.

Second stage - 2 to 10 years after diagnosis (longest stage)


  • Increasing memory loss and confusion.
  • Shorter attention span.
  • Problems recognizing close friends and/or family.
  • Repetitive statements and/or movements.
  • Restless, especially in late afternoon and at night.
  • Occasional muscle twitches or jerking.
  • Perceptual motor problems.
  • Difficulty organizing thoughts, thinking logically.
  • Can't find right words - makes up stories to fill in blanks.
  • Problems with reading, writing and numbers.
  • May be suspicious, irritable, fidgety, teary or silly.
  • Loss of impulse control - sloppy - won't bathe or afraid to bathe - trouble dressing.
  • Gains and then loses weight.
  • May see or hear things that are not there.
  • Needs full-time supervision.


  • Can't remember visits immediately after you leave.
  • Repetitive movements or statements.
  • Sleeps often; awakens frequently at night and may get up and wander.
  • Perceptual motor problems - difficulty getting into a chair, setting the table for a meal.
  • Can't find the right words.
  • Problems with reading, numbers - can't follow written signs, write name, add or subtract.
  • Suspicious - may accuse spouse of hiding things, infidelity; may act childish.
  • Loss of impulse control - sloppier table manners. May undress at inappropriate times or in the wrong place.
  • Huge appetite for junk food and other people's food; forgets when last meal was eaten, then gradually loses interest in food.

Terminal stage - 1 to 3 years


  • Can't recognize family or image of self in mirror.
  • Loses weight even with good diet.
  • Little capacity for self care.
  • Can't communicate with words.
  • May put everything in mouth or touch everything.
  • Can't control bowels, bladder.
  • May have seizures, experience difficulty with swallowing, skin infections.


  • Looks in mirror and talks to own image.
  • Needs help with bathing, dressing, eating and toileting.
  • May groan, scream or make grunting sounds.
  • May try to suck on everything.
  • Sleeps more.
Care of Alzheimer's Patients: A Manual for Nursing home Staff, by Lisa P. Gwyther, ACSW, Member, Committee on Patient and Family Services, Alzheimer's Association.
Barton House -
Phone: 1-480-991-9912
7007 East Mountain View Road
Scottsdale, AZ 85253
Kleege Enterprises - www.KLEEGE.COM
Phone: 1-858-481-3081 Fax: 858-481-2674
12625 High Bluff Drive
San Diego, CA 92130

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