Overview
A diagnosis of Alzheimer's disease means a person will experience a gradual decline in cognitive abilities and changes in personality over time. Understanding the progression and stages of Alzheimer's can help patients and their loved ones know what to expect and prepare for the future.
The Massachusetts General Hospital Memory Disorders Division, which includes the Alzheimer Therapeutic Program, offers comprehensive diagnostic and treatment services to help individuals manage the challenges of living with Alzheimer’s disease.
Learn about Alzheimer’s symptoms and risk factors
Learn about Alzheimer’s diagnosis and treatment
The Stages of Alzheimer's Disease
Alzheimer’s disease progresses over time, and healthcare providers often describe its course in stages based on the severity of Alzheimer’s symptoms and their impact on daily life.
The simplest classification used by the Alzheimer's Association includes three stages of Alzheimer's disease, plus an early pre-diagnosis phase.
- Pre-diagnosis (preclinical): In this phase, changes in the brain begin to develop, but symptoms are not yet noticeable. Advanced imaging and research-based tests may detect these changes, but they are not part of routine clinical care at this stage.
- Early-stage Alzheimer's disease (mild): In the early stages of Alzheimer's disease, symptoms begin but are so mild that other people may not be able to notice them. They may be mistaken for typical age-related forgetfulness. At this stage, the person living with Alzheimer’ symptoms don't interfere with daily life.
- Middle-stage Alzheimer's disease (moderate): The middle stage is typically the longest stage of Alzheimer's, lasting for years. In the moderate stage of Alzheimer's disease, symptoms become more noticeable and begin to interfere with daily activities. You may experience mood swings and psychological symptoms like depression and begin to forget things from your past.
- Late-stage Alzheimer's disease (severe): Late-stage Alzheimer's disease is characterized by severe dementia symptoms that make it difficult or impossible to manage daily life. People with late-stage Alzheimer's disease require constant care, have difficulty communicating, and eventually require assistance with all activities.
Functional Assessment Staging Tool
The Functional Assessment Staging Tool (FAST) is a widely used system for classifying the stages of dementia, including dementia caused by Alzheimer’s disease. The FAST system divides Alzheimer’s progression into seven stages, from pre-symptomatic changes to end-stage care.
- Stage 1: Proteins are building up in the brain, but you have no noticeable symptoms yet.
- Stage 2: You may experience small lapses, like occasionally forgetting a word or misplacing objects. These changes are so mild that loved ones and doctors may not notice. You can still function independently.
- Stage 3: You start to show symptoms that loved ones or doctors might notice, such as repeating the same question multiple times or struggling to learn people's names.
- Stage 4: You begin to make more obvious mistakes, such as being unable to remember what year or struggling to perform complex tasks. You may struggle with language or get lost in familiar areas.
- Stage 5: You may require help with basic tasks. You may struggle to recognize people you know or have noticeable personality changes, like increased irritability or withdrawal.
- Stage 6: Language skills decrease, limiting how you can express yourself. You may have significant personality changes, delusions, and paranoia. You need round-the-clock help with daily tasks. Sleep disturbances and increased rates of infection are common.
- Stage 7: You lose the ability to communicate and to perform essential functions like eating and walking. Hospice care or professional care homes may be needed, as most households cannot provide the intensive care required during end-stage Alzheimer's disease.
A FAST assessment helps determine where a person falls within the seven stages of Alzheimer’s disease. Understanding these stages guide on care planning and the type of support needed for the patient and their loved ones.
Managing Alzheimer's Disease Progression
The early stages of Alzheimer's disease are the best time to prepare for the future. During this time, you can make important decisions.
- Discuss your wishes: Talk with family members about your preferences for long-term health care.
- Plan ahead legally and financially: Consider creating a living will and other legal documents while you can actively participate in decision-making. Preparing for healthcare expenses can ease stress for you and your loved ones later on.
- Evaluate your living environment: Small changes can make your home safer and easier to navigate, such as:
- Labeling important items or rooms
- Adjusting furniture to make it more accessible
- Installing safety features, like handrails or better lighting
Frequently Asked Questions
How fast does Alzheimer's disease progress?
The progression of Alzheimer's disease varies from person to person. On average, people live between four and eight years after diagnosis, although some may live longer with proper care and support. The middle stage (moderate dementia) is usually the longest phase, often lasting for several years.
Do Alzheimer's drugs slow progression of the disease?
Most Alzheimer's medications focus on managing symptoms rather than slowing its progression. These drugs can temporarily improve memory, thinking, or behavior, making daily life more manageable.
Recent medications, such as lecanemab and donanemab, have been approved for treating early-stage Alzheimer’s disease (mild cognitive impairment and mild dementia). These monoclonal antibodies help the immune system target and break down amyloid proteins in the brain, which damage brain cells. Clinical trials have shown that both medications can slow the progression of Alzheimer’s symptoms. However, they are not suitable for all patients and may cause significant side effects.
How long does end-stage Alzheimer’s last?
Late-stage Alzheimer’s is typically the shortest phase of the disease, lasting about one to two years on average.
How do you tell what stage of Alzheimer’s someone is in?
If you’re concerned that you or a loved one may have Alzheimer’s, the best course of action is to speak with a doctor. A medical professional can perform a comprehensive evaluation to diagnose Alzheimer’s disease, provide guidance, and help connect you with resources to navigate each stage of the disease.
What makes Alzheimer’s worse?
Several factors can contribute to the progression of Alzheimer’s symptoms:
- Untreated vascular disease, such as high blood pressure or heart disease, is linked to a faster progression of Alzheimer’s. Managing these conditions can help support brain health.
- Alzheimer’s symptoms may worsen in the evening. This phenomenon, called sundowning, can cause increased confusion, agitation, or restlessness as daylight fades.
