The first, or mild stage, begins gradually. It is often impossible to place a precise date on AD's onset. The afflicted person, as well as their loved ones, may or may not be aware that a change is occurring. Forgetfulness is usually the first symptom noticed. Frequent misplacement or the loss of familiar items increases. There may be minor place and time disorientation. Difficulty finding words, or dysnomia, may cause the person to withdraw socially to avoid embarrassment. Mild anxiety over these subtle changes may occur, as well as minor changes in personality. This initial stage may last from 2 to 4 years.
The second, or moderate stage, proceeds with a progressive decline. This is the longest stage and may last anywhere from 2 to 10 years. There is a noticeable deterioration of memory. Complex activities such as driving usually must be given up. Basic self care often requires supervision. The person in the moderate stage may begin using words inappropriately. They are often restless and there is a decline in social skills. Wandering may become a problem. The person may fail to recognize some family and friends. This stage shows a marked confusion as to day and night.
The final, or severe stage, is the shortest. It may last from 1 to 3 years. The terminal person may become uncomprehending. There is a marked weight loss. They may require total care in an institutional setting. They no longer recognize people or their surroundings. There may be an onset of seizure activity. Difficulty swallowing may require that a feeding tube be inserted. Death usually results from aspiration ( the taking of food or fluid into the lungs), or from an infection. The average time from the onset of Alzheimer's disease to death, is in a range of 8 to 10 years.
Click here to read one caregiver's account of the stages she observed in her mother.
Be aware that these stages are a general picture of the course of AD. The length of each stage can vary greatly. A person with Alzheimer's may not go through any well-defined stages.
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