Alzheimer's Disease: 7 Stages of Dilemma (Definitive Pictorial Guide)

Alzheimer’s Disease is a disorder in which:

  • Initially, a person begins to find difficulty in recalling and remembering for a short period of time.
  • As it develops in further stages, the patient starts to forget the names, addresses, and things.
  • The later stages make one finding challenges in performing even simple day-to-day activities.
  • The final stages begin to show a severe impact on the overall body functions and movements too.
Alzheimer's Disease: 7 Stages of Dilemma (Definitive Pictorial Guide): The girl wishing an old man happy birthday while presenting the gift. The old man forgot his birthday date and so asking about the birthday gift while sitting in a garden upstair.
Alzheimer's Disease: Illustration of a girl and an old man who is suffering from Alzheimer's Disease and forgets his birth date!

7 Stages of Alzheimer's Disease (Detailed with Images)


Memories: Our ‘Own’ Personal Belonging

Memories are not less than the private treasures that we keep safe in the chamber of our brain. They can trigger our extreme emotions without making us go through any new or fresh event. It can suddenly make us smile, cry, or laugh. However, memory is good or bad; it is anyone’s closest possession.

The Bad Memories

We all get one or more of those memories that we want to get rid of. But alas and alack, there is no software or system that can delete them permanently.

The Good Memories

On other hand, we all get such memories too, which are too precious and pleasant to cherish. We never want to lose them. We want to embrace them again and again.

One of the Greatest Losses

What if our brain doesn’t support us well and we forget some of them or all?! Dealing with forgetfulness is a bizarre situation to live with.

Considering this, we should be very humble, kind, and sympathetic towards people who suffer from such a loss.

The sheer motive of this article is to spread awareness about Alzheimer’s disease and arouse the feeling of empathy and support for such patients.

Let’s start this journey by understanding the meaning of Alzheimer’s disease.

What is Alzheimer's Disease?

Many people, especially in old age, suffer from Alzheimer’s disease and experience an odd situation.

Remember those grannies or old-age people who ask you, again and again, the same question repetitively? Some of us empathize and behave friendly. Many children also make a mockery of such people or patients and even mimic them. It is not at all a matter of making fun though.

It is a progressive neurological disorder and called “Alzheimer’s Disease”.

Let’s get a detailed insight into it!

3 Phases of Alzheimer's Disease

The 7 stages of Alzheimer's disease can be categorized into three phases of dementia:

  1. Mild Phase (Pre-dementia phase): Early Stage of Alzheimer's
  2. Moderate Phase (Dementia): Middle Stage of Alzheimer's
  3. Severe Phase: Later Stage of Alzheimer's


In this stage, a person doesn't manifest any kind of subjective or objective symptoms. No functional or cognition symptoms are observed. The person doesn't show any kind of changes in mood or behavior also.

Age-related Normal Forgetfulness

Most of the population that falls in the age group of 65-plus experience functional and cognitive difficulties. Elderly people file objective complaints that are characteristic in nature. They find problems in those areas where they had no issues before 5 to 10 years.

Sign and Symptoms of the Alzheimer's Disease at Stage 2

The common issues involve difficulty in:

  1. Recalling the names
  2. Concentration
  3. Selecting the right words while speaking


  1. Mostly, these symptoms or changes are not notable by even the close acquaintance or external observing people with normal aged forgetfulness.
  2. People with such symptoms are more prone to decline at higher rates in comparison to people who belong to the same age group but are healthy and do not have any kind of subjective complaints.

MCI (Mild Cognitive Impairment)

People, who are in this early stage of Alzheimer's disease, manifest subtle deficiencies and failures in mental and neurological areas. However, those people, who are closely associated with the subject of stage three, can notice the changes. The deficits can be observed in many ways.

Sign and Symptoms of the Alzheimer's Disease at Stage 3

A person suffering from MCI (Mild Cognitive Impairment) may show the following diverse symptoms:

  1. Noticeable repetition of queries
  2. Concentration deficits
  3. Compromised performance capacity in executive the functional tasks
  4. Declined performance in job or professional works
  5. Tremendous difficulty in getting proficiency in new job skills
  6. Instead of mastering, evident decrements in capacities (For example difficulty in mastering the new computer skills)
  7. Difficulty in organizing the complex social events, search as birthday parties, dinner party, etc

Other Cases

  1. Many persons may also manifest some other overtly evident symptoms such as anxiety, mood swings, or other types of mood-related changes.
  2. People who are not suffering from any kind of overt psychological or medical conditions, they might also manifest varied symptoms. The differences in the impairments can be seen even in the people belonging to the same kind of group.
  3. In a majority of people, who are manifesting the symptoms of stage three of Alzheimer's disease, the evident signs and symptoms of dementia can be observed over the time period of 2 to 4 years.
  4. If an MCI sufferer is not associated with any kind of complex tasks related to the occupation or social activities, the close acquaintance, friends, family members, and even the people who are closely connected to such an MCI patient, might not evidently get to know about the disease.
  5. In most cases, when the signs and symptoms become noticeable, the patient already reaches to the midway or close to the end of the stage. Before the concerned people take the patient for any clinical consultation, the sufferer already reaches a crucial stage. In such a scenario, where an MCI subject could have taken probably about 7 years of approximate time, the progression to the next level of the disease might occur in 2 to 3 years only.


People associated with a person suffering from Alzheimer's disease in this stage must seek help for the patient as soon as possible. This is an early stage but must not be ignored.

Biomarker tests prove to be beneficial in determining if the person is suffering from stage-3 of Alzheimer's disease. For determining the actual condition, a person may undergo:

  1. Cerebrospinal fluid tests
  2. Brain imaging.

The Management of Stage-3's Patients

A person in stage 3 of Alzheimer's disease needs counseling for both personal and professional works. If a patient has a desire to continue a complex social or occupational role, the person needs to undergo counseling sessions for that.

In such a case, it becomes a sensitive situation to deal with. Where a normal person might suggest for retirement or strategic withdrawal, this decision may result in leading the patient towards:

  1. Alleviated mental stress
  2. Adverse psychological conditions
  3. Overt manifestation of anxiety

Mild Alzheimer's Disease

In stage 4 of Alzheimer's disease, the diagnosis can be made with precision and accuracy as the impairment symptoms can be observed evidently. In this stage, the patients find an inability in managing their complex daily-life performances. This is the most common functional deficit in stage 4.

Sign and Symptoms: The Difficulty Areas

The inability or difficulty can be observed in the following activities:

  1. Preparation of meal for the guests
  2. Finance management
  3. Shopping for personal stuff
  4. Marketing for the family
  5. Difficulty in writing the correct amount on the check
  6. Difficulty in writing the right date while filling a check
  7. The compromised ability to market the food and groceries independently
  8. Visible issues because of compromised functional capacity
  9. Difficulty in managing the personal finances
  10. Difficulty in recalling recent events, visits, or holidays.
  11. Decreased or compromised performances where the skills are used such as cooking for the guests or family members (It is about those too who used to cook well before their disease)
  12. Compromised ability to place food orders from a menu (The patient is often seen giving this job to someone else saying, "You order please".
  13. Committing the obvious mistakes while remembering the date week month year or even the season
  14. The independently living patients might find difficulty in making the payments of the bills or paying the rent.

What Can We Expect

Usually or generally, the patients do not find difficulty in remembering or recalling:

  1. Their current address Significant recent events
  2. Weather conditions outside
  3. Name of the prominent personalities such as the head of the state.

What You Need to Know

  1. In this stage, the need for supervision seems evident while performing finance-related jobs.
  2. In spite of obvious cognition deficits, the patient can survive independently.
  3. The progression of the beginning of the next stage might take the mean duration of about 2 years.
  4. The mood factor can often be seen dominating the patient. In the general language or terminology of a psychiatrist, this is known as the withdrawal and flattening of the effect.

The absent emotional responsiveness is often notable in this stage. A significant difference can be observed in emotional responsiveness that decreases in comparison to previous cases.

This might also be the result of:

  1. Patient's denial of their inability
  2. Compromised performances
  3. Deficits.

Advice (Appeal) to the Caretakers of the Patients

  1. It is not so that the patients of stage 3 of Alzheimer's disease do not realize their deficits and shortcomings. They are aware of their issues and indeed it is painful for them to witness or experience their own decreased intellectual capacity. It is quite fearful for the patients when their deficiencies are about to reveal in front of others. Consequently, Alzheimer's patients tend to withdraw their participation in conversations and activities. It is appealed to the person belonging to the patient to keep this into consideration.
  2. The caretaker of such patients must understand the situation that how their psychological defense mechanism becomes operative and result in the denials. Many times, the patient tries to hide there in abilities and deficits from not only people around them but also from themselves. People next to such patients must deal with them with patience and understanding.

As the complicated medical pathology is absent, the diagnosis of stage 3 of Alzheimer's disease can be made in the commencement of this stage with considerable certainty.

Moderate Alzheimer's Disease

In this stage, the magnitude of the deficit is at a level that catastrophe-free community survival comes into consideration.

The functionality characteristics change in this stage. The basic activities that are performed in daily life also become a challenge because of increased deficiencies.

The patient manifests the inability in:

  1. Selecting the appropriate clothing options as per the weather conditions or the occasion (everyday circumstances).
  2. In some situations, if not reminded about changing the clothes, the patient continues to don the same outfits day after day. It rouses the need for counseling in choosing the appropriate clothing.

Stage 5 might pertain for the main duration of approximately 1.5 years.

Moderately Severe Alzheimer's Disease

In this stage, performing daily activities such as bathing, clothing, or toileting also becomes a challenge. In most cases, this stage is so severe that the Alzheimer's disease patients might have no or little knowledge about their ongoing life circumstances such as weather conditions or their current address This stage can be broken into 5 successive substages as per the inability in performing the functions.

In many cases, the patient's cognitive deficits reach a state where they can also show confusion, uncertainty, or a state of mess in identifying their spouse, parents, friends, or family members.

Stage 6a

In this stage of Alzheimer's disease, the magnitude of the cognitive deficits reaches a level where the patient gets unable to perform the fundamental activities of day-to-day life.

Let's understand the level of functional and cognitive deficits by the example of the difficulty in clothing properly.

The patient might face:

  1. Inability in choosing the clothing without assistance
  2. Beginning of the need of assistance in putting on the clothes properly
  3. Difficulty in putting on the clothes in the correct direction
  4. Difficulty in putting on the arms of the sleave
  5. Issues in dressing in the correct sequence
  6. The lack of understanding in judging that's what are they wearing. A patient might put on the clothes of a street dress or a party dress over the clothes of a nightdress.

Stage 6b

Let's take another example of bathing difficulties. The patient might face the following type of issues:

  1. Loss of taking the bath independently without any kind of assistance from others.
  2. Most commonly, the earliest characteristics can be the inability of setting the temperature of the bathing water without any assistance. However, if once set the temperature of the bathwater, then the person can bath independently.
A person may reach from stage 6a to stage 6e in an average time of 2.5 years approximately.

Other Symptoms

  1. As soon as the stage progresses, some other kinds of additional difficulties and deficits in dressing and bathing can be observed. For example, in addition to the previous issues, a patient may also find difficulty in handling the other bathing mechanics.
  2. The challenges in bathing and clothing are the classic earliest examples where the patient's compromise capacity can be observed during stage 6 of Alzheimer's disease.
  3. The other common symptom that one can observe in this stage is the deficit in daily hygiene modalities such as brushing the teeth properly and independently.

Stage 6c

During stage 6c, the evolution of Alzheimer's disease results in difficulties in toilet mechanics. The following deficit results may take place:

  1. Forgetfulness in flushing the toilet properly
  2. Inability in using the tissue paper properly

Stage 6d

As stage 6d evolves, patient starts to face the issue of urinary incontinence.

Stage 6e

As stage 6e evolves, urinary incontinence leads to fecal incontinence.


Common Symptoms of Later Stage

  1. Difficulty in managing and maintaining the cleanliness while toileting independently and without any assistance
  2. Need of assistance in maintaining the continence

Strategic Actions to Take

In most cases, the issue of incontinence can be prevented or treated completely by frequent toileting. Subsequently, it becomes necessary to take some strategic actions for managing incontinence.

For preventing the incontinence episodes, the following strategies can be taken into consideration:

  1. Giving assistance to the patient by supervising the toileting
  2. Giving assistance to the patient in reaching the restroom.
  3. Placing the appropriate bedding
  4. Using the absorbent garments

Symptoms of Inabilities and Difficulties

  1. Severely affected calculation ability regardless the patient is how much well educated. Consecutive backward counting from 10 to 1 can also be a great challenge for the patient. This ability is frequently compromised.
  2. Difficulty in channelizing the energy into productive and useful activities
  3. Mistaking in identifying the people, regardless it is about their family members or close friends
  4. Confusion between spouse our parents
  5. Inability in Speech and Recalling
  6. Breakdown in speech articulating abilities
  7. Visible breakdown in speech ability
  8. Difficulty in recalling the current events and the prominent life events such as former occupation
  9. Difficulty in recalling the names of the closely associated people and places such as names of the parents or country in which day took their birth.
  10. Difficulty in recalling the names of the prominent figures such as state head, or the national head.
  11. The deficit in recalling the names of the previously attended schools, colleges, or other institutions

However, they know their own name.

Symptoms of Emotional changes

  1. Despite having the neurochemical basis behind the disturbing emotional changes, the situation also affects the patient's psychological reactions at a great measurement.
  2. The patients start to respond to the circumstances differently because of the functional and cognitive deficits.
  3. Manifestation of neologisms, paucity of speech, and verbigeration (stuttering).

Outcomes: Changes in Patient's Behaviour

The handling of such patients need:

  1. Appropriate directions
  2. Patience
  3. Support
  4. Understanding
  5. Counseling

Caution and Warnings

If not given the above properly then the patient might:

  1. Begin to pace or fidget
  2. Place certain objects in a position where they do not belong
  3. Move the objects of the surrounding around
  4. Perform the inappropriate activities
  5. Manifest the purposeless executions

Understand What a Patient Goes Through

  1. Fear, shame, and frustration about their mistakes, forgetfulness, and circumstances
  2. Development of threatening and verbal outbursts
  3. Violence-filled behavior
  4. Fear of getting left alone from their close ones because of their inability of surviving independently

Treatment of Psychological and Behavioral Symptoms

  1. Counseling and support in performing the activities properly and appropriately
  2. Counseling the patients about their illness and its psychological impact and the pharmacological interventions
The average duration of persisting the stage 6 is about 2.3 years. By the end of this stage, the issues and the conditions worsen doubly in intensity.

Severe Alzheimer's Disease

This is a stage of Alzheimer's disease where a patient needs continuous assistance for survival and performing the basic activities of day-to-day life.

This final stage can be categorized into 6 consecutive substages.

Stage 7a

In this stage, speech becomes a highly compromised function. One can expect only half a dozen sensible words from the patient after an intensive interaction or numerous queries.

Stage 7b

As stage 7a progresses, the function of speech gets highly compromised and contracts to a very limited circumference. The number of intelligible words reaches only one or two.

Stage 7c

At this stage, the ability of walking independently and without any kind of assistance gets lost invariably. The loss of ambulatory ability can also be noticed during the end of stage 6 and the commencement of stage 7.

Such a case occurs in case of:

  1. Poor care
  2. Side-effects of medications
  3. Already persisting physical disability

The loss of ambulation can be avoided or postponed in case of ultimate care during the beginning of the 7th stage.

In most cases, stage 7a may continue for the approximate duration of one year and stage 7b may persist for the approximate duration of 1.5 years.

Stage 7c

Where the earliest stage (7a) of this disease limits the speech ability to only a few intelligible words, the later stage (7c) of this disease might end up a patient speaking merely one intelligible word. The speech intelligence is highly compromised in this stage and indeed essentially lost.

Subsequently, the ambulation-related abilities also face tremendous challenges. The patient needs a higher level of assistance while walking.

The average duration of substage 7c can be about 1 to 1.5 years.

Stage 7d

The progressed substage 7c or the early duration of substage 7d might be one level ahead of compromised ambulatory abilities. The patient starts to find difficulty in even sitting properly when there is no assistance. The evolution of this stage goes to a condition where a patient might fall over if there is no holding arm-rest in the chair for the patient.

This stage might end up taking about 1 year.

Stage 7e

This stage takes away the ability to smile from the patient. Instead of giving the smile, a patient can only perform grimacing facial movements.

This stage might continue for the approximate duration of 1.5 years.

Stage 7f

This is a stage where the patients lose the ability to hold up their own heads independently and without any assistance or support. This substage is followed by a condition or state where a patient becomes totally immobile. The patient meets the support even to sit up properly without falling. It is the most challenging stage from the survival point of view. However if given the appropriate support and care, a patient can survive for a period of years.

The later stage brings several evident neurological and physical changes. The most common challenges of a sufferer of Alzheimer’s disease are as follows:

  1. Physical rigidity that increases by the time
  2. Difficult in performing the operations of major joints because of passive range of motion such as compromised functionality of the elbows
  3. Overt physical deformities such as contractures, that is, a kind of irreversible deformity. It becomes impossible to perform the full range of movements that are associated with the joints. Trying to make such a move might give severe pain to the patient.
  4. Prevented active and passive range of joint-related motions in multiple extremities
  5. In addition to the elbow, contractures in the fingers and wrists
  6. During the early substages of stage 7, about 40% of patients experience deformities at different extremities. A patient cannot perform the joint movement even more than halfway.
  7. In later substages, more than 95% of patients experience deformities and immobility. A patient in stage 7 evidently manifests the neurological reflex changes.
  8. One can relate with the notable emergence of the reversed progression from a toddler to an infant stage. In this sequence, the primitive, developmental, and infantile changes can be observed.
  9. The re-emerging reflexes such as the sucking reflex and grasping reflex can be observed. If compared with an infant, an elderly person processes much greatest strength and physical size, so the reflexes and the impact can also be very strong. The provided care may result in both positive or negative impacts on the patient.
  10. Infantile reflexes such as Babinski reflex can also be observed.
  11. The patient with Alzheimer's disease gives an abnormal response on stimulating the foot sole. It includes the fanning of foot digits or dorsiflexion of the toe.


In the case of such a patient, pneumonia can also be one of the most frequent causes of death. Terminal pneumonia can be caused by aspiration also. Such patients are more vulnerable to tasting the end of the life when:

  1. It is a case of an elderly person.
  2. The patient has mild or severe symptoms of stroke, cancer or, other heart-related diseases.

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