The 7 Stages of Alzheimer’s Disease
Alzheimer’s disease is commonly described in seven stages, from normal function with no detectable symptoms (stage 1) to very severe decline (stage 7).
The scale was developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center, and is helpful both in prognosis and in developing a caregiving program. Though Alzheimer’s affects each person differently, these seven stages cover most aspects of its normal progression. Some symptoms may appear earlier or later in the disease process, and progression differs case by case.
The progression at a glance
1No impairment2Very mild decline3Mild decline4Moderate decline5Moderately severe6Severe decline7Very severe decline
Stage 4: mild or early-stage Alzheimer’sStages 5 and 6: moderate to moderately severe, mid-stageStage 7: severe or late-stage
Stage1
No impairment (normal function)
Though early changes may have started in the brain, symptoms like memory problems and personality changes aren’t detectable.
Stage2
Very mild decline
Slight cognitive decline that may be due to either normal aging or early disease effects. This can manifest as memory lapses with commonly used words or confusion about “lost” or “misplaced” objects. Dementia symptoms may be identified by medical examination or noticed by family or acquaintances.
Stage3
Mild decline
Mild cognitive decline, which may be conspicuous enough for Alzheimer’s to be diagnosed by a trained professional. Difficulties in memory and concentration may be noticed by those who interact with the individual on a regular basis. Difficulties may include:
- Perceptible difficulties recalling words or names
- Issues remembering names of new people
- Problems functioning in social or work settings
- Forgetting recently read or learned material
- Difficulties planning or organizing
Stage4
Mild or early-stage Alzheimer’s
Moderate decline
Moderate deterioration, which can be identified by a medical professional through a thorough interview to detect symptoms such as:
- Short-term memory issues
- Diminished ability to perform complex calculations mentally
- Difficulty performing multi-step tasks, such as planning social events, paying bills or balancing a bank account
- Forgetting details of his or her life
- Poor moods and introverted behavior, particularly in complex social or intellectual situations
Stage5
Moderate or mid-stage Alzheimer’s
Moderately severe decline
Noticeable decline, manifesting in clear lapses in memory and logic as well as a need for assistance with daily activities; however, eating or using the bathroom may not be affected. General problems at this stage include:
- Inability to remember personal address, telephone number or other specific details from their past such as schools or favorite books
- Confusion about day, time and location
- Difficulty with basic calculations
- Confusion selecting clothing appropriate to social occasions or weather
Stage6
Moderately severe or mid-stage Alzheimer’s
Severe decline
Memory problems continue to worsen, with possible changes in personality and an increased reliance upon others for help with daily activities. Characteristics of stage 6 are:
- Lost awareness of recent past and environment
- Awareness of his or her name but problems recalling their past
- Ability to recognize familiar people, but difficulty remembering relationships (discerning between family, friends, caregivers, etc.)
- Help is required dressing to ensure clothing is both appropriate and worn correctly
- Drastic alterations in sleep patterns (sleeping during the day, insomnia at night)
- Problems handling details of using the bathroom
- More frequent difficulty controlling bladder and/or bowels
- Severe personality and behavior changes, including mistrust and delusions
- Wandering, which may lead to getting lost when combined with memory issues
Stage7
Severe or late-stage Alzheimer’s
Very severe decline
Effects include the inability to respond to the environment, interact with others and, over time, control movement. Patients in stage 7 need help with almost all aspects of personal care, and it is common for them to lose the ability to smile, sit without support and hold up their head. Muscle rigidity and impaired reflexes are also common, which can lead to trouble swallowing.
Frequently asked questions
How many stages of Alzheimer’s are there?
Seven, on the scale developed by Barry Reisberg, M.D., which this page follows. Other descriptions group the disease into fewer stages; the labels above show how the seven map onto early-stage, mid-stage and late-stage Alzheimer’s.
What happens in stage 5 of Alzheimer’s?
Clear lapses in memory and logic and a need for assistance with daily activities, though eating and using the bathroom may not yet be affected: forgetting one’s address or phone number, confusion about day, time and place, difficulty with basic calculations, and trouble choosing clothing appropriate to the occasion or weather.
What happens in stage 6 of Alzheimer’s?
Worsening memory, possible personality changes and greater reliance on others: lost awareness of recent events and surroundings, recognizing familiar people but not relationships, needing help dressing, disrupted sleep, difficulty with toileting and continence, mistrust and delusions, and wandering.
What are the signs of late-stage Alzheimer’s?
In stage 7 a person can no longer respond to the environment or interact with others, needs help with almost all personal care, and commonly loses the ability to smile, sit without support and hold up the head. Muscle rigidity and impaired reflexes can lead to trouble swallowing.
When is Alzheimer’s usually diagnosed?
Stage 3, mild cognitive decline, may be conspicuous enough for Alzheimer’s to be diagnosed by a trained professional; stage 4 can be identified by a medical professional through a thorough interview.
Not sure which stage you are seeing?
Silverado’s dementia care specialists can talk through the changes you are noticing and help you understand what support might look like next.
