7 Stages of Alzheimer’s: What to Expect

The statistics for Alzheimer’s disease-related deaths dwarf the casualties of the COVID-19 pandemic. More than 1 million Americans have died of COVID-19, but about 45 million Americans will die of Alzheimer’s disease if effective prevention and treatment are not developed, says Dr. Dale Bredesen, a neuroscience researcher and neurodegenerative disease expert.

Given the prevalence of the disease, understanding the stages of Alzheimer’s disease progression is helpful for affected individuals or family members.

“The stages help serve as a guide for families to help understand the disease course; however, it’s important to know that everyone’s path through the disease will vary,” explains Dr. Anjali Patel, a neurologist at Atlantic Health System’s Overlook Medical Center in Summit, New Jersey.

Read on to discover the seven stages of Alzheimer’s disease and the associated signs, precautions and treatments for each stage.

[READ Anosognosia vs. Alzheimer’s: Understanding the Key Differences]

Stages of Alzheimer’s Disease

The seven stages of Alzheimer’s are also known as the Global Deterioration Scale or the Reisberg Scale. Created by Dr. Barry Reisberg, a renowned geriatrician, the scale is designed to measure cognitive decline throughout the progression of all types of dementia, including Alzheimer’s disease.

“The seven stages of Alzheimer’s outline the progression from being asymptomatic to the late stages of dementia,” Patel says.

Each stage is due to a clinical manifestation of the damage and deterioration in the brain, she adds.

— Stage 1: Before symptoms appear.

— Stage 2: Basic forgetfulness.

— Stage 3: Noticeable memory difficulties.

— Stage 4: More than memory loss.

— Stage 5: Decreased independence.

— Stage 6: Severe symptoms.

— Stage 7: Lack of physical control.

Stage 1: Before symptoms appear

During this stage of Alzheimer’s disease, a person won’t have any outward signs of memory or cognitive changes, and there won’t be changes to their daily life and functioning, Patel says.

At this time, there may be biomarker evidence of possible Alzheimer’s disease before any noticeable symptoms occur, shares Dr. Marc Lawrence Gordon, a neurologist with Northwell Health and chief of neurology at Zucker Hillside Hospital, one of Northwell’s 21 hospitals in New York. Some people get a spinal tap that tests for common markers of Alzheimer’s disease. Individuals with a family history of Alzheimer’s disease may be particularly interested in early testing to start earlier treatment and cognitive therapy.


— There are no noticeable signs at this time.


Bredesen, who is also a New York Times’ best-selling author, explains several keys to preventing cognitive decline:

— Eating a plant-rich diet that is mindful of excess carbohydrates and focused on fiber and probiotics.

— Exercising with a combination of aerobics and strength training.

Sleeping seven to eight hours per night.

— Managing stress.

— Frequent brain training, like learning a new skill or doing a puzzle.


— There is no available treatment at this time.

[SEE: Early Signs of Dementia.]

Stage 2: Basic forgetfulness

In this stage of Alzheimer’s disease, someone may start to forget small, seemingly inconsequential details. These changes may or may not be noticeable to others.

“It is important to note that the symptoms of Alzheimer’s disease occur relatively late in the process — by the time a diagnosis of Alzheimer’s is made, the underlying biochemical changes have been ongoing for about two decades,” Bredesen clarifies.


— Forgetting where you placed an item, like your keys.

— Longer recall times to remember someone’s name or a particular word.


— Continue to perform the precautions listed in stage 1.

— Address and identify other underlying diseases, such as sleep apnea or Lyme disease, that could be contributing to cognitive decline.


— You may want to consider getting blood tests that can show the underlying brain changes of Alzheimer’s. “Examples are p-tau181, ptau217, GFAP, NfL, and Abeta 42:40 ratio. These offer complementary information about brain status,” Bredesen explains.

[Signs It’s Time for Memory Care]

Stage 3: Noticeable memory difficulties

After getting to this stage of Alzheimer’s disease, a person will begin to have memory difficulties that are noticeable to others.


— Needing others to repeat questions in order to comprehend.

— Difficulty with work tasks, like learning a new computer program.

— Increased difficulty with finding the right words.


As this is the last of the “early” stages of Alzheimer’s, it’s a good time to start preparing for the future while your loved one still has the majority of their cognition.

— Establish a medical power of attorney should your loved one be unable to make their own medical decisions.

— Create a network of trustworthy medical specialists, like a primary care provider and neurologist.

— Enjoy spending time with your loved one conversing and doing brain-training activities, such as puzzles, word searches or memory games.


— A person at this stage may be eligible for newly Food and Drug Administration-approved anti-amyloid agents, like lecanemab, Patel says. The medication reportedly slows the decline of the disease by removing beta-amyloid, a protein-like substance associated with Alzheimer’s disease progression, in the brain.

Stage 4: More than memory loss

At this stage of Alzheimer’s disease, a person will have more impairments than just memory. Bredesen adds this is the stage where mild cognitive impairment turns into dementia, as activities of daily living

begin to be impacted.


— Forgetting daily routines or activities of daily living, like getting ready for the day.

— Difficulty keeping up with bills, or double-paying them.

— Trouble with writing out checks correctly.

— Withdrawing from social interactions.

— Trouble recognizing faces or navigating familiar terrain.


— Continue cognition-retention strategies as mentioned above, like diet and exercise.

— Begin cognitive stimulation therapy or some type of formal cognition intervention, if not started already. This may include structured group activities for brain-training activities, talk therapy, or music or art therapy.

— Try a talking photo album, where your loved one can view photos and press a button to play an audio clip of that person saying their name or giving a brief message.

— Place clocks prominently in rooms where your loved one spends time to help them stay oriented to the time of day and their schedule.


— At this point, people may begin taking medications designed for early Alzheimer’s disease. Options for earlier to middle stages include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon).

— Proof-of-concept trials have shown improvement in cognition when treated with factors associated with cognitive decline, like sleep, stress, exercise, diet and hydration, Bredesen says.

Stage 5: Decreased independence

During this stage of Alzheimer’s disease, people with the disease may struggle to care for themselves and safety

concerns can arise. However, a person’s memory will fluctuate at this stage.


— Wandering.


— Forgetting to turn off electrical appliances.


— Arrange for caregiving services or placement in a memory care facility. Patel says those at this stage will have trouble with caring for their daily needs and hygiene and cannot live independently.

— Provide your loved one with verbal reminders about their schedule and pertinent tasks, like brushing their teeth before bed.

— Provide assistance with medications and nutrition, as the individual won’t be able to manage that on their own.


— Many individuals need medications for symptoms caused by Alzheimer’s disease, like a mood stabilizer for paranoid thoughts, Patel says.

— Individuals may continue taking the medications they took at previous stages, like donepezil, or drugs for middle to later stages, such as memantine (Namenda).

Stage 6: Severe symptoms

During this stage of Alzheimer’s disease, the memory symptoms continue to worsen, but now the physical ability to carry out basic tasks also starts to decline.


— Difficulty recalling one’s own personal history.

— Trouble recognizing a spouse or close family members.

— Difficulty with tasks like getting dressed or using the restroom.

— More significant disturbances with sleep and mood.

Urinary incontinence followed by bowel incontinence.


— Continue listening and talking to your loved one and remind them who you are.

— At this point, your loved one will need more direct supervision and attention with activities of daily living.


— Continuing medications for Alzheimer’s disease and mood stabilization.

Stage 7: Lack of physical control

At this stage of Alzheimer’s disease, the individual will need continuous care and assistance, Patel says.


— Difficulty with any communication. The individual will only be able to speak a few words.

— Inability to walk on their own.

— Rigidity in the extremities.

— Difficulty swallowing.


— Passive range of motion stretching to assist with rigid extremities.

— Protecting the airway by feeding slowly with soft or pureed foods.

— Comfortable pillows and wedges in bed to prevent bedsores and pain.


— 24/7 care and monitoring.

— Continuing medications and mood stabilizers.

— Monitoring for tooth decay and pressure ulcers, which are common at this stage in Alzheimer’s disease.

How Long Do the 7 Stages of Alzheimer’s Last?

Alzheimer’s disease is a neurodegenerative illness that gradually progresses over many years, Gordon says.

Each person’s trajectory through the stages ofAlzheimer’s disease will vary. Overall life expectancy after diagnosis is anywhere from three to eleven years on average, Mayo Clinic notes.

According to the Fisher Center for Alzheimer’s Research Foundation, the average duration of each of the seven Alzheimer’s stages in an otherwise healthy individual are as follows:

When to Visit a Doctor

See a doctor for Alzheimer’s disease as soon as possible, even before symptoms occur, Bredesen says.

“For those who have not pursued active prevention, and have not sought medical treatment for brain fog, when noticeable memory loss occurs, they should not delay,” he explains. “It’s best to seek evaluation and treatment at a memory center, or from a neurologist who specializes in memory disorders.”

Bredesen also recommends that everyone 40 years of age or older have a “cognoscopy” or a cognitive evaluation, whether or not they have symptoms.

The evaluation consists of three items:

1. A set of blood tests that show inflammation levels, insulin resistance (a main indicator in Type 2 diabetes), nutrient deficiencies, vascular damage and toxin exposure.

2. A simple cognitive assessment, which takes less than 25 minutes.

3. If you already have memory loss symptoms, then Bredesen recommends a volumetric brain MRI, meaning the computer measures the sizes of various parts of the brain. He emphasizes brain imaging is optional if you have no symptoms and you have a normal score on the cognitive assessment.

More from U.S. News

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What Are the Stages of Dementia?

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7 Stages of Alzheimer’s: What to Expect originally appeared on usnews.com

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