Coping with Mid-Stage Alzheimer's

Reviewed by: HU Medical Review Board | Last reviewed: June 2019

Alzheimer’s disease is a progressive disease that is often broken down into three general stages: early (also called mild), middle (moderate), and late (severe). The stages do have some overlap, but each stage brings different symptoms as well as the severity of symptoms. Each person with the disease is different, and so different people may progress through the stages at different times with different primary symptoms. The middle stage of Alzheimer’s disease tends to be the longest stage and can last for years.1 Knowing the general symptoms of this stage and information about what many people encounter during this stage can help patients, family members, and friends navigate through moderate Alzheimer’s disease.


In the middle stage of Alzheimer’s disease, the symptoms start to become more noticeable to others, especially as the condition progresses. A higher level of care will slowly become necessary as time goes on. In the beginning of this stage, an individual may still know and remember significant memories of their life and important details of their life, but may have trouble with higher-order tasks like paying bills or following directions somewhere. This is because more and more nerve cells in the brain are being damaged, making it harder to do things they once did.1 Other symptoms commonly seen during this stage include1,2:

  • Forgetfulness about events in personal history
  • Increase in moodiness or social withdrawal
  • Increase in frustration or paranoia/suspicion
  • Confusion about day, time, or place
  • Needs assistance in choosing appropriate clothing
  • Increased risk of wandering
  • May forget to bathe or perform other personal hygiene
  • Changes in sleep patterns – may sleep during the day, etc.
  • Possible occasional loss of bladder or bowel control
  • May make up stories if they can’t remember things
  • May start to have increased confusion or agitation in the evening, aka “sundowning

In middle-stage Alzheimer’s, family or caregivers may notice the person with Alzheimer’s starting to “sundown.” Sundowning involves restlessness, agitation, confusion, or aggression that starts when it begins to get darker outside and daylight starts fading.3 It can last into the later evening and interfere with the person’s bedtime, as well. While the causes are not entirely known, it is thought that perhaps being overly tired, confusion about sleep-wake cycles, or unmet needs like pain relief or thirst may have something to do with it.3 If sundowning occurs and is a problem, coping skills like staying calm, distracting the person, and following a routine can help. If it persists, talk with the person’s doctor about what is occurring. There may be a medical reason for the behavior or other explanation.

Strategies for daily living

In this stage, a person with Alzheimer’s might still live fairly independently, especially at the beginning of the stage. As the disease progresses, alternatives to care may be put in place, like a full-time aide or caregiver, or moving to a specialized assisted living home or memory care unit. Coping strategies for this time can include4:

  • Placing reminders and cues in rooms like signs and directions
  • Reminding the person of who you are and where they are often
  • Minimize distractions like clutter
  • Encourage a healthy lifestyle with diet, activity, and socializing
  • Provide consistent reassurance
  • Follow a routine
  • Adapt surroundings to their abilities
  • Install locks or alarms if wandering becomes a problem; utilze GPS devices

Adaptations and strategies will change over time, as the middle stage of Alzheimer’s can last years and years, with significantly different levels of functioning and abilities and different times.

Be aware of the functioning of a person with Alzheimer’s, as this can change, possibly putting them in danger. The middle stage of Alzheimer’s is the longest stage, and the beginning of this time looks very different from the later part. Talk to a doctor about when a higher level of care or supervision may be needed for their health and well-being.

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