A woman in a garden of forget-me-nots shown through 7 phases, in the last 3 phases a man is helping her

What Are the Stages of Alzheimer's Disease?

Reviewed by: HU Medical Review Board | Last updated: November 2022

Alzheimer's disease gets worse over time but affects people differently. The severity and timing of the illness may vary. It can be hard to know which stage your loved one is in because stages may overlap.1

There are different ways to describe the stages of Alzheimer's. Some doctors categorize Alzheimer's disease into 3 stages: early, middle, and late. Other doctors group symptoms into 7 stages. These are known as the Global Deterioration Scale (GDS).

GDS stages get progressively worse and include:1-3

  • Stage 1: Pre-clinical
  • Stage 2: Basic forgetfulness
  • Stage 3: Noticeable memory problems
  • Stage 4: Major memory loss
  • Stage 5: Decreased independence
  • Stage 6: Severe symptoms
  • Stage 7: Decreased or inability to control bodily functions

Figure 1. Reisberg's stages of Alzheimer's

Stage 1: Before memory loss

Alzheimer's disease begins in the brain before a person starts showing symptoms. This is called pre-clinical Alzheimer's disease.

Stage 1 can start 10 to 15 years before any symptoms appear. There is no treatment for pre-clinical Alzheimer's disease right now, but doctors hope that in the future, there will be drugs to stop the progress of the disease at stage 1.3

The risk of Alzheimer's disease increases with age. Be sure to visit your primary care doctor regularly as you age so they can screen you for Alzheimer's.1

Stage 2: Forgetfulness

Everyone can forget things from time to time. And forgetting things can happen more often as people get older. People in the earliest stages of Alzheimer's might forget things like people's names or where they left their keys.1,2

The person with stage 2 Alzheimer's can still do things like drive and work. But memory problems will happen more often. You might notice these problems before your loved one does. If you do, you can suggest they get treatment sooner to slow the progression of Alzheimer's.1,2

Stage 3: Noticeable memory problems

This stage can bring changes that are noticeable to many people. Diagnosis is common at stage 3 because the person's daily routine becomes disrupted.1,2

In this stage, people commonly have problems with forgetting names and misplaced objects. Symptoms might include:1,2

  • Forgetting recently read material, like news articles or books
  • Problems finding and speaking common words
  • Forgetting plans
  • Difficulty staying organized in daily tasks
  • Social or work problems

This may be a difficult time for your loved one. They may deny that anything is wrong. That is normal. But talk to your loved one's doctor early, before symptoms get worse. Your loved one's doctor can help guide treatment options, including medicine and care planning.1

Stage 4: Major memory loss

In this stage, damage to the brain often affects things other than memory. Language, organization, and calculation skills may all be impacted. Because of this, completing everyday tasks can be difficult.1

Stage 4 can last many years. Major memory problems occur in this stage. People usually remember important details from their life better than everyday details.

For example, they might be able to recall the state where they live or their spouses's name. But their memory of the distant past will usually be worse than their memory of things from today.1

Other challenges in stage 4 include:1,2

  • Being confused about where they are or what day it is
  • Getting lost or wandering off
  • Sleep problems, like sleeping more during the day and trouble sleeping at night
  • Problems choosing the right clothing for the weather

Your loved one might have a tough time with situations that require a lot of thinking. Social gatherings might be especially frustrating. Those in this stage might be:1

  • Moody
  • Withdrawn
  • On edge

Stage 5: Decreased independence

Until this stage, your loved one may have been able to live on their own with no regular help. Checking in on them might have been enough. But by stage 5, your loved one might not remember the people who used to be most important to them. Learning new things is now hard or impossible. Also, basic tasks like grooming and getting dressed may be too hard.1

Common symptoms in this stage include:1,4,5

  • Paranoia – Feeling like others are out to get them
  • Hallucinations – Seeing, hearing, touching, tasting, or smelling things that are not there
  • Delusions – Believing in something that is not true, for example that an imposter has replaced a family member

Stage 6: Severe symptoms

In stage 6, people with Alzheimer's will have symptoms that will impact their ability to manage their care. They will be more dependent on others for help.1

It can be difficult to communicate with your loved one at this stage. They may still use words and phrases, but it can be hard for them to express specific thoughts. For example, they may be unable to tell you where exactly they are feeling pain.1

Your loved one's personality may significantly change in stage 6. They might have more:1

  • Anxiety
  • Hallucinations or delusions
  • Paranoia
  • Frustration with you or those around them

Not everyone with Alzheimer's disease will have severe behavioral changes. But if your loved one is experiencing such changes, try not to take it personally. Their frustrations are part of the disease's progress and not a reflection on you.1

Stage 7: Decreased or inability to control bodily functions

As Alzheimer's progresses, it destroys brain cells. This can lead to severe mental and physical impairment. Your loved one may start to have problems with their body shutting down. This happens when their mind can no longer process, communicate, or delegate tasks effectively.1

Your loved one's needs will increase a lot now. They will need help walking, sitting, and even swallowing. Because they are not as mobile, they can get infections more easily. At this point, your loved one will need full-time care.1

Stages of Alzheimer's disease

Knowing the stages of Alzheimer's is essential, but it is just the beginning. With this knowledge, you can better understand your loved one's condition and what treatment they need.1

Caring for someone with Alzheimer's can be difficult. You have to take care of their physical needs, make financial decisions, and deal with the emotional stress. Rely on your support network to help you. This includes other family members, friends, doctors, and support groups.1

Remember to take care of yourself to provide the best care for your loved one.1

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