Middle-Stage Symptoms of Alzheimer’s

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

Alzheimer’s disease is broken into 3 stages: early, middle, and late. Middle-stage Alzheimer’s is typically the longest stage. It lasts for many years. Symptoms become more noticeable during this time. The person in middle-stage Alzheimer's may not be able to do all their daily tasks without help.1

The middle stage of Alzheimer’s is a stage of transition. It can look very different depending on the person and how far the disease has progressed. Regardless, people with middle-stage Alzheimer’s will start to need more consistent help and care. At this stage, Alzheimer’s becomes more stressful for both the person who has it and their caregivers. But knowing all of the signs can help navigate this tricky time.1,2

Physical symptoms

People with middle-stage Alzheimer’s begin to show noticeable physical symptoms. Some may have difficulty controlling their bladder and bowels. They may start to need help with toileting during this stage. Caregivers may want to set a toileting schedule. They can also try limiting (but not banning) liquids before bed.1-3

Sleep is one of the things most affected. Middle-stage Alzheimer’s can cause changes in sleep pattern (sleep disruption). This could look like sleeping during the day or becoming restless at night. Many people with Alzheimer’s experience “sundowning.” This is restlessness, agitation, anxiety, and wandering during the late afternoon and early evening. Muscle twitches and repetitive movements are also common.1-3

Mental and emotional symptoms

Memory issues get worse and more disruptive during middle-stage Alzheimer’s. People may forget personal events or information about themselves. This can include things like their telephone number and address. They may also become more confused. For example, they may not know what day it is or where they are.1-3

Middle-stage Alzheimer’s can also cause mood changes. The person with Alzheimer’s may become moody or withdrawn. This can happen especially in new or overwhelming situations. Difficulty organizing and communicating thoughts are also common. This can make connecting with others more difficult.1-3

Personality changes also appear in middle-stage Alzheimer’s. The person with Alzheimer's may begin to show behavioral changes in this stage. Each person is different. So each will have a different set of behaviors and changes. Some may:1-3

  • Become aggressive
  • Be suspicious of everyday objects and events
  • Engage in compulsive, repetitive behaviors like hand-wringing

Assistance and care during middle-stage Alzheimer’s

A person in the middle stage of Alzheimer’s may need help for daily tasks. It depends on what the person can do by themself. Some can still do certain tasks or find ways to simplify them. Many people with middle-stage Alzheimer’s can still participate in daily activities if they have assistance.1,2

In middle-stage Alzheimer’s, routine assistance and care become more necessary. As more care is needed, caregivers may consider an adult day center. These centers can provide temporary breaks for caregivers. The staff at the center make sure the person with Alzheimer’s is safe and cared for.1

Middle-stage Alzheimer’s can be stressful for the person with Alzheimer's and caregivers alike. If you notice symptoms of middle-stage Alzheimer’s, or if new symptoms appear, talk to your doctor to find the best way forward for you.

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