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What are the stages of Alzheimer's and dementia?

“What stage is my mother in? What can we expect next?”

Alzheimer’s disease and the other dementias are usually slow and progressive illnesses. The average length of life after a diagnosis of Alzheimer’s is eight years, although many people live much longer.

While there are different theories and views of staging, many senior care professionals, including David Troxel, co-developer of the Best FriendsTM Approach to Alzheimer’s care, believes that understanding three basic stages can help families prepare for the caregiving journey.

Early dementia

In this stage, people with Alzheimer’s retain some insight into their situation, but are getting more and more confused and forgetful. They may begin to lose language skills, have trouble handling money and paying bills, forget once-familiar tasks and have some personality changes.

One woman Troxel worked with said her mother was “fighting the battle” during this stage. She knew what was happening and fought to keep her independence.

During this stage it was tough for the family to manage issues around driving and money management, but with honest and caring communication the mother finally accepted their help.

Middle dementia

People in early-stage dementia can retain enough function to fool family and friends about their condition. But the game is up in stage two, marked by significant memory loss and confusion. Dad may forget or not recognize family and friends, repeat himself often, and have problems sequencing tasks like putting on clothes in the wrong order. He begins to lose independence. It is no longer safe for him to live alone and manage his own affairs.

“Dad stopped bathing, shaving and wearing clean clothes during this time,” a son remembers. “He became apathetic and seemed depressed.”

No wonder this is the point at which most families intervene and seek help for their loved one. They may arrange a power of attorney in order to manage finances, and turn to an adult day center, in home senior care provider or residential care community during this stage of dementia.

Socialization and support are important at all stages of the Alzheimer’s journey, but they are a key intervention during middle dementia. Structuring the day, arranging activities, and preventing isolation are important goals—goals that in home workers who have completed the Home Instead Senior Care® network’s Alzheimer’s and Other Dementia Program support. Besides offering daily assistance with dressing, bathing, meal preparation and other tasks, these trained CAREGiversSM know how to plan activities they and their clients can enjoy together and how to have fun with their clients.

Late dementia

In many ways, Alzheimer’s can be considered a fatal illness. Late in the illness, the person is more prone to falls and infection. The swallowing reflex often declines, making the person vulnerable to aspiration pneumonia. While the person has experienced some incontinence, now he or she may lose full control of bladder and bowels.

Caregiving becomes quite profound and focused on physical care and well-being. Although the person may not recognize family or friends, it’s important to continue expressing love and affection. There’s still a person inside, who needs dignity and respect. Of great help during this final period are hospice services, which can provide excellent medical, spiritual and social care.

Companions along the way

“Supportive companions are important no matter where your family member is in this long journey,” says Troxel. “Building a strong network of caregivers, support groups, and friends can help a family prepare for and address needs and challenges at every stage of Alzheimer’s.” To find support groups, contact your local Alzheimer’s Association chapter. To find in home care support, contact your local Home Instead Senior Care office.

Get moral support and Alzheimer's resources in your Facebook feed by liking Home Instead on Facebook.

To find a caregiver in your area, contact your local Home Instead Senior Care office.

Thoughts and stories from others

  1. September 24, 2016 at 10:43 pm
    Posted by Sam Gail

    Not sure what my mom's Alz stage is but her paranoia is more problematic than her memory. The doctor diagnosed her as alzheimer but not sure if it's other types of dementia. I'm here visiting her and she has a carer that lives with her except Sunday. She thinks family member's are after her, trying to harm her, very fearful & start to be aggressive & misunderstood anything you says and she thinks cell phone can tell her at what stage she is - is she leading or the family members? Is she no 1 or not and if she is by what %. Red light is bad. Any explanation about the phone ?
  2. September 13, 2016 at 08:15 pm
    Posted by catherine walker

    Mum go ct scan 4yrs ago this month but only got results last yr due to her not opening letters from g.p she has vascular & mixed dementia doesn't talk much now appetite is poor and gets aggressive and threatens to walk out house lives with me n husband and son but he stays more at girlfriends as its battle with mum to prompt her getting so hard breaking my heart this has changed her really quick my grandson witnessed her outburst g.p needs to get more support
  3. August 10, 2016 at 08:14 pm
    Posted by Gail

    Thank you Susan for your tips on your mom. My sister is in the 6th also. They said 6 of a 10 year....wasn't sure what that meant but what you spoke about helped me understand. My eldest sister 85 has dementia and I am 6 hrs away. Speak often on phone but that is getting hard for her. Thank you so much. Sending blessings to you as you continue the journey with your dear mom
  4. July 19, 2016 at 01:07 pm
    Posted by Susan

    My mom is now in stage 6. She still knows me when I get in front of her and speak. But her confusion and aggression plus paranoia is really getting worse. I go see her at least once a week with everyday I call to see how's she's doing. I want to know how you handle these late stages of trying to calm and talk to her. If I say the wrong thing oh lord it's bad. So most of the time I stay quiet and try to tell her I'm there for her and it's ok. When she does sound like my mom she's appolizes for putting this on me and wants me to know she's sorry and she loves me.

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