What to Expect in Each Stage of Alzheimer’s

There are seven different stages of Alzheimer’s disease, which are identified and classified using a tool called the Global Deterioration Scale (GDS). The GDS covers pre-Alzheimer’s (when there are no symptoms) to the most severe decline. It tracks physical and neurological changes, including your ability to carry out activities of daily living (ADLs), like eating meals, and instrumental activities of daily living (IADLs), which require a greater level of thinking (like cooking meals). The timing of each stage can vary from person to person. Here’s what you might see at each stage and how to plan ahead.

This is often called preclinical Alzheimer’s, meaning symptoms aren't yet noticeable. You likely won’t be able to detect any changes in your memory or ability to do any task. Even your doctor won’t pick up on any signs. But there are changes happening in your brain, notably increasing amounts of two different proteins, first amyloid and then tau. 

IADLs and ADLs. At this stage, you’re fully independent.

Typical duration. This stage can range from 10 to 25 years. 

How to take action. If you're worried that you're at risk for Alzheimer's, talk with your doctor to see if there are any steps you can take to prevent it (like getting enough sleep) and any signs that you should look out for. 

You may notice that it’s harder for you to remember names or where you left your glasses, which may just be annoying to you but not noticeable to those around you or to your doctor. For many, this is normal age-related forgetfulness. But in someone who will develop Alzheimer’s, amyloid plaques are building up between within the brain’s neurons or nerve cells and increasing tau proteins are creating tangles within the neurons.

IADLs and ADLs. You’re mostly independent.

Typical duration. This stage can last for 15 years. 

How to take action. Try simple tools to help with memory, like using an electronic calendar to keep track of appointments, shopping lists, and when to take medications. Print out a sheet with your most important contact numbers and post it in a central place in your home.

As amyloid and tau deposits increase, they destroy nerve cells, leading to loss of thinking skills, or cognition. You may ask the same question over and over or find it hard to stay organized. The less complex your daily tasks, the longer it may take you to notice these changes. On the other hand, the more challenging these tasks, the sooner you’ll be aware of problems.

IADLs. You may have difficulty with higher level thinking, like managing money, planning large social events, completing work tasks, and finding the right words when communicating. You might consider retiring if you still work.

ADLs. You can take care of basic needs but may need more reminders. 

Typical duration. This stage can last for 7 years.

How to take action. Work with your doctor to find out if you have early-stage Alzheimer’s and, if so, discuss treatments to slow how fast it progresses and steps to live safely at home. Make decisions about legal, financial, and long-term care plans, like whether a memory care center or at-home care would be best for you. This may help relieve some of the anxiety you may be feeling. Spend your time and energy on the people and activities that matter most to you.

Trouble with thinking and memory are very obvious at this stage. You may not be able to correctly fill out forms, go shopping, cook, or even order from a menu without help. It becomes harder to remember recent events and even the day of the week. You may start to have mood swings and want to withdraw socially. 

IADLs. It’s hard to manage complex activities of daily life, but with enough help, you might still be able to live on your own. 

ADLs. Driving yourself may no longer be safe, but you should be able to do most basic daily activities.

Typical duration. The range for this stage is about two years. 

How to take action. Ask for help where you need it, like running errands or getting to medical appointments. Give a trusted loved one permission to act on your behalf for medical and legal matters.

Memory problems are severe enough that you can no longer live on your own. On many days, you may be confused about the current events, even the day and time, although you may remember important details about yourself. 

IADLs. You’ll need someone to handle many tasks for you, like making your meals, managing your money, and paying bills. 

ADLs. Basic activities, like picking the right clothes to wear or even changing into clean clothes, are hard to do for yourself. 

Typical duration. This stage can last for 1.5 years.

How to take action. Find a caregiver to help with daily tasks. Increase home safety by having clutter removed, making sure rooms and hallways are well lit, and removing harmful cleaning products and other chemicals that, with time, you will not recognize.

You may not have any memory of past or current events or be able to correctly identify loved ones. At the end of this stage, you may not be able to speak using the correct words or do activities you once enjoyed. Instead, you may fidget or do meaningless things. Your memory declines to the point where you could get lost if you go out alone. You’ll likely go through personality changes and lash out at others out of fear and confusion. 

IADLs. Handling these activities is no longer possible. 

ADLs. Five notable problems follow in order: the ability to do remaining ADLs, like getting dressed; hygiene issues like not being able to bathe on your own because you can’t sense the right temperature or maintain good oral hygiene; a loss of toileting, progressing from mechanics, like not being able to wipe properly, to urinary and then fecal incontinence; inability to recall main parts of history or current life like identity of close family members or events.

Typical duration. This stage can last for about 2.5 years.

How to take action. You’ll likely need around-the-clock care for ADLs. Your health care might include behavioral therapy to remind you of correct behaviors as well as needed medications.

This final stage of Alzheimer’s itself has six stages, each with a progressive loss of function.

From stage 7a to 7b, your speech may decline from a few words to just one. In the next stages, you lose the ability to walk on your own (7c), sit up without help (7d), smile (7e), or hold up your head (7f). Over the course of stage 7, your body becomes rigid and develops deformities, keeping your joints from moving within the full range. You also experience problems swallowing.

ADLs and IADLS. You’re not able to get through any of these on your own.

Typical duration. Stages 7a, 7c, and 7d last about 1 year. Stages 7b and 7e can last about 1.5 years.

How to take action. Because you need help with every part of daily living, you need 24/7 care. The right level of care early in this stage may help you stay mobile. Additional services, like hospice care, can bring comfort during this final stage.