continued:

Alzheimer's stages: How the disease progresses

Moderate dementia due to Alzheimer's disease

During the moderate stage of Alzheimer's, people grow more confused and forgetful and begin to need help with daily activities and self-care.

People with moderate Alzheimer's disease may:

  • Show increasingly poor judgment and deepening confusion. Individuals lose track of where they are, the day of the week or the season. They often lose the ability to recognize their own belongings and may inadvertently take things that don't belong to them.

    They may confuse family members or close friends with one another, or mistake strangers for family. They often wander, possibly in search of surroundings that feel more familiar and "right." These difficulties make it unsafe to leave those in the moderate Alzheimer's stage on their own.

  • Experience even greater memory loss. People may forget details of their personal history, such as their address or phone number, or where they attended school. They repeat favorite stories or make up stories to fill gaps in memory.
  • Need help with some daily activities. Assistance may be required with choosing proper clothing for the occasion or the weather and with bathing, grooming, using the bathroom and other self-care. Some individuals occasionally lose control of their urine or bowel movements.
  • Undergo significant changes in personality and behavior. It's not unusual for people with moderate Alzheimer's to develop unfounded suspicions — for example, to become convinced that friends, family or professional caregivers are stealing from them or that a spouse is having an affair. Others may see or hear things that aren't really there. Individuals often grow restless or agitated, especially late in the day. People may have outbursts of aggressive physical behavior.

Severe dementia due to Alzheimer's disease

In the severe (late) stage of Alzheimer's, mental function continues to decline and the disease has a growing impact on movement and physical capabilities.

In severe Alzheimer's, people generally:

  • Lose the ability to communicate coherently. An individual can no longer converse or speak coherently, although he or she may occasionally say words or phrases.
  • Require daily assistance with personal care. This includes total assistance with eating, dressing, using the bathroom and all other daily self-care tasks.
  • Experience a decline in physical abilities. A person may become unable to walk without assistance, then unable to sit or hold up his or her head without support. Muscles may become rigid and reflexes abnormal. Eventually, a person loses the ability to swallow and to control bladder and bowel functions.

Rate of progression through Alzheimer's stages

The rate of progression for Alzheimer's disease varies widely. On average, people with Alzheimer's disease live eight to 10 years after diagnosis, but some survive as long as 25 years. Pneumonia is a common cause of death because impaired swallowing allows food or beverages to enter the lungs, where an infection can begin. Other common causes of death include complications from urinary tract infections and falls.

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References
  1. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Nov. 18, 2012.
  2. Understanding stages and symptoms of Alzheimer's disease. National Institute on Aging. http://www.nia.nih.gov/Alzheimers/Publications/stages.htm. Accessed Nov. 19, 2012.
  3. Stages of Alzheimer's disease. Alzheimer's Association. http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp# . Accessed Nov. 19, 2012.
  4. Sperling RA, et al. Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia. 2011;7:280.
  5. Mild cognitive impairment. The Alzheimer's Association. http://www.alz.org/dementia/mild-cognitive-impairment-mci.asp. Accessed Nov. 27, 2012.
  6. Albert MS, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 2011;7:270.
  7. Halter JB, et al. Hazzard's Geriatric Medicine and Gerontology. 6th ed. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=540. Accessed Nov. 18, 2012.
  8. Dementia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/delirium_and_dementia/dementia.html. Accessed Nov. 19, 2012.
AZ00041 Jan. 4, 2013

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