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Natural Progression & Staging Of Alzheimer's Disease - DementiaGuide.com
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About Dementia
Alzheimer's Disease

Natural Progression and Staging

Preclinical | Mild | Moderate | Severe


Without treatment, Alzheimer's disease is a generally progressive one, which gets worse over time - usually over several years. Typically, people with the disease first notice that their memory is not as good as it used to be. This in and of itself is not the same as having the disease, because memory complaints are extremely common as people get older. In fact, most people who recognize that their memory is not as good as it used to be do not go on to develop dementia.

Three things take the problem of poor memory complaints into the realm of dementia. One is when the problem extends beyond memory and affects other aspects of cognition , such as language (e.g. problems finding the right word) or calculation (e.g. inability to make change). Even these problems, in and of themselves, do not mean that a person has dementia. For that to be the case, these problems have to be severe enough to interfere with function; in other words, they have to begin to interfere with people doing what they would ordinarily do in the course of a day. But even this isn't the whole story. Particularly in the last few years, we have come to recognize that dementia occurs when people with memory and other cognitive problems also have problems with judgment, and insight and their emotional relationships with other people (which together are called executive function ).


A common profile of mild dementia is the person who has trouble with recent memory (for example, might ask the same question several times, or read the morning paper and not remember any details of what they have read). Typically, at this stage, the person is beginning to have difficulty with certain complex functions such as using the telephone, or managing finances, taking medications or driving. During the mild stage, many people have difficulty controlling their emotions, and so can become irritable and short-tempered.


In the moderate stage, people no longer can do complex activities such as handling medications, driving, doing housework, preparing meals or even using the telephone without help, but they can care for themselves with prompting. Typically, they need to be reminded to change their clothes, to take a bath or shower. Often they have difficulty learning anything new, and commonly, although they remember a lot of stories from their past, they mix up details, and the order in which things occur. Physically, they are often reasonably well, but it is not uncommon that they begin to move slowly. Often at this stage, there is also suspiciousness. By this time, their judgment for many aspects of their life, including personal safety is too impaired for them to be counted on.


In severe dementia, people need more and more help with personal care. Without treatment, it is very common that they no longer can control their bowels or bladder. Often, they lose weight, and often even lose a sense of who they are. Commonly, they cannot speak in full sentences. Sometimes in this stage, they become delusional, believing things about other people that are not true. A common delusion is that people are stealing from them; another is that where they live is no longer their house, and they will want to 'go home'. They can mistake their spouse for their mother, or a child for a spouse.

This is the sad and fearsome story of what happens in Alzheimer's disease when it is not treated, and when it fails to respond to treatment. What happens with treatment can vary, but usually results in some symptoms improving, others stabilize and some slowly progressing. In consequence, it is not uncommon to see persons with Alzheimer's disease who have been on treatment for many years who have features of all of the stages - such as the person whose memory is not too impaired, and whose judgment is usually good, but who nevertheless believes that they are being lied to.

See Also:
About Dementia > Alzheimer's Disease > Weight Loss
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Last updated January 13, 2019
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