Here’s a quick look at the seven stages of Alzheimer’s disease progression.

Lindsay Cook, PharmD, is a consultant pharmacist working with long-term care facilities.

Alzheimer’s disease—the most common dementia—is a progressive neurological condition. It typically affects older adults and often causes symptoms like memory loss, confusion, and changes in behavior.

To help physicians diagnose Alzheimer’s disease, Dr. Barry Reisberg, a psychiatrist at the New York University School of Medicine, developed the Global Deterioration Scale (GDS). The GDS defines seven distinct clinical stages of Alzheimer’s disease that are often condensed into a three-stage classification system: early, middle, and late.

The length of each stage varies based on the three-stage system. All three stages could last for years. However, the middle stage of the condition is typically the longest, while a person may experience late-stage Alzheimer’s disease for several weeks. Here’s what else you need to know about the stages of Alzheimer’s disease.

1. Preclinical Alzheimer’s Disease 

There are no issues with memory or thinking in the first stage of the GDS.³ However, a person may be in this stage for years. That’s because brain changes related to Alzheimer’s disease may already be present even though signs are absent.

Clinical interviews and medical evaluations are insufficient to detect Alzheimer’s at this stage. However, a different type of examination can potentially find biomarkers—biological signs that measure the presence of a disease in your body.

Some biomarkers may indicate low levels of beta-amyloid proteins and high levels of tau proteins. These proteins were initially thought to be early warning signs of Alzheimer’s disease.

While scientists agree that beta-amyloid proteins are likely important in understanding Alzheimer’s disease, further research may focus on other protein theories. Healthcare providers may instead use different methods, such as neurological exams and behavioral or cognitive tests, for a proper diagnosis.

2. Very Mild Cognitive Decline, Age-Related 

Symptoms may become noticeable in the second stage of Alzheimer’s disease. Similar to the first stage, this state does not show significant evidence of dementia in clinical interviews and evaluations. Some people may report growing memory problems, such as forgetting once familiar names or struggling to recall where they put everyday objects.

3. Mild Cognitive Impairment 

The third stage of Alzheimer’s disease is also known as mild cognitive impairment (MCI). In this stage, you may see more explicit evidence of memory loss, lack of focus, and trouble thinking. According to the GDS, people experiencing two or more of the following symptoms are said to be at stage 3:

• A decline in work performance that’s noticeable to coworkers
• Anxiety surrounding being unable to remember things
• Denial of memory problems or other cognitive issues
• Difficulty socializing with others
• Getting lost when going to a location for the first time
• Forgetting names or “losing words”
• Losing a valued or treasured object, such as a wedding ring or social security card
• Retaining or remembering very little of what was just read, which can be determined through clinical evaluation

Unlike the previous stages, clinical tests and evaluations can pick up signs of impairment, especially issues related to concentration.

4. Mild Dementia, Moderate Cognitive Decline 

With stage 4 Alzheimer’s disease, physicians can detect clear signs of Alzheimer’s disease in clinical interviews and after careful evaluation.

Those with this stage of Alzheimer’s disease may experience difficulty remembering aspects of their personal life experiences and display reduced comprehension of current events. Still, people with stage 4 Alzheimer’s disease can generally remember what time and day it is, where they are, and recognize familiar faces.³

5. Moderate Dementia, Moderately Severe Decline 

The fifth stage of Alzheimer’s disease is known as moderate dementia. Clinical evaluation and interviews in these cases can root out memory and cognitive deficits. Those in this stage of Alzheimer’s disease may have:

• Trouble remembering important aspects of their life, such as their address or close friends and family members’ names
• Difficulty identifying the current date, day of the week, or season
• The inability to count down from 20 by twos or fours
• Difficulty getting dressed by themselves

Some people in this stage may retain long-term memories of major life events or the names of their spouse and children. Motor tasks such as using the restroom or eating independently may also come easily.

6. Moderately Severe Dementia 

When a person is in the sixth stage of Alzheimer’s disease, they have noticeable difficulty with memory and thinking. General characteristics of stage 6 include:

• Difficulty counting down from 10
• Difficulty or inability to recall recent life experiences or events
• Disrupted sleep/wake cycles, insomnia, or other sleep problems
• Needing assistance for basic daily activities, such as bathing, using the bathroom, or getting dressed
• Occasional inability to remember the names of a spouse, partner, or caregiver

In addition, the sixth stage is marked by changes in personality and behavioral symptoms. These may include delusional behaviors (e.g., talking to their image in the mirror) or feelings of anxiety or irritability.

7. Very Severe Dementia 

Stage 7 is the last stage of Alzheimer’s disease, and late-stage Alzheimer’s disease can last from weeks to years. A person in this stage loses most, if not all, of their independence as thinking, memory, and control over bodily functions all severely decline. Those in stage 7 will often require full-time support from a caregiver.

Prognosis and Treatment 

Alzheimer’s disease prognosis varies on a personal basis. People may live four to eight years after diagnosis—though that time may reach up to 20 years for some individuals. However, it’s important to note that the condition does not lead to death. Instead, it becomes fatal because of complications from Alzheimer’s disease like pneumonia.

Although there is no cure for the condition, the following are medication-based treatments available to help with the symptoms:

• Cholinesterase inhibitors: These medicines—such as donepezil, galantamine, and rivastigmine—can be used at all stages of Alzheimer’s disease and help increase acetylcholine. Acetylcholine is a nerve cell communication chemical for cognitive functioning.
• Memantine: Used in cases of moderate or severe Alzheimer’s disease, this medication affects how fast intracellular calcium builds up. Intracellular calcium is a regulating messenger for learning and memory, and irregularities are associated with conditions like Alzheimer’s disease.

How Can You Slow the Progression? 

It may be possible to slow the progression of Alzheimer’s disease by:

• Exercising regularly: Aerobic exercise specifically has been associated with a slower progression. Cardio exercise leads to increased blood flow throughout the body.
• Having a healthy diet: Low-fat diets with increased fruit and vegetable consumption can be helpful and contribute to a lowered risk of cognitive decline.
• Keeping your brain active: Consider doing something challenging, like puzzles or strategic card games. Also, spend social time with others or do something social and personally meaningful such as volunteering.
• Not smoking: A higher risk of cognitive decline is linked to smoking.

A Quick Review 

Alzheimer’s disease progresses through seven stages based on the GDS. While there is no cure for Alzheimer’s disease at this time, medical intervention and therapies may help manage the condition or slow its progression. If you notice your loved one starting to display signs of Alzheimer’s disease, do your best to help your loved one receive a proper diagnosis.

 Medically reviewed byLindsay Cook, PharmD