Stages of Alzheimer’s Disease

This week we’ll dive in to the stages of Alzheimer’s disease. There are three general stages which can be broken down more specifically into seven stages. The Functional Assessment Staging Tool was developed decades ago and validated in the early 1990s regarding the progression and evolution of Alzheimer’s disease.

FAST:

1. No difficulty either subjectively or objectively.

2. Complains of forgetting location of objects. Subjective work difficulties.

3. Decreased job functioning evident to co-workers. Difficulty in traveling to new locations.

4. Decreased ability to perform complex tasks: planning dinner for guests, handling.

personal finances (such as forgetting to pay bills), etc.

5. Requires assistance in choosing proper clothing to wear for the day, season, or occasion

6.

A. Improperly putting on clothes without assistance or prompting (e.g., may put street

clothes on over night clothes, or put shoes on wrong feet, or have difficulty buttoning

clothing) occasionally or more frequently over the past weeks.

B. Unable to bathe properly (e.g., difficulty adjusting bathwater temp.) occasionally or

more frequently over the past weeks.

C. Inability to handle mechanics of toileting (e.g., forgets to flush the toilet, does not wipe

properly or properly dispose of toilet tissue) occasionally or more frequently over the

past weeks.

D. Urinary incontinence occasionally or more frequently over the past weeks.

E. Fecal incontinence occasionally or more frequently over the past weeks.

7.

A. Ability to speak limited to approximately a half-dozen intelligible different words or

fewer in the course of an average day or in the course of an intensive interview.

B. Speech ability is limited to the use of a single intelligible word in an average day or in

the course of an intensive interview (the person may repeat the word over and over).

C. Ambulatory ability is lost (cannot walk without personal assistance).

D. Cannot sit up without assistance.

E. Loss of ability to smile.

F. Loss of ability to hold head up independently.

Taken from: https://www.compassus.com/sparkle-assets/documents/functional-assessment-staging-fast.pdf

Pre-clinical Alzheimer’s disease is generally thought of as stage 1-2, and is only diagnosed through use of research biomarkers. People in this stage are asymptomatic and do not show any signs or symptoms of memory loss.

Early, or mild, Alzheimer’s disease occurs in stages 3-4. As opposed to the pre-clinical stage, a person in this stage is now showing signs and symptoms of cognitive change (i.e. memory loss) that affects their day to day life. In this stage, a person generally can function independently and many people can “hide” their memory loss from loved ones, but usually shows up as forgotten bills or drops in short-term memory noticed in conversation. Some examples I’ve heard:

“Mom, do you not remember us talking about going to dinner tonight? We just talked about it yesterday?”

“You’ve had this doctor’s appointment for months, and I just reminded you this morning.”

In early Alzheimer’s it is critical for the person affected to begin advance care planning. Start organizing medical and durable power of attorney and have conversations about what Matters with your loved ones.

Middle, or moderate, Alzheimer’s disease occurs in stages 5 and the early 6s. In this stage a person clearly has memory or other cognitive deficits contributing to a change in day to day activities and often will require assistance in care. Whether that looks like more help from family, moving to an assisted living facility/skilled nursing facility, or paying for a personal caregiver, the disease is much more obvious than early Alzheimer’s disease. This stage can last longer than early and late-stage, and so it is important for caregivers to find resources to support themselves and to try to prevent burnout. Many places have an “Area Agency on Aging” that has resources for people in this situation.

Late, or severe, Alzheimer’s disease occurs in the later stages of 6 and continues in to 7. In this stage a person’s cognitive ability has decreased to the point that managing basic day to day tasks, such as toileting, bathing, eating, and drinking become increasingly difficult and then impossible. This is the terminal stage of the disease and it is important to focus on preserving the dignity and comfort of the person suffering, usually through the form of hospice care.

These stages are important because every person with Alzheimer’s disease will advance through them sequentially. Not every person will progress at the same rate, but every person will progress. The average life expectancy after being diagnosed with Alzheimer’s disease is 4-8 years, and this is heavily dependent on which stage a person is already in when they are diagnosed. If you are reading this and you are concerned about your memory, be sure to talk to people you love about what Matters to you. If you are reading this and you are concerned about a loved one’s memory, be sure to talk to that person about what Matters to them. It is never too early, but one day it will be too late.

Key Points:

• Alzheimer’s disease is a progressive, fatal disease that advances in a predictable manner

• Communicate your wishes and what Matters to those you love

• Make advance care plans before you need them