Alzheimer’s is a progressive illness, meaning it begins in subtle ways and grows progressively more severe. Nonetheless, the exact pace and magnitude of its progression varies from person to person.
Alzheimer’s disease generally progresses through several stages of increasingly problematic symptoms.
Although Alzheimer’s is often diagnosed in the mild, or early, stage, the brain changes underlying it may begin years earlier.
Symptoms tend to appear when people are older than 65. However, in cases of early-onset Alzheimer’s, symptoms emerge before age 65. Early onset Alzheimer’s accounts for about 1% to 6% of all cases.
Alzheimer’s begins with buildups of malformed amyloid-beta proteins — called amyloid plaques — and tangles of another protein, called tau, inside nerve cells.
Although no symptoms are outwardly visible during this phase, the amyloid plaques provide an early sign of the disorder that can be seen via imaging tests, such as magnetic resonance imaging (MRI).
A physician can help determine the utility of early testing for Alzheimer’s biomarkers, such as through a person’s family history.
Mild Alzheimer’s (early-stage)
Alzheimer’s-related brain changes begin in the hippocampus, an area associated with learning and memory. This leads to greater difficulty remembering new information, such as forgetting an appointment, repeating questions after hearing the answer, or forgetting where one has placed an item. These changes initially can be hard to distinguish from normal age-related memory challenges or from other forms of dementia.
Similarly, many people begin to experience trouble with orientation in these early stages, easily becoming confused or lost.
Of great concern to patients and loved ones alike are the mood and personality changes that accompany Alzheimer’s.
Confusion may lead to or magnify feelings of anxiety, which sometimes can trigger aggression.
Money management is a frequent concern of both those with Alzheimer’s and their families. A person’s declining cognitive abilities complicate tasks such as paying bills and making sound finacial decisions. As the disorder progresses, people with Alzheimer’s may try to hide their financial difficulties in order to retain their independence.
Another common early symptom tied to confusion and forgetfulness is taking longer than usual to complete routine tasks.
The mild symptoms experienced earlier grow more pronounced during this stage of Alzheimer’s.
Individuals tend to need more help with daily activities, while memory loss grows to the point of forgetting personal details such as one’s address or phone number.
Memory loss often accompanies further personality changes, including unfounded suspicions of friends, family, and other caregivers, and imagining things that are not there or that have not happened. The inability to recall events or recognize others sometimes accompanies violent outbursts that may include lashing out at those nearby.
Growing anxiety, anger, and the erosion of self-esteem also can lead to changes in a person’s sexual behavior, resulting in difficulty with intimacy or falling in love.
Confusion at this stage typically grows more profound, to include mistaking strangers for family, losing track of greater chunks of time, and wandering to the point that it becomes unsafe to leave home unaccompanied.
Severe Alzheimer’s (late-stage)
In Alzheimer’s later stages, cognitive symptoms grow severe and physical capabilities begin to erode.
Individuals may become unable to communicate coherently, speaking in ways that make no sense to others.
The affected person often needs considerable assistance with daily activities, such as eating, dressing, basic hygiene, and going to the bathroom.
Muscle control declines in this stage, leading to the need for help walking and/or holding one’s head upright. Other signs of muscle decline include the loss of bladder and bowel control.
Late-stage disease also can cause difficulty swallowing, a condition called dysphagia that raises the risk of aspiration pneumonia, in which inhaled food or liquid causes a potentially life-threatening inflammation or infection of the lungs. Aspiration pneumonia is a leading cause of death among those with Alzheimer’s.
Some patients might experience delusions and hallucinations, in which case it is critical to seek professional medical help.
Last updated: June 16, 2021
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