Alzheimer's disease progression
People who have Alzheimer's disease differ in the pattern of problems they have and the speed with which they become worse. The person's abilities may fluctuate to some extent from day to day, or even within the same day. What is certain is that the person with Alzheimer's or another progressive form of dementia will get generally worse. Sometimes a massive decline can occur rapidly over a few months; in other cases it may happen over a number of years.
Phases of the disease
Following are some of the features seen in some people with different levels of Alzheimer's disease and other forms of dementia. Not all of these will be present in every person, not every person will go through every phase; some people will show problems not mentioned here. The most severe problems will not necessarily occur with every person with dementia, as people die of other causes, e.g. heart failure, pneumonia, etc., before they reach the most severe phase of dementia.
Mild dementia - The Forgetful Phase
This phase may last from 2 to 4 years. The person may be:
- Apathetic, show less sparkle;
- Less interested in hobbies, activities;
- Unwilling to try new things;
- Unable to adapt to change;
- Less able to make decisions or plans;
- Slower to grasp complex ideas;
- Ready to blame others for "stealing" mislaid items;
- More self-centred, less concerned with others and their feelings;
- More irritable or upset if they fail at something;
- More likely to repeat themselves, or forget their line of thought;
- More forgetful of details of recent events;
- Seeking the familiar, shunning the unfamiliar.
Moderate Dementia - The Confusional Phase
This is usually the longest phase and may last from 2 to 10 years. The person may:
- Need assistance and supervision with tasks;
- Forget saucepans, kettles or leave stove on;
- Be very forgetful for recent events. Memory for distant past generally seems better, but some details may be forgotten or confused;
- Be neglectful of hygiene or eating, perhaps saying they had a bath or meal when they have not;
- Rapidly becomes lost if out of familiar surroundings;
- Feel safer at home and avoid visiting places;
- Become very repetitive;
- See or hear things that are not there;
- Become angry, upset or distressed very rapidly;
- Behave inappropriately, e.g. going outdoors in nightwear;
- Forget names of friends or family,or confuses one family member with another;
- Wander around streets, perhaps at night, sometimes becoming completely lost;
- Be confused regarding time and place, and time of day, for example, may go out shopping at night.
Severe Dementia
This is the final phase, which only ends in death. It can last for 3 or more years. During this phase, the person is severely disabled and requires total care. They may:
- Lose ability to understand or use speech;
- Be incontinent of urine and/or faeces;
- Be unable to remember for even a few minutes, eg. that they have just had a meal;
- Need help with feeding, washing, bathing, using the toilet, dressing;
- Show no recognition of friends or relatives;
- Take clothes off inappropriately;
- Fail to recognise everyday objects;
- Be disturbed at night;
- Be restless, perhaps looking for a long-dead relative;
- Be aggressive,especially when feeling threatened or closed in;
- Have uncontrolled movements;
- Have difficulty walking,eventually perhaps becoming confined to a wheelchair;
- Eventually immobility is permanent and in the final weeks or months the person is bedfast;
- Eventually there is unconsciousness, perhaps initially shallow, but eventually deep.
Last Reviewed: 07 March 2002
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