The Alzheimer's Digest: How Alzheimer's Progresses

Changes in the brain of someone with Alzheimer's may start a decade or more before they have any symptoms of the disease -- long before anyone realizes there's a problem.

As the disease causes more damage in the brain, symptoms begin to appear. Forgetfulness is often the first symptom of mild Alzheimer's disease. Often, people with mild Alzheimer's get lost in familiar settings, have trouble finding their keys and other items, and ask the same questions repeatedly.
The disease becomes worse over time. The person with Alzheimer's moves to a moderate stage of the disease and then a severe stage. This decline often takes several years.

Signs of Moderate Alzheimer's

During moderate Alzheimer's, the damage affects parts of the brain that control different functions.

You may notice these things when someone you care about has moderate Alzheimer's:

Memory. He or she may forget details about their past.

Difficulty with chores. Someone with Alzheimer's may have trouble doing tasks with multiple steps, such as:

Cleaning the house
Getting dressed
Using the telephone

Communication problems. Your friend or relative might:

Have trouble finding the right word
Lose track of what they were planning to say
Struggle to understand what other people are saying to them

Behavior issues. People with moderate Alzheimer's may:

Become frustrated or angry more easily
See or hear things that aren't really there
Seem paranoid about unreal threats
Act impulsively
Wander away from home and get lost

During the moderate stage of Alzheimer's, people with Alzheimer's can still remember details about their lives and the people around them. They can take care of some tasks on their own.
But at this stage, they will need help from a caregiver -- such as a friend or family member -- to keep them clean, safe, and calm. Although they can be somewhat independent, they may no longer be able to live on their own.

They are not able to drive at this point, so they will need someone to take them to doctor visits and do other errands with them.

Signs of Severe Alzheimer's

In the severe stage of Alzheimer's, the damage from the disease becomes widespread through the brain. At this stage, your loved one may have these symptoms:

Memory and communications problems. He or she will have trouble remembering the names of people they care about. They may not be able to communicate with others. They may stop interacting with their surroundings -- for example, not noticing when someone is speaking to them.

Problems with self-care. Your relative or friend might have a hard time with basic tasks such as:

Feeding themselves
Using the restroom
Getting dressed

Eventually, they may lose bowel and bladder control and have trouble swallowing.

Physical problems. Someone with severe Alzheimer's could develop other health issues, including:

Weight loss
Skin infections
Pneumonia

They may find walking becomes more difficult. In time, they might not be able to walk at all.
Sleep changes. They may spend more time sleeping during the day but sleep more lightly at night.
In the severe stage, people with Alzheimer's disease need a great deal of help from caregivers. Often family members can no longer take care of them at home.
Some families choose to move their loved ones to a facility such as a nursing home so they get the level of care that they need.

For end-of-life care, a hospice may be a good option.