The course of Alzheimer’s disease is not the same in every person, but symptoms seem to develop over the same general stages. In most people with Alzheimer’s, symptoms first appear in their mid-60s.

Scientists know that Alzheimer’s progresses on a spectrum with three stages—an early, preclinical stage with no symptoms; a middle stage of mild cognitive impairment (MCI) (NIH/ADEAR); and a final stage of Alzheimer’s dementia. At this time, doctors cannot predict with any certainty which people with MCI will or will not develop Alzheimer’s.

Forgetfulness: Knowing when to ask for help

While mild forgetfulness can be a normal part of aging, it can also be a sign of more serious memory problems, such as mild cognitive impairment, dementia, or even Alzheimer’s disease.

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer’s disease. Over the past few years, scientists have learned a lot about memory and why some kinds of memory problems are serious but others are not.

Maria has been a teacher for 35 years. Teaching fills her life and gives her a sense of accomplishment, but recently she has begun to forget details and has become more and more disorganized. At first, she laughed it off, but her memory problems have worsened. Her family and friends have been sympathetic but are not sure what to do. Parents and school administrators are worried about Maria’s performance in the classroom. The principal has suggested she see a doctor. Maria is angry with herself and frustrated, and she wonders whether these problems are signs of Alzheimer’s disease or just forgetfulness that comes with getting older.

What are the first signs?

Mild forgetfulness can be a normal part of the aging process. But when memory problems begin to seriously affect daily life, they could be early signs of Alzheimer’s disease or another dementia. Here are some of the early warning signs:

  • Memory loss that disrupts daily life
    Asking the same question or repeating the same story over and over again. Forgetting information just learned or losing track of important dates, names and places. Relying heavily on memory aids like Post-it notes or reminders on your smartphone.
  • Difficulty planning or solving problems
    Difficulty concentrating on detailed tasks, especially involving numbers; for example, keeping track of bills and balancing a checkbook.
  • Forgetting how to do familiar tasks
    Forgetting how to do activities that were previously routine, such as cooking, making repairs, or playing cards.
  • Confusion with dates, time or place
    Distorted perception of dates, time or place. Becoming disoriented or feeling lost in familiar places.
  • Trouble with spatial relationships
    Difficulty reading words on a page, judging distances, telling colors apart.
  • New problems with words in speaking or writing
    Trouble finding the right word or calling things by the wrong name. Conversations can be a struggle and difficult to follow.
  • Misplacing objects and the inability to retrace steps
    Finding objects in unusual places, like a watch in the refrigerator. Misplacing things and inability to retrace steps; accusing people of taking things.
  • Altered decision making; poor judgement or relying on someone else, such as a spouse to make decisions or answer questions
    Making poor decisions, such as giving away money inappropriately. Less attention to grooming.
  • Withdrawal from work or social situations; difficulty initiating activities and participating in social interactions
    Watching television or sleeping more; lacking motivation. Scaling back on work projects or becoming less involved in favorite hobbies.
  • Mood swings and changes in personality
    Getting upset more easily, feeling depressed, scared or anxious. Being suspicious of people.

The Stages of Alzheimer’s Disease

Mild Alzheimer’s disease

As the disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include:

  • wandering and getting lost
  • trouble handling money and paying bills
  • repeating questions
  • taking longer to complete normal daily tasks
  • losing things or misplacing them in odd places
  • personality and behavior changes

Alzheimer’s disease is often diagnosed (NIH/ADEAR) at this stage.

Moderate Alzheimer’s disease

In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. Symptoms may include:

  • increased memory loss and confusion
  • problems recognizing family and friends
  • inability to learn new things
  • difficulty carrying out multistep tasks such as getting dressed
  • problems coping with new situations
  • hallucinations, delusions, and paranoia
  • impulsive behavior

Severe Alzheimer’s disease

People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down. Their symptoms often include:

  • inability to communicate
  • weight loss
  • seizures
  • skin infections
  • difficulty swallowing
  • groaning, moaning, or grunting
  • increased sleeping
  • lack of control of bowel and bladder

Source: National Institute on Aging, Alzheimer’s Disease Education and Referral Center.