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Alzheimer's stages

by Barry Reisberg


Federico Ortíz-Moreno *


Alzheimer's disease gets worse over time. The experts have defined a "stages" to describe how the skills of a person change as the disease progresses. Given this, it is important to remember that the steps are general guidelines and that symptoms vary greatly. Each individual is unique, but here describes what happens to the majority. People with Alzheimer's disease live an average of eight years before its symptoms have begun to be noticed by other people, but life expectancy varies from only three to 20 years, depending on age and other health conditions of the individual. The seven stages presented here are based on a system developed by Barry Reisberg, M.D., director of the Center for research into dementia and aging Silberstein of the school of Medicine of the NYU, in the United States.



These are the seven stages described Dr. Barry Reisberg, which shows an involution of life itself. As well as the baby grows up to become a child, teenager, young adult and complete its cycle of life, the order presents the doctor Reisber in in the opposite direction. Here are the 7 stages he is talking about.


Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns.


Staging systems provide useful frames of reference to understand how the disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years.


The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.


Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories.




   Stage 1:

No impairment (normal function)


Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.


   Stage 2:

Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)


Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.


   Stage 3:

Mild cognitive decline


Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms 


Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:


·        Word- or name-finding problems noticeable to family or close associates

·        Decreased ability to remember names when introduced to new people

·        Performance issues in social or work settings noticeable to family, friends or co-workers

·        Reading a passage and retaining little material

·        Losing or misplacing a valuable object

·        Decline in ability to plan or organize


   Stage 4:

Moderate cognitive decline

(Mild or early-stage Alzheimer's disease)


At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:


·        Decreased knowledge of recent occasions or current events

·        Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s

·        Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances

·        Reduced memory of personal history

·        The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations


   Stage 5:

Moderately severe cognitive decline

(Moderate or mid-stage Alzheimer's disease)


Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:


·        Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated

·        Become confused about where they are or about the date, day of the week or season

·        Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s

·        Need help choosing proper clothing for the season or the occasion

·        Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children

·        Usually require no assistance with eating or using the toilet


   Stage 6:

Severe cognitive decline

(Moderately severe or mid-stage Alzheimer's disease)


Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:


·        Lose most awareness of recent experiences and events as well as of their surroundings

·        Recollect their personal history imperfectly, although they generally recall their own name

·        Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces

·        Need help getting dressed properly; without supervision, may make such errors as putting pyjamas over daytime clothes or shoes on wrong feet

·        Experience disruption of their normal sleep/waking cycle

·        Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)

·        Have increasing episodes of urinary or fecal incontinence

·        Experience significant personality changes and behavioural symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviours such as hand-wringing or tissue shredding

·        Tend to wander and become lost


   Stage 7:

Very severe cognitive decline

(Severe or late-stage Alzheimer's disease)


This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.


·        Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered

·        Individuals need help with eating and toileting and there is general urinal and faecal incontinence

Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired. 


* Dr. Barry Reisberg, Director del Centro de Investigación de Demencia y Envejecimiento Silberstein

de la Escuela de Medicina de la Universidad de Nueva York, en Estados Unidos.




Algunos datos:


   ALZHEMER / Los números...    


  • En el mundo existen más de 36 millones de personas con Alzheimer.

  • Cada año 4.6 millones de personas más.

  • Un nuevo caso cada 4 segundos.  

  • El número de casos se duplica cada 20 años.

  • Para el 2030: Más de 75 millones.

  • Para el 2040: Más de 81 millones.  

  • Para el 2050: Más de 135 millones.  

  • En México: Más de 800 mil personas.



* Datos tomados de la ADI y fuentes varias.     



Información tomada de apuntes personales y fuentes varias.  





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