Lessons Learned: The Stages of Alzheimer’s

When beloved restaurateur, magazine publisher, and celebrity chef B. Smith at age sixty-two became forgetful, preoccupied, and temperamental, her husband, Dan Gasby, worried that their loving marriage was on the rocks. Then came the morning he could no longer deny what was happening to B.the day they both had to admit that something was terribly wrong and that they needed medical help. The diagnosis of early onset Alzheimer’s disease signaled the end of one life and the start of another for both B. and Dan. 

Alzheimer’s is an overwhelming and devastating disease that is twice as likely to hit African-Americans. B. and Dan decided to share their story, hoping to help other families cope with the disease. Their book, BEFORE I FORGET, takes you inside their journey as they learn to deal with the day-to-day challenges of Alzheimer’s. In honor of National Alzheimer’s Awareness Month (November), here is an excerpt from the book highlighting some of the important lessons that Dan learned as he began to navigate his wife’s disease.



When I first became aware of Alzheimer’s, I read about its three stages. Then I noticed in some other articles that it was described as having seven stages. Of course, I decided to go with the seven stages. After all, being in stage one of seven is a lot better than being in stage one of three, right?

Unfortunately, it doesn’t work that way. The three-stage model is, of course, the simpler one to go by. The seven-stage model allows for greater specificity of diagnostic tests. It also allows for more nuanced home care and directives. For example, many people with Alzheimer’s feel they can drive their cars right through the second of three stages, and their caregivers tend to relent. Advised, instead, that driving into the third stage of the seven-stage model is risky, caregivers tend to end their loved ones’ driving days sooner, as they should.


The Three-Stage Model:

Stage One: Mild/Early

Short-term memory loss becomes apparent, especially in re­gard to recent conversations and events. The patient may ask questions repeatedly and struggle in speech to find common words. Writing may become difficult. Hand-to-eye coordina­tion may become somewhat impaired: handling silverware at the table, for example, may be a challenge. All these symptoms may bring on, or be accompanied by, mood swings and depres­sion and/or apathy. Driving may also be an issue. Generally, Stage One lasts two to four years.

Stage Two: Moderate/Middle

Long-term memory loss becomes evident now, too; child­hood recollections may fade, and the patient may have trouble recognizing family members and other familiar faces. There is general difficulty understanding current events, confusion about time, and loss of awareness of place, even of one’s own home. There are more dramatic mood swings and depression, along with fits of anger and aggression; also uninhibited behavior. Sleeplessness is com­mon; so is sleeping too much. Delusions may occur. There are physical tremors and general slowness, and difficulties in dressing and toilet­ing. Generally, this stage lasts from two to ten years.

Stage Three: Severe/Late

There is profound memory loss and an inability to communicate and com­prehend others. Round-the-clock help is needed for all personal hygiene as well as to guard against falls. There are issues with swallowing and incontinence. Delusions are common, even prevalent. At the end stage, the patient becomes immobile and unresponsive. Generally, it can last one to three years.


The Seven-Stage Model:

Stage One: There is no impairment; memory and cognitive abili­ties appear normal.

Stage Two: There are minor, often unnoticed memory lapses; indistin­guishable from the normal memory issues of aging.

Stage Three: There is more difficulty finding words; the patient of­ten becomes aware of this before others do and tries to cover it up. Objects are often misplaced; new facts are hard to retain. There are some mood swings and depression.

Stage Four: There is increasing short-term memory loss, and difficulty in completing sequential tasks like cooking and driving. Planning becomes difficult, if not impossible, as are sim­ple mathematical challenges, like balancing a checkbook or just keeping track of loose money. There are greater mood swings and depression.

Stage Five (Early dementia/moderate Alzheimer’s): All symp­toms are more pronounced now: more severe memory loss, including long-term memory loss; severe diminu­tion in judgment and coordination; driving is a serious risk now.

Stage Six (Middle dementia/moderately severe Alzheimer’s): The patient is oblivious to current events; there is little or no long-term memo­ry. Home care is needed for dressing, eating, and toileting. Agitation and delusions are common, especially in the late afternoon or early evening (“sundowning”). There is a failure to recognize family members; suspicion of others. Wan­dering is quite common.

Stage Seven (Late or severe dementia): Speech becomes lim­ited. There is difficulty walking and sitting. Round-the-clock home care is needed. There is end-stage immobility and unrespon­siveness.





Photo Credit: Heather Weston

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