What are the different stages of Alzheimer’s disease?

Alzheimer’s disease rarely appears before the age of 65. After this age, its prevalence increases to 2-4% of the general population and rises sharply to 15% by age 80. In the UK, approximately 944,000 people are currently living with dementia, which includes Alzheimer's disease, the most common form. This number is projected to exceed 1 million by 2030 and could reach 1.6 million by 2050. Women appear to be more affected, as for every 25 patients, 10 are men and 15 are women. However, this difference may be due to the fact that women tend to live longer than men.

What is Alzheimer’s disease? What are its symptoms?

Alzheimer’s disease usually progresses for around ten years before the first symptoms appear. This progression results from the slow buildup of brain lesions, which varies from one patient to another. The rate of cognitive decline is unique to each person, and the order in which symptoms appear also differs. 

The symptoms of Alzheimer’s disease are numerous and can include: 

• Memory problems: This is the most common and noticeable symptom.
• Difficulty with executive functions: For example, forgetting how to use a phone.
• Disorientation in time and space: Patients may get lost on a familiar route or be unable to remember the date.
• Language or vision problems: These may appear early, but are less common. Issues may include difficulty reading or recognizing objects.

As the disease progresses, other issues can develop, such as:

• Speech difficulties (aphasia): Difficulty forming and understanding words.
• Movement issues (apraxia): Trouble with coordinated movements.
• Behavioural and mood changes: Anxiety, depression, or irritability can become more apparent.
• Sleep disturbances: Insomnia or irregular sleep patterns.

The progression of Alzheimer’s is not the same for everyone. Indeed, not all patients present the same clinical picture, nor experience the same progression, nor suffer the same disability. Some people maintain social, intellectual, and emotional functioning for a long time, even after being diagnosed.

What are the stages of Alzheimer’s disease?

According to the DSM-5 (the American Psychiatric Association’s classification system), Alzheimer’s disease is classified into two broad categories:

1. Minor neurocognitive disorders: Early-stage symptoms are present but do not significantly affect daily life. However, everyday tasks require more effort, and cognitive decline is mild.
2. Major neurocognitive disorders (dementia): The patient’s autonomy is compromised, and cognitive decline is significant. They require help with tasks like planning, organizing, and anticipating actions.

Additionally, Alzheimer’s disease is commonly divided into four stages, though these can sometimes be broken down further. These stages do not have clear-cut boundaries and often overlap.

1. Prodromal or pre-dementia stage: This is when the earliest symptoms begin. Memory problems, particularly with episodic memory (personal experiences and events), start to appear. For instance, patients may forget recent conversations or appointments. Although these lapses are frequent, they are usually mild. The patient is often aware of these issues and may develop strategies to counteract, such as using reminders. At this stage, the person remains independent in daily life.
2. Mild stage: At this point, dementia becomes more apparent. Patients may experience:
3. Difficulties with instrumental functions: Such as apraxia (difficulty executing movements), aphasia (language difficulties), and agnosia (difficulty recognizing objects or people).
4. Difficulties with executive function: Reasoning, planning, and organizing become harder, leading to a loss of independence. Apathy (withdrawal from activities), depression, or mood swings may also occur.
5. Moderate stage: Memory problems become more severe. Independence diminishes further, and everyday tasks become increasingly challenging.
6. Severe stage: In the final stage, the patient loses all autonomy. They can no longer recognize loved ones or familiar places. Communication becomes nearly impossible, and mobility declines to the point where they may become bedridden. The body’s basic functions progressively deteriorate, and patients often die from complications such as swallowing difficulties or pneumonia.

In the final months of life, patients require round-the-clock care. During this time, the focus shifts to palliative care and comfort care, prioritizing the patient’s quality of life.

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