The 7 Stages of Alzheimer's Disease based on the Global Deterioration Scale (GDS) 02 Apr, 2021

Families are often thrown off balance when a loved one with Alzheimer's exhibits unpredictable behaviors. Indeed, for people who have zero experience in providing care for individuals with this disease, situations can get overwhelming. That's why it takes loads of patience, understanding, and dedication to be a family caregiver.

Alzheimer's affects each person uniquely, which means the symptoms one person manifests aren't the same as the other. Thus, it can be confusing and intense for family caregivers. But it would be helpful if families have a guide that can help them manage their experiences and expectations about the trajectory of Alzheimer's disease.

What We Know About the 7 Stages of Alzheimer's Disease

Dr. Barry Reisberg of New York University was the first person to intricately describe the most important symptoms of Alzheimer's disease. Along with this, he also developed The Global Deterioration Scale (GDS), which gives caregivers a rundown of the state of the cognitive function of people with Alzheimer's.

While many physicians identify only three stages of Alzheimer's Disease — early, mid, and late, Dr. Reisberg's GDS outlines seven Alzheimer's Disease stages, from Stage 1 to Stage 7. This model has been instrumental for families in gauging their loved one's condition and identifying the type of care appropriate for a specific stage.

The 7 Stages of Alzheimer's Disease based on the Global Deterioration Scale (GDS)

The 7 Stages of Alzheimer's Disease based on the Global Deterioration Scale (GDS)

In the first 3 Alzheimer's Disease stages, diagnosis is nearly impossible because symptoms are typical of an aging person. Even healthcare providers and families won't be able to spot that something is amiss. This is known as Preclinical Alzheimer's Disease.

However, these changes soon as the disease progresses and symptoms become pronounced.

Seven Stages of Alzheimer's Disease:

  1. Stage 1: Normal Outward Behavior
  2. Stage 2: Very Mild Changes
  3. Stage 3: Mild Decline
  4. Stage 4: Moderate Decline
  5. Stage 5: Moderately Severe Decline
  6. Stage 6: Severe Decline
  7. Stage 7: Very Severe Decline

Stage 1: Normal Outward Behavior

This is a stage before a clinical diagnosis is detected. Other health practitioners refer to this stage as "No Cognitive Decline."

At this stage, a person won't show any symptoms of memory impairment. On the outside, everything is normal. In fact, it will take 10 or 15 years more before people develop the symptoms of cognitive decline.

However, inside, the brain is changing. Unless an imaging test, like a positron emission tomography (PET) scan, is performed to look at how the brain works, Alzheimer's remains undetectable. A cerebrospinal fluid (CSF) analysis is also a reliable test that checks for any evidence of amyloidosis — an influential factor in developing Alzheimer's.

Amyloidosis is a disease wherein an abnormal protein called amyloid builds up in the brain, which disrupts and affects cognitive functions. Currently, the chance of detecting Alzheimer's at the first stage is almost nil unless the person undergoes a PET scan or CSF analysis. Otherwise, the person stays cognitively unimpaired until after several years.

Stage 2: Very Mild Changes

If your loved one's cognitive abilities start to slip, it may be an indication that they're entering Stage 2 of Alzheimer's.

At this stage, the changes in cognitive functions are still very subtle that family members and even doctors may not pick up. The behavioral changes are similar to that of an aging person, so the presence of Alzheimer's is still hard to catch on.

For example, a loved one forgets a word or misplaces their wallet or key. These symptoms are common for seniors and can even happen to younger people. Therefore, if you notice a loved one forgetting something, you can't immediately jump to the conclusion that they have Alzheimer's. It could be just a normal part of aging. Hence, during this stage, Alzheimer's is still undetectable because no obvious memory problems are evident.

These slight changes don't interfere with the day-to-day living of the person. As a matter of fact, the person remains capable of working and living independently. Sooner, these memory lapses become more frequent, and if family members are observant, they may get the drift of what's happening. Read more to know about what are the 7 stages of alzheimer's disease.

Stage 3: Mild Decline

Alzheimer's Disease Stage 3 occurs about seven years before the onset of Alzheimer's. At this level, changes in the person's thinking and reasoning are apparent, that it's easy to tell they're no longer connected with normal aging. As a result, doctors will be able to identify the impairment in cognitive function and then diagnose Alzheimer's.

Family members and friends may also begin to notice the cognitive issues as memory concerns go beyond occasional forgetfulness. Their focus and concentration slightly decrease and can manifest through the following symptoms:

  • Forgetting something they recently read
  • Finding the right words during conversations
  • Asking the same question again and again
  • Difficulty in planning and organizing
  • Trouble remembering names after the introduction

People at this stage also frequently lose their valuables because of increased forgetfulness. In addition, they also tend to forget to pay their bills, attend their appointments, and do other household chores. The person may feel mild to moderate anxiety and maybe in denial of their memory challenges, which are normal. For working individuals, their performance at work drops.

What is still possible during this stage?

At Stage 3, the person can still pretty much do most of their household responsibilities, like cleaning and preparing meals. They're also capable of doing personal tasks, like bathing and toileting. The most help that they need is reminders and little supervision.

Family members can provide reminding support to ensure that their loved ones fulfill the rest of their obligations. Since memory loss is frequent, it's best if loved ones retire from their jobs to avoid getting stressed. After diagnosis, your doctor may suggest treatment options, like medications and care planning.

Stage 4: Moderate Decline

At Stage 4, a loved one is now clinically diagnosed with early-stage Alzheimer's. Mild thinking and reasoning issues during the Stage 3 become more prominent and may affect a person's organizational, language, and arithmetic skills. Apart from this, new cognitive issues emerge while old ones get worse.

Some of the indicators include:
  • Forgetting personal details or life histories
  • Failing to remember what month and season it is
  • Having trouble ordering food or cooking meals
  • Having difficulty writing a check or doing simple arithmetic
  • Short-term memory loss (a loved one may not remember what they eat for breakfast)
  • Losing the ability to manage finances
  • Having difficulty expressing thoughts
  • Declining problem-solving skills
  • Social withdrawal
  • Changing sleep patterns
  • Confusion, depression, and other personality changes
What is still possible during this stage?

At this stage, a person can still:

  • Have a certain level of self-sufficiency to do light tasks
  • Recall the major details in their life
  • Realize the state they're in
  • Have better memory of their distant past than recent events

The Stage 4 symptoms are the upgraded symptoms of Stage 3. Thus, short-term memory loss and forgetfulness occur more frequently. The person's ability to concentrate also declines. A healthcare provider will be able to spot immediately if an individual has cognitive decline through an examination and interview.

If a loved one is driving, it's recommended that they stop. It would be dangerous to focus on the road. On average, this stage lasts for about two years.

Stage 5: Moderately Severe Decline

At Stage 5, the loved one's ability to perform their day-to-day activities starts to lose. At this level, they need support from families or caregivers to bathe, change their dress, or prepare meals. Apparently, these simple tasks become too much for them. Also, major cognitive deficiencies emerge to the extent that they forget important details, like their home address and phone number.

At this stage, common symptoms are:
  • Difficulty remembering facts and essential details
  • Difficulty dressing appropriately according to season
  • Significant confusion
  • Struggle with learning new things
  • Location and time disorientation
  • Hallucinations
  • Paranoia
  • Delusions
What is still possible during this stage?

At Stage 5, a person with Alzheimer's can still:

  • Maintain a certain level of functionality and independence
  • Recognize their family member
  • Tell a story
  • Remember their childhood and youth

The care demands at this stage may start to overwhelm family caregivers, especially if they belong to the "sandwich generation." These are career people who juggle bringing up their kids with giving care to their aging parents.

Whether a loved one lives or doesn't live with any family members, moving them to a safer assisted living or memory care community is the best option at this stage. In a community, they receive sufficient care and attention, which improves their quality of life. On average, this stage lasts one and a half years.

Stage 6: Severe Decline

At Alzheimer's Disease Stage 6, the loved one requires considerable help to carry out daily tasks, including toileting and bathing. The person will struggle with cognitive skills, and counting becomes very difficult. Due to the significant brain damage, symptoms are severe. They can manifest in ways like:

  • Mistaking other people for someone else
  • Inability to recall personal history, recent events, and people's names
  • Delusions, agitation, anxiety, hallucinations, paranoia
  • Confusion
  • Difficulty talking or speech problems
  • Bladder and bowel incontinence
  • Key personality changes and behavior issues
What is still possible during this stage?

At this stage, a person can still:

  • Recognize family members' faces but not their names
  • Have the ability to connect using senses, like listening to music

Families must understand that, at this stage, their loved one isn't fully aware of what they're doing. At this point, they have limited memory. So families shouldn't take the changes, like forgetting names, personally. Stage 6 Alzheimer's lasts approximately two and a half years.

Families have the option to consult their care provider for medications and behavioral strategies that can help manage terrible symptoms.

Stage 7: Very Severe Decline

The final stage is the most challenging phase for both the person with Alzheimer's and their families. The person is terminally ill. The body starts to shut down, and they enter a near-death phase.

At this stage, loved ones need 24-hour support on all the activities of daily living (ADL), like dressing, eating, bathing, and toileting. Due to the severe physical impairment, they also need help with ambulation. They may also catch infections, like pneumonia, which can further complicate their conditions.

At this stage, a loved one:
  • Loses the ability to eat, walk, and respond to their environment
  • Has difficulty swallowing or can't swallow at all
  • Can't speak or communicate
  • Can't tell if they're thirsty
  • Need 24-hour supervision and care support
What is still possible during this stage?
  • A loved one may still have the ability to utter words or phrases.

On average, a loved one may be able to live up to two and a half years. Ideally, they should be in a memory care community where they receive 24/7 care and live the rest of their life with less pain.

After Learning What Stage of Alzheimer's a Loved One Is, What's Next?

It's always good to be involved in your loved one's care plan. One of the ways to do this is to get educated about what they're going through. There are two significant benefits to knowing what stage of Alzheimer's your loved one is in.

  1. 1. Better Care Plan

    Now that you know how far the disease has progressed, you can help devise a better care plan. You can coordinate with your physician or care provider and come up with the best care ideas. Questions of their safety to remain at home should also be opened up. As much as you want to stay with your dad or mom, their care needs must come first.

    2. Better Preparation (Financially, Emotionally, Mentally)

    Another benefit of knowing the Alzheimer's stage of your loved one is that you can prepare ahead of time. If they have a home and are allowed to remain there at the time being, you can help remodel some areas to increase safety features. If they have properties, you can plan out their finances accordingly. You can also arrange their needed medical supplies, like a wheelchair, to prepare when their mobility or condition declines. If you need extra assistance, you have ample time to find an assisted living or memory care community.

As a family, you have enough time to cope with the emotional and mental stress if you know what stage of Alzheimer's your loved one is in.

The Role of Family Members

The entire family can feel the effect of Alzheimer's. Hearing the news can trigger sadness, hopelessness, stress, and other negative reactions. When a loved one is diagnosed, the whole family goes through the struggles associated with the disease.

As a family caregiver, your primary role is to offer a strong support system to your loved one. In many cases, people who receive diagnosis have subtle to mild cognitive decline. The symptoms aren't disruptive enough to need specialized care.

Your loved one may still stay at home for a time, which is practical and cost-effective. While they're at home, family members can take turns to assume the role and responsibilities of a caregiver.

How can a family member provide a solid support system?

Some of the responsibilities to do so are outlined below.

  1. 1. Learn how to respond by self-education

    News of Alzheimer's may come as an unexpected blow to families. Thus, many people get overwhelmed and don't know how to deal with the situation. This is when self-education comes in. Based on dementia statistics, approximately 15.7 million family caregivers care for a loved one or a friend who has Alzheimer's disease or other forms of dementia.

    Millions of these people don't have a healthcare profession nor experience in giving care. Most of these family caregivers are self-taught. They learn things, like meal preparation and medication management, as they go along. They study various resources online and take note of their care provider's advice and suggestions. Learning all these things allows them to understand better, respond, and give care, making them effective family caregivers.

    2. Engagement in Everyday Conversations

    Engaging a loved one in conversations is an essential task of family caregivers. As Alzheimer's progresses, the person loses the ability to communicate and think. Thus, it's critical to engage them in talks to exercise their brain.

    Small talks or long conversations can help stimulate and increase brain activity. Several studies prove that this can slow the progression of Alzheimer's or other dementia. Some of the tips to effectively engage them in conversations are using simple and short sentences, speaking slowly and clearly, and using a loving tone when talking.

    3. Support their interests and hobbies

    There are many safe and fun activities you can do with a loved one with Alzheimer's. You can try doing some of these activities with them. However, it's better to support them with their hobbies and interests.

    If your loved one loves to paint, even if you don't know how to hold a paintbrush, it will make them happy if you join them in their painting sessions. Other fun activities you can do with them are cooking, dancing, listening to music, and knitting. Ask your loved ones what their hobbies are and do it with them. Simple things mean so much for people with Alzheimer's.

    4. Offer help with activities of daily living (ADL)

    If your loved one with Alzheimer's lives with you, getting help with their daily tasks is easy. But if not, take the time to visit them as often as possible. At the early stage of the disease, they may still be competent to live independently. But it doesn't mean you can leave them be.

    You can help in simple things, such as planning out their day, reminding them of their appointments, or creating a to-do list for them. These small things make them think they're still in control of their lives. As the disease advances, their self-sufficiency level declines. When that moment comes, you can support them in more demanding tasks, like cooking, house cleaning, and running errands.

    Remember, don't offer help beyond what they need. People with Alzheimer's want to maintain their independence by completing tasks on their own. If you do everything for them, it's like taking away their autonomy, and they won't like it. Let them do the tasks that they can, and help in tasks that they can't.

    Senex Memory Advisors offer no cost professional advice to families on choosing the right Assisted Living and Memory Care communities. They not only assist in evaluating your parents needs, but they also provide possible solutions when parents need assisted living.

    Their proprietary assessment tool is designed to reduce costs by finding the most appropriate solutions for assisted living or memory care communities for seniors. Senex Memory Advisors work with you to find the best-fit solution for aging parents. Thank you for reading What are the Seven Stages of Alzheimer's Disease article. Click here to read more about Everything You Need to Know About Alzheimer's Disease. 

    If you have questions on finding an assisted living or memory care for your loved one, click here to discuss your queries with a certified dementia advisor or write to


Syed Rizvi

Syed has years of experience dealing with people, understanding their needs, and helping them find solutions to their problems.
As a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), Certified Montessori Dementia Care Professional (CMDCP), Syed is committed to working closely with Senior and their family knowing what is it like for individuals facing a challenging time, at times groping in dark trying to figure what is the appropriate next step or care level for their unique situation.
Syed and Senex Memory Advisors are fully committed to working closely with families in creating a personalized, step-by-step process memory care plan at zero cost.

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