Alzheimer’s disease usually begins slowly with very mild symptoms at first that begin to worsen over time. Because early Alzheimer’s symptoms progress slowly, many people are not diagnosed right away. In the early stage, people are often aware that something isn’t right but they manage to hide their symptoms well enough that others don’t notice. People may not want others to know because they are embarrassed or ashamed, or because they fear losing their independence if friends or relatives find out about their condition. Many people with Alzheimer’s are not diagnosed until the disease has progressed into its middle stage, when the signs and symptoms become too obvious to miss. At this point, it is often a family member who notices the symptoms and then makes an appointment for the person to be seen by a healthcare professional.

The initial stages of Alzheimer’s disease are similar to normal age-related changes in memory: occasional forgetfulness, difficulty with simple calculations, inability to express thoughts clearly. While bothersome, these symptoms may not be cause for alarm. Many people experience these age-related changes and most of them do not have Alzheimer’s disease. However, in some cases the symptoms go beyond normal age-related changes and when this happens, the person may have early dementia. Below are some of the mental and behavioral changes that can occur in the early stage of Alzheimer’s disease (also called mild Alzheimer’s) according to the National Institute on Aging.

• Loss of spark or zest for life.
• Difficulty learning new things and making new memories.
• Impaired memory for recent events.
• Poor judgment about money.
• Trouble finding words - the person may substitute or make up words that sound like or mean something like the forgotten word.
• Less talkative (to avoid making mistakes).
• Shorter attention span and less motivation to stay with an activity.
• Getting lost in familiar places.
• Trouble organizing and thinking logically.
• Asking repetitive questions - the same or similar questions several times.
• Withdrawing or losing interest in activities.
• Uncharacteristic anger when frustrated or tired.
• Refusal to make decisions.
• Difficulty with routine chores.
• Forgetting to eat, eating only one kind of food, or eating constantly.
• Losing or misplacing things by hiding them in odd places or forgetting where things normally go (e.g. putting shoes in the refrigerator and milk in the closet).
• Hoarding things of no value.

Unfortunately, as the disease progresses, the changes in memory and behavior get worse. Forgetfulness progresses to a point where it interferes with daily life. Family members are often the first ones to notice these changes and suggest to the patient that they seek medical help (or seek medical help for the patient themselves). In the middle stages of Alzheimer’s disease, people may have difficulty recognizing familiar people or places and may have trouble reading, writing, or understanding speech. Below are some of the characteristics of the middle stage of Alzheimer’s disease (also called moderate Alzheimer’s) according to the National Institute on Aging:

• Decreased concern for appearance, hygiene, and sleep become more noticeable.
• Mixing up people’s identities, such as thinking a son is a brother.
• Trouble recognizing familiar objects; may take things that belong to others.
• Continuously repeating stories, favorite words, statements, or motions
• Poor judgment resulting in wandering off (risking exposure to the elements), falling, self-neglect, or exploitation by others.
• Restless, repetitive movements in late afternoon or evening (often called “sundowning”) which may include pacing, trying doorknobs, or fingering fabrics.
• Increasing difficulty organizing thoughts or following logical explanations.
• Trouble following written notes or completing tasks.
• Fabricating stories to fill in gaps in memory.
• Threatening or accusing others for no reason or cursing inappropriately.
• Inappropriate and childish behavior, such as kicking, hitting, biting, screaming, or grabbing.
• Becoming sloppy or forgetting manners.
• Seeing, hearing, smelling, or tasting things that are not there.
• Accusing a spouse of an affair or family members of stealing.
• Taking frequent naps or awakening at night believing it is time to go to work.
• Thinking a mirror image is following him or a television story is happening to her.
• Needing help finding the toilet, using the shower, remembering to drink, and dressing appropriately for the weather or occasion.
• Exhibiting inappropriate sexual behavior, such as mistaking another individual for a spouse, disrobing or masturbating in public.

As the disease progresses to its late stage, patients lose the ability to perform the simplest tasks. They may no longer recognize friends and family members and may even fail to recognize themselves. Eventually, Alzheimer’s disease patients need around the clock care. Some of the symptoms of late stage (or severe) Alzheimer’s disease according to the National Institute on Aging include:

• Failing to recognize self or close family.
• Speaking in gibberish, staying mute, or mumbling incoherently.
• Refusal to eat or forgetting to swallow; may choke frequently.
• Groaning, screaming, or repetitively crying out.
• Losing control of bowel and bladder.
• Losing weight; skin may become thin and tear easily.
• Appearing uncomfortable or crying out when moved or touched.
• Forgetting how to walk or being too unsteady or weak to stand unassisted; may fall frequently.
• Having seizures or frequent recurring infections.
• Sleeping a lot during the day.
• Requiring total assistance for all activities of daily living.

The course of Alzheimer’s disease is different for different people. The average time from diagnosis to death is around eight years, but this depends on how far the disease has progressed before it is diagnosed. Some people may not live for more than three years after diagnosis, while others may live for ten years or more.