Common questions about Alzheimer's disease.

Q I've heard there are stages of Alzheimer's disease. Can you explain what they are and what they mean for me as a caregiver?

A Although Alzheimer's disease progresses differently in each individual, there are seven stages that appear to be common to the disease. I prefer to classify the disease as mild, moderate and late stage, however.

During the mild Alzheimer's disease stage, you and others may notice that the individual is having problems planning or organizing, reading a paragraph and understanding it, or performing properly at work. He or she may have problems performing challenging mental math, such as counting backwards from 100 by sevens, and performing complex tasks, such as shopping, planning a dinner party, or paying bills.

During moderate or mid-stage Alzheimer's disease, an individual may need help choosing the right clothing, may be unable to recall important personal details like his or her birthday, address, or where he or she went to school and may get confused about where they are or about the date or time of year. This is when more day-to-day caregiving may become necessary.

By the time the disease reaches the late stage, individuals lose most awareness of recent experiences and events, as well as their surroundings, may forget the name of their spouse or primary caregiver sometimes, need help getting dressed and experience disruptions in their normal sleep/wake cycle. By the end, they are no longer able to respond to their environment, speak, walk without help, or even smile or hold their head up. They have problems swallowing and their reflexes become abnormal.

Please keep in mind, however, that there is often quite a lot of overlap between the stages, and a patient may exhibit symptoms of several stages simultaneously.

--Laurel Coleman, MD

Alzheimer's Association 

Board of Directors

Practicing geriatrician 

Augusta, ME

Q How do I know when it's time to move my father into a nursing home?

A Not every daughter can provide 24-hour skilled care and supervision indefinitely. It's realistic and necessary to consider that at some point your father may need more care from trained professionals than what you can provide at home on your own. However, there is no one right time for a move to assisted living or skilled nursing care. It depends more on your family's capacity, tolerance, health, competing obligations, values and preferences than it does on the disease's progression.

--Lisa P. Gwyther, MSW, LCSW 

Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences Director, Duke Aging Center

Family Support Program Duke University Medical Center Durham, NC