What are the stages of Alzheimer's

Dementia: The Different Stages

The progression of Alzheimer's disease is also described by science in a similar way to an "inverse childhood development" (retrogenesis according to Barry Reisberg). The theory assumes that people with Alzheimer's disease degrade their skills in roughly the reverse order that healthy children build them up during normal development. In the course of Alzheimer's dementia, the affected person loses their normal independence in everyday life and becomes more and more dependent on care and support. The American psychiatrist Barry Reisberg used this theory to describe typical stages of the disease.

What stages are there in dementia according to Reisberg?

The stages described by the well-known Alzheimer's researcher Barry Reisberg make it possible to gain a better understanding of the disease. The stages of dementia according to Reisberg are as follows:

  • Stage 1 (normal function): The disease develops from normal mental performance.
  • Stage 2 (very slightly reduced perception): As a result, the person affected perceives slight cognitive disorders. These are subjective complaints and not yet dementia. Retention and memory are impaired. Names and dates are forgotten. In some situations the memory is missing and often things are misplaced. Prophylaxis training begins at this stage.
  • Stage 3 (slightly reduced perception): At this stage, the environment also notices the first cognitive deficits. This affects the work performance, the choice of the right words and the finding of names. Content that has just been read is forgotten and difficulties arise in planning and organizing everyday life. Problems also arise with spatial orientation and objects are misplaced more often. These symptoms of a mild cognitive disorder can on the one hand be signs of the onset of Alzheimer's dementia, but they can also have other causes.
  • Stage 4 (beginning dementia): The onset of dementia is marked by the entry into stage 4. In the further course, the cognitive disorders are clearly noticeable. The person concerned has difficulties independently performing complex tasks (e.g. solving calculation examples and planning a meal for guests). In addition, there may be difficulties in cooking, in dealing with money or in operating electrical appliances and in finding your way around familiar places. The sick person suffers psychologically from the loss of their abilities and their independence. This can result in a bad mood and withdrawnness, and depression can also develop. The promotion of independent activities and skills that are still available helps to strengthen self-confidence. According to the theory of retrogenesis, the level of performance at this stage can be compared with a child / adolescent from eight to twelve years of age.
  • Stage 5 (moderate dementia): The sick person can no longer cope with everyday life without support. Help is needed with choosing clothes, for example. Seasonal changes are often no longer recognized and personal hygiene declines. It is difficult to remember important, personal data (e.g. address, telephone number, date of birth). Affected people are sometimes confused about where they are or what day it is today (disorientation). The person suffers from nonspecific fears and may also react angrily to the loss of certain skills. According to the theory of retrogenesis, a person's level of performance at this stage is roughly the same as that of a child between the ages of five and seven.
  • Stage 6 (severe dementia): The ability to perform basic activities is lost. Support is necessary in many areas of life, e.g. washing, going to the toilet and putting on clothes. Affected people may have difficulties consciously perceiving recent events and their surroundings. In addition, there can be significant changes in sleep behavior (e.g. sleeping during the day and restlessness at night). Behavioral problems and incontinence can develop. The names of people close to you can usually not be named. The perceived deficits are often responded to very emotionally, e.g. with anger, rebellion or despair. According to the retrogenetic model, a person at this stage corresponds to their level of performance after a two- to four-year-old child.
  • Stage 7 (very severe dementia): At this advanced stage, the affected person's ability to speak and walk is increasingly reduced. In the further course it is no longer possible to sit upright and keep your head upright. The ability to smile is lost. The sick person develops a need for harmony and is emotionally as well as physically very vulnerable and completely at the mercy of his / her environment. But even those who lose their language have a lot to say. Non-verbal communication becomes the basis of the nursing relationship. Suitable stimulation and training can prevent bed restraint for a long time and thus improve quality of life. According to the retrogenesis theory, in this last stage, the performance of those affected is comparable to that of a toddler from twelve months to birth.

NoteStudies indicate that if the therapies are started early, the duration of the individual stages can be doubled. Especially when starting therapy early, this means that the early phases can be extended and the late, care-intensive phases shortened.