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Stages of Alzheimer’s Disease

The analogy of one’s mind as a multi-layered onion is one way of thinking of dementia [1].  Starting in childhood, successive layers are added over the years as one acquires new memories and skills. Dementia results in the slow peeling away of the onion layers, in which the more recently acquired items are lost first, followed by the more remote memories and skills and eventually even the most basic skills including eating, walking and speaking are peeled away and lost [1].  This process is also called retrogenesis.

A number of staging systems have been developed to help understand how the disease progresses and for making future plans.  One staging system classifies Alzheimer’s Disease in three stages:  early, middle and late.  Another staging system, known as the Reisberg Scale, divides the disease into seven stages [2].  The length of each stage will vary and stages may overlap.

Early Stage

  • loss of short term memory

  • inability to learn and recall new information

  • language deficits (e.g. inability to find words, lose track of conversation)

  • mood swings and personality changes

  • person can compesate for cognitive deficits and continue to function independently [2]

Middle Stage

  • decreased long term memory

  • supervision and increased assistance required for ADLs and IADLs

  • agitation, hostility, aggressiveness, uncooperativeness, apathy

  • "sundowning" i.e. increased behavioural problems in the evenings such as fatigue, disrupted sleep/wake cycles

  • wandering, rummaging and repetitive behaviour

  • altered appetite, sleep and sexual behaviour

  • delusional thinking i.e. suspiciousness of family and friends

  • hallucinations may occur in 10-15% of patients [2]

Late Stage

  • can’t recognize self or family

  • complete deterioration of personality

  • little capacity for self care

  • patients eventually become bed-ridden and unable to function [2]


Living the Diagnosis

In 1995 American artist William Utermohlen was diagnosed with Alzheimer’s Disease.[4]  He began a series of self portraits that vividly portray the effect of the disease.  An article in the New York Times has a number of the portraits and a slide show available.  Mr. Utermohlen’s medical findings and an analysis of  his work are available in a 2001 paper published in The Lancet[3].







1. Argonin, Marc E. Dementia Defined. In: Carlat, Daniel J, editor. Practical guides in psychiatry-dementia. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 2-14.

2. Kraemer HC, Taylor JL, Tinklenberg JR, Yesavage JA. The stages of Alzheimer's disease: a reappraisal. Dementia & Geriatric Cognitive Disorders 1998; 9(6)299-308.

3. Crutch SJ, Isaacs R and MN Rossor. Some workmen can blame their tools: artistic change in an individual with Alzheimer's disease. Lancet 2001; 357: 2129-33.

4. As well as the New York Times article you may find the following accounts of his work and exhibitions interesting:

All references for this section