The first stages of Alzheimer’s disease are marked by decreasing self-determination. As one proceeds through early stages, there is an increasing need for external supports but independent survival is likely. In the later stages, independent survival in the community is no longer possible. The plans and skills learned in the early stages will determine, in part, the smoothness of these stages. The later stages are clearly marked by more than just memory loss. Indeed there are multiple skills lost (e.g., judgment, reasoning, planning, learning new skills or facts). There is often little self-directed engagement. Palliative memory care (e.g., day programs, placement in memory care units) is necessary, as short-term memory is severely impaired to the point that the forgetful person no longer is aware of forgetting. Each repeated question or comment is made for the first time from his or her perspective

Early dementia is the fifth stage of Alzheimer’s disease. A person in stage four often cannot recall major aspects of their life such as their current address, the present weather conditions. If he or she lives alone without external assistance, they will not survive as they can’t prepare meals, pay bills, etc. However, they can attend to personal care such as bathing, dressing, and toileting. Overlearned skills continue to work as long as there is external support and prompting. The ability to participate in conversation that relies on long-term memory remains quit good as long as the audience is small and attentive. Although skill may be compromised, the person in stage four can participate in games and enjoys movies, TV shows, and sporting events that they enjoyed in the past. If one plans activities based on the interests and skills during earlier stages, one can have a very good life by truly living in moments with activities they enjoy. This stage may last an average of about two years.

Middle dementia is the sixth stage of Alzheimer’s disease. The ability independently to choose appropriate clothes is compromised. Independent bathing and hygiene can no longer be counted on. Short-term as well as long-term memories are compromised. They know their own names but confuse identity of others. However, they still can be engaged in lifelong interests as long as the focus is on productivity rather than competence and someone else directs them toward an activity based on a skill or interest that still works. Music, old TV shows, pets, and children can provide much needed stimulation and engagement as well as reduce agitation. This stage averages about 2.5 years.

Late stage dementia is the seventh stage of Alzheimer’s disease. If one lives into stage seven, language skills and production are severely compromised. The ability to walk without assistance is lost. The ability to feed oneself is lost. Depending on the care, this stage may last up to five years. Fortunately, most of those with Alzheimer’s disease do not live into this stage as other events such as stroke, heart disease, and cancer may intervene. Hospice services are often useful adjuncts to care.

Although we cannot control whether we will end our life with progressive decline, we can proactively make plans for a better life if we start early. Just as we start financial planning and healthcare early, we must be monitoring and planning our memory resources early. Don’t listen to those that lament that there’s nothing you can do about Alzheimer’s disease. The real problem is that we often wait until we can do nothing to start the plan to have a better if forgotten life.