Alzheimer’s disease unfolds over the course of decades. It is slow and progressive. Alzheimer’s is a chronic disease that may or may not produce symptoms and the symptoms vary from one person to the next. The good news is that, as with any chronic disease, we can manage and treat all seven stages of Alzheimer’s disease if we focus on memory and engagement in the world. This article focuses on memory rehabilitation before you become demented. The next part will focus on rehabilitation if memory loss becomes severe enough and you meet the criteria for dementia.

Normal. The normal stage of memory loss is where we all hope to stay. You are independent. You have senior moments. You are engaged with life and have good initiative. You manage your own short term memory with strategic memory supports.

Forgetfulness. Forgetfulness is the stage where short-term memory is a little worse than it should be (e.g., forgetfulness a little worse than for age, more trouble with very complicated tasks than is your norm). You have senior moments and a bit more. You are engaged with life and have good initiative. Memory rehabilitation consists of more external memory supports and evaluation that allows you to be proactive. It’s the planning and work you do here that sets the course if things get worse.

Early confusional state. Early confusion is the stage where short-term memory is clearly worse than normal aging. You remain independent and you still do quite well on the memory screenings such as the Mini Mental State Exam. You take inordinately long to do tasks that you used to do quickly. You have more trouble spending time doing what you like because of the time it takes to sort and do the paperwork. You may be becoming less engaged. Others are concerned but you do not need external care. Rehabilitation consists of stepping up short term memory supports and making plans (e.g., how long to do the checkbook, how long to continue to work, how to keep doing the activities that you enjoy) in case your memory loss increases in the future. You need to make sure you plan ways to stay engaged socially and intellectually.

Late confusional state. Late confusion is the stage where medical workups diagnose early Alzheimer’s disease. Memory loss is more severe and complex tasks such as doing a checkbook, using technology, remembering to pay the bills, or preparing meals may be compromised. Independence is marginal but you do very well on all but complex tasks. Rehabilitation needs to focus on both you and your potential caregiver. You need to live by your calendar and have a daily calendar that you make out and carry with you each day. You need to include both what you have to do and what you love to do on calendar and you need to involve family if you have not already some so. Life can be good if you confront little that is new or challenging.