We all hope to remain in the first stage of Alzheimer’s disease, Normal. This is the time during our life when we are free of objective as well as functional decline. This is the stage where senior moments are just senior moments. This is the stage when the efficiency of your memory slows along with everything else. You may need more external memory supports and you may not be able to multitask as well as in the past but you are fully competent and self-directed. If given a rigorous memory evaluation, you will do as well as you ever did. This stage may last all of your life but there are no guarantees. Fifty percent of those living beyond age 85 may not show signs of Alzheimer’s disease.

Forgetfulness is the second stage of Alzheimer’s disease. Forgetfulness shows up in one of several ways. First, it may present as worry about your own memory. At least 50% of persons over 65 worry about their memory. Nearly half of those who express worry declined after 7 years. In short, cognitive decline occurs as many as two decades before there is a decline serious enough to be dementia. Second, Forgetfulness may present as poorer than expected performance on a rigorous memory test. Forgetful persons are still competent and self-directed. They need to develop and liberally use external memory supports and make plans in case there is a progression in the future. There is no estimated time course for this stage.

Early confusion is the third stage of Alzheimer’s disease. Confusion becomes apparent during complex tasks. Balancing the checkbook takes much longer than in the past. Work performance declines and retirement should be considered. The ability to organized events declines. Mastering new complex skills (e.g., computer, a new language) may be difficult at best. The need for external memory supports is imperative as is planning in case of future decline. Issues such as managing your own investments or even the checkbook need to be considered. This stage may last as long as 7 years in those who will decline further.

Late confusion is the fourth state of Alzheimer’s disease. Forgetting is much more dramatic (may forget a recent visit from family, may get lost while driving, may not be able to shop for food, or may forget to pay some of the bills). The ability to perform complex actives such as managing personal finances or preparing meals may be impaired. Despite the confusion, a person at this stage can survive independently and is not demented. The person at this stage clearly forgets that he or she forgets. They may appear apathetic and withdraw from interests and socialization. The need for caregiving begins if all is to run more smoothly in the future. The person in the late Confusional stage may no longer be competent or self-directed. This stage may last about two years.