Progressive Changes in Alzheimer's


The Duke Family Support Program offers valuable insight into how a person with Alzheimer's may change behavior over time. With grateful acknowledgement and with their permission, we offer this information to you. It is included within their Tool Kit for Alzheimer's & Dementia Caregivers.


Common Changes in Mild Alzheimer’s

  • Loses spark or zest for life—does not start anything.
  • Loses recent memory without a change in appearance or casual conversation.
  • Loses judgment about money.
  • Has difficulty with new learning and making new memories.
  • Has trouble finding words—may substitute or make up words that sound like or mean something like the forgotten word.
  • May stop talking to avoid making mistakes.
  • Has shorter attention span and less motivation to stay with an activity.
  • Easily loses way going to familiar places.
  • Resists change or new things.
  • Has trouble organizing and thinking logically.
  • Asks repetitive questions.
  • Withdraws, loses interest, is irritable, not as sensitive to other’s feelings, uncharacteristically angry when frustrated or tired.
  • Won’t make decisions—“I’ll have what she is having.”
  • Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens
  • Forgets to pay, pays too much, or forgets how to pay—may hand the check-out person a wallet instead of the correct amount of money.
  • Forgets to eat, eats only one kind of food, or eats constantly.
  • Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
  • Constantly checks, searches, or hoards things of no value.




Common Changes in Moderate Alzheimer’s

  • Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
  • Mixes up identity of people, i.e. thinking a son is a brother, or wife is a stranger.
  • Poor judgment creates safety issues when left alone: may wander and risk exposure, poisoning, falls, self-neglect, or exploitation.
  • Has trouble recognizing familiar people and own objects: may take things that belong to others.
  • Continuously repeats stories, favorite words, statements, or motions.
  • Has restless, repetitive movements in late afternoon or evening—pacing, trying doorknobs, fingering draperies.
  • Cannot organize thoughts or follow logical explanations.
  • Has trouble following written notes or completing tasks.
  • Makes up stories to fill in gaps in memory. Might say, “Mama will come for me when she gets off work.”
  • May be able to read but cannot formulate the correct response to a written request.
  • May accuse, threaten, curse, fidget, or behave inappropriately, such as kicking, hitting, spitting, biting, screaming, or grabbing.
  • May become sloppy or forget manners.
  • May see, hear, smell or taste things that are not there.
  • May accuse spouse of an affair or family of stealing.
  • Naps frequently, or awakens at night believing it is time to go to work.
  • Has more difficulty positioning the body to use the toilet or sit in a chair.
  • May think mirror image is following him or television story is happening to her.
  • Needs help finding the toilet, using the shower, remembering to drink, and dressing for the weather or occasion.




Common Changes in Severe Alzheimer’s

  • Doesn’t recognize self or close family.
  • Speaks in gibberish, is mute, or is difficult to understand.
  • May refuse to eat, chokes, or forgets to swallow.
  • May repetitively cry out, pat, or touch everything.
  • Loses control of bowel and bladder.
  • Loses weight and skin becomes thin and tears easily.
  • May look uncomfortable or cry out when transferred or touched.
  • Forgets how to walk or is too unsteady or weak to stand alone.
  • May have seizures, frequent infections, falls.
  • May groan, scream, or mumble loudly.
  • Sleeps more.
  • Needs total assistance for all activities of daily living.

Woman Looking Out a Window




Why Caregivers Hesitate To Get Needed Help

  • “I don’t want to be a bother. What’s the use?”
  • “No one cares for him the way I do.”
  • “I should be able to do this myself. He’s my husband till death do us part.”
  • “We’re saving for a rainy day.”
  • “Getting help with this feels like another irreversible step.”
  • “The doctor didn’t say we needed day care.”
  • “Her Alzheimer’s is the least of our problems.”
  • “We have daughters for that.”
  • “My husband told me never to let strangers work in the house—they steal.”
  • “If I turn to social workers, they will put her away.”
  • “He doesn’t want to go to an adult day care.”
  • “Those people are unreliable—they never showed up for my grandma.”
  • “He would never forgive me.”
  • “All that red tape is an invasion of our privacy.”
  • “He’s ok to drive—he sees better than I do.”
  • “Can I trust these people to appreciate what a wonderful man he was?”
  • “It will seem to her that I am giving up on her.”
  • “I can’t stand to think what this new step will mean to her and to me.”
  • “I have put years of my life into taking care of her. What will I do if I give up?”
  • “It’s too much effort to get relief for just a short time.”
  • “He can’t protect himself. It’s my responsibility to protect his image, his dignity. You would not believe some of the things he does.”
  • “I can’t afford the service and I don’t qualify for anything. We’re not a charity case.”
  • “It’s so frustrating just trying to get information about services. Everybody has a different rule, a different requirement.”
  • “The people who talk to you are not always nice. They can make you feel stupid and behave as if they are doing you a favor. Why should I put up with that?”
There is Help Available
- non-judgemental help by trained professionals - people who know what you are going through, who know how distressing it all can be, who know how to help you to help yourself, who know how to keep your privacy and preserve the dignity of your family member with Alzheimer's. You don't have to go through this alone. Let us help.
Pensive Woman



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Need Help Anytime?



Calls are confidential. The phones are staffed by clinicians who can provide information about dementia, crisis assistance, caregiving and treatment options and elder abuse. This service is free and is available twenty-four hours a day, seven days a week.


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