What to Expect in the Late Stages of Alzheimer’s Disease

Sherry Christiansen
By Sherry ChristiansenJuly 6, 2018

As Alzheimer’s advances into the later stages, caregivers and family members can expect quite a few new symptoms of the disease. Fortunately, being prepared now can help people better cope with the challenges of the late stages of Alzheimer’s.

Although the disease doesn’t affect every person the same way, informed caregivers can often reduce later stage crisis. Read our list of the symptoms to expect in the late stages of Alzheimer’s to better prepare for tomorrow, today.

Late Stages of Alzheimer’s Disease Symptoms

The needs of the person with Alzheimer’s become much more demanding as the disease progresses. In the late stages of Alzheimer’s, the person with the disease loses the ability to respond appropriately and is unable to converse with others. They will also develop an inability to control movements like sitting, standing and walking.

Here are some other common symptoms of the disease that can occur:

  • Catches colds and infections (like pneumonia) easily
  • Day/night reversal of sleep pattern
  • Difficulty communicating
  • Difficulty sleeping
  • Difficulty swallowing
  • Difficulty using the toilet independently
  • Eventually requires help with activities of daily living, 24 hours per day
  • Eventually unable to walk (wheelchair bound)
  • Hoarding, rummaging
  • Inability to eat independently
  • Inability to sit and eventually to swallow
  • Incontinence
  • Increasing difficulty communicating
  • Loss of awareness of surroundings
  • Needs help walking
  • Needs progressively more help with personal care
  • Personality changes such as aggression, anxiety, hostility, irritability or uncooperativeness
  • Repetitive questioning
  • Sexually inappropriate behavior
  • Socially withdrawn
  • Sundowners (increased agitation at certain times of the day)
  • Verbally aggressive or demanding behavior
  • Wandering (occurs in 3 out of 5 people with AD)

Other Dementia Stages and Symptoms

Neurologists divide Alzheimer’s into several stages, including three-stage and seven-stage phases of the disease.

We discuss the three-stage model of dementia below, but you can also learn about the seven stages of the disease on our Dementia Resources page.

Mild Dementia

People in the mild dementia phase of Alzheimer’s can still function independently at times, however, they may have memory lapses that adversely affect activities of daily living (ADLs). Other symptoms include:

  • Getting lost in familiar places
  • Increasingly severe memory loss
  • Personality changes (such was withdrawing socially)
  • Problems managing complex tasks
  • Trouble expressing thoughts and feelings

Moderate Dementia

People with moderate dementia need more help with ADLs than those in the mild phase of dementia. It becomes progressively more and more difficult to care for one’s self at this stage of the disease. Common symptoms include:

  • Agitation and unfounded suspicions
  • Memory loss of events of the distant past
  • Poor judgment and increasing confusion
  • Requires more assistance with dressing, bathing, and grooming
  • Sleep pattern problems (restless at night, sleeping during the day)
  • Significant behavior and personality changes

Severe Dementia

Further mental decline and worsening physical abilities occur as Alzheimer’s progresses into this final phase of dementia. Symptoms include:

  • Complete loss of the ability to communicate
  • Complete loss of physical abilities such as sitting and walking
  • Increase in the incidence of infections (such as pneumonia)
  • Loss of ability to control movements such as holding the head up or swallowing
  • Loss of control of bladder and bowel function
  • Need for full-time daily assistance with bathing, dressing, eating and other ADLs

Behavioral and Cognitive Symptoms of Dementia

Behavioral Symptoms

Michelle Niedens, L.S.C.S.W., in “The Neuropsychiatric Symptoms of Alzheimer’s,” states that “80% of individuals with dementia will experience neuropsychiatric (affective and behavioral) symptoms.”

Personality changes such as anxiety, depression or irritability are common in the early stages of the disease. Later, agitation, physical or verbal outbursts, pacing and restlessness are more common.

Behavioral symptoms have been identified as the most challenging and distressing for caregivers and family members. They are oftentimes the determining factor in deciding to move a family member with Alzheimer’s into a structured living environment.

Cognitive Symptoms

Cognitive symptoms start out mild in the early stages of Alzheimer’s and gradually worsen as each stage progresses. In the late stages of Alzheimer’s, the person with the disease is no longer able to form new memories or access old ones. Language abilities become worse until the person is no longer able to communicate. Judgment and reasoning skills continue to diminish and eventually, the person with dementia loses the ability to reason altogether.


As Alzheimer’s destroys normal behavior, memory and thinking skills, people with the disease oftentimes become confused and disoriented. They can easily get lost, even in places that are familiar to them, such as their own neighborhood. When a person with Alzheimer’s gets lost or wanders, confusion and/or communication deficits may interfere with the ability to ask for help, leaving people with the disease very vulnerable.

Wandering occurs in 3 out of 5 people with Alzheimer’s. It’s important for caregivers and family members to understand that wandering puts the person’s personal safety in grave danger. In fact, if a person who wanders isn’t found within 24 hours, statistics show that 50% will end up with some sort of serious injury or death.

Reasons people with dementia may wander include:

  • A full bladder
  • Constipation
  • Fatigue, infections
  • Fear
  • Frustration
  • Hunger or thirst
  • Misperceived threats
  • Skin irritation
  • Untreated pain

If you are a caregiver going through the early or late stages of Alzheimer’s, you need support. Read more about support services, which include emotional support groups and therapy.  You can also always contact The Alzheimer’s Association.

Has a senior loved one exhibited any late stages of Alzheimer’s symptoms? We’d like to hear your stories in the comments below.

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Sherry Christiansen

Sherry Christiansen

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