Middle stage - what to expect

The middle stage of Alzheimer’s disease is also called "moderate Alzheimer's disease." In this stage, thinking and memory continue to deteriorate but many people will still be somewhat aware of their condition. People in the middle stage of Alzheimer’s disease need help with many daily tasks.

For families and caregivers, it is the point where they may increasingly need to provide care. It may include moving the person to a care facility. This stage often seems the longest. Everyone involved will need help and support because of the increasing challenges faced by those with Alzheimer's disease and their family.

For family members and caregivers

Even though the middle stage of the disease brings with it more challenges, you can help make life easier for the person with middle-stage Alzheimer’s disease.

Common symptoms Helpful strategies
Cognitive abilities:
  • Memory problems become more obvious, for example:
    • Remembers own name but not address or phone number
    • Forgets recent events and own history
    • Has difficulty identifying family and friends, but still recognizes familiar faces
    • Loses or misplaces things and takes things that belong to others
  • Less ability to concentrate
  • Confusion—difficulty organizing thoughts or following logic
  • Disorientation to time and place
  • Problems understanding and expressing spoken and written language
  • Difficulty making choices
  • Use reminders and cues including notes, pictures, signs or seasonal objects
  • Offer information if he is struggling, for example, "Hi mom, it's me, Bill, and I've brought your granddaughter, Ann, to visit you."
  • Get his attention and keep eye contact while talking; limit distractions such as the radio or television
  • Speak slowly and clearly; use simple language and repeat the message if necessary
  • Stick to concrete rather than abstract ideas ("Isn't it a nice day?" rather than "What do you think about the weather today?")
  • Use physical gestures to reinforce your messages
  • Remember that he is not intentionally being difficult
  • Limit number of choices to one or two.
Moods and emotions:
  • Mood shifts may include anxiety, suspicion, sadness, depression, frustration, anger, hostility, apathy and agitation
  • Pervading sense of loss or insecurity
  • Try to identify, acknowledge, and deal with underlying emotions being expressed, which you may miss if you focus only on her words
  • Use strategies and keep activities that support her independence and that focus on what she can still do
  • Encourage a healthy lifestyle, including physical activity, healthy eating, and familiar and meaningful activities
  • Avoid disagreeing, arguing or trying to convince her that what she believes is untrue or inaccurate
  • Reassure and comfort her
  • Try remembering the past as a helpful strategy
  • Apprehension, withdrawal or passivity
  • Restlessness (pacing, wandering)
  • Repetitive questioning or actions
  • Delusions (believing things that aren't true)
  • Hallucinations (hearing, seeing, feeling, smelling, or tasting things that aren't there)
  • Uninhibited behaviour (from overtly sexual behaviour to aggression)
  • Remember that all behaviour is a form of communication; try to figure out what he is trying to express e.g., fear, discomfort, frustration
  • Watch for behaviour changes that may be from physical illnesses such as a urinary tract infection or the flu
  • Consider whether the behaviour is mostly annoying, or whether it is dangerous or causes anxiety
  • Identify and avoid situations that trigger uncomfortable reactions (e.g. Is the behaviour triggered by noise, too many people, too many expectations? Is he hungry or in pain?)
  • Offer him choices
  • Try gentle persuasion
  • Remain calm, reassure and distract to a more pleasant topic or location
  • Contact the Alzheimer Society to register him with the MedicAlert® Safely Home®; learn strategies to prevent wandering
  • Speak to a doctor about medications that may be able to help
Physical abilities:
  • Help needed for activities of daily living, including dressing, eating, bathing, using the toilet
  • Changes in sleep/wake patterns
  • Changes in appetite
  • Spatial problems that can affect movement and co-ordination
  • Know her preferred tastes and past routines
  • Keep things simple: clothes that are easy to put on, simple hairstyles, etc.
  • Adjust scheduled activities to times best suited to her
  • Adapt activities to accommodate lost abilities and make the most of remaining ones
  • Identify and adapt any potential dangers in the home. These include rugs that she could trip on. Grab bars in the tub or shower can help her with bathing.
  • Speak with an occupational therapist for advice on routines, activities, and adapting the home to make it as safe and accommodating as possible
  • Seek homecare support

Speak with a doctor about treatment options for the disease. As well, pay attention to other issues of daily health, such as regular medications and dental needs, among others. Although the middle stage requires some additional and different strategies than for the earlier stage, some of the same strategies will still apply.

More suggestions—taking care of the caregiver and planning for the future

Despite your best efforts, caring for someone with dementia becomes harder as the disease moves on, and the person you are caring for becomes more dependent on you. This is a time when many family members need more support for themselves. The following tips are to help family members take care of themselves and plan for the future.

  • Avoid isolation and loneliness by keeping up with social activities and contact with others as much as possible.
  • Take care of your own health.
  • Learn about the disease.
  • Join a caregiver support group to connect with others living with the day-to-day issues of Alzheimer's disease and facing practical challenges, grief and loss.
  • Watch for signs of stress and how it can affect your health and ability to provide care.
  • Be aware that you may already be grieving the gradual losses caused by the disease.
  • Seek professional help if feelings of depression or anxiety are overwhelming.
  • Be flexible about routines and expectations.
  • Try to be positive and use humour as a part of care strategies.
  • Make time for yourself by using respite care options, including adult day programs, professional homecare services, other family members or friends, volunteer caregivers and friendly visiting programs.

Planning for the future: Refer to and follow any documents that the person with the disease has already prepared, to help look after his financial, legal and care wishes. If plans are not already in place, start the process as soon as possible.

  • Arrange financial, legal and care matters and decide who will be responsible for these functions. Follow his wishes, if you know them. Otherwise, decisions will need to be based on his lifelong values and desires and what you think the person would want.
  • Learn about the services that will be available as the disease progresses and both your needs change (homecare, respite care, community programs like Meals on Wheels and care facilities).
  • Learn what to look for in a care provider or facility.
  • Plan for your own future. Changes throughout the disease process may affect how you will live your own life in the coming years.
  • Your local Alzheimer Society can advise you on the above issues and the kinds of professionals who can help to address them.

What's next?

Because Alzheimer's disease is progressive, you will continue to need more information and support. You may want to take time in the middle stage of the disease to think about what is important to you in the years that you live with Alzheimer's disease. Learning how the disease progresses and the changes it will bring can help you make plans for the future. However, only you can decide when is the right time to seek more information.

Help and support from the Alzheimer Society

Living with Alzheimer's disease at any stage can be challenging. Feeling a variety of emotions, including grief and loss throughout all stages of the disease is normal. Acknowledge your feelings, care for yourself and seek the practical help and emotional support that you need.
The Alzheimer Society in your community can provide educational resources to help you learn more about the disease, referrals to help you access the practical support you need, and one-on-one and group support to help cope with the emotional impact of the disease. Contact your local Alzheimer Society.
[This information provides guidance but is not intended to replace the advice of a health-care professional. Consult your health-care provider about changes in the person's condition, or if you have questions or concerns.]

Last Updated: 11/08/2017