The Middle Stage of Alzheimer's Disease

By the Middle Stage, it is obvious that "something is wrong" and that a medical evaluation is necessary. Sometimes the person with Alzheimer’s Disease may be unaware of the decline. Even the person who is aware of changes become less aware as time passes. The unpredictability of the decline and changing ability of the person to function from day to day can increase caregiver stress.

Symptoms become more severe in the Middle Stage and often include:

  1. Poor Short-Term Memory: After completing a meal, the elder may ask, "When do we eat?:"
  2. Disorientation to Person, Place or Time: A person in this stage may not know the name or relationship of a close relative or think that the current time is 10 to 30 years ago;
  3. Inability to Perform Skilled Movements: The person may be unable to use eating utensils, tie shoelaces or operate the washer or stove;
  4. Language Difficulties: It may take more effort to express ideas or needs with major word-finding problems; sentences may not make sense; speech may be slow;
  5. Social Withdrawal: The elder may feel uncomfortable or awkward in new places or with groups of people, be socially dependent on caregivers and feel depressed;
  6. More Spontaneity, Fewer Inhibitions: There may be inappropriate comments to friends, questions to strangers or an attempt to undress in a public place;
  7. Agitation: An elder may exhibit anger or anxiety if unable to express needs or when faced with confusing situations. Frustration may lead to verbal or physical outbursts, such as yelling or throwing furniture;
  8. Restlessness, Fidgeting, Pacing or Aimless Wandering: The person may feel restless in a chair and unable to sit for any length of time. S/he may wander around the house or pace the hallway;
  9. Sleepiness: The person may be slow-moving and sleepy. S/he may sleep 10 hours at night and nap during the day. The person may even nap while sitting during a meal;
  10. Severe Sleep Disturbances: Some people sleep 14 to 16 hours a day. Others sleep only two to four hours each night with or without daytime naps. Some mix up the day/night cycle;
  11. Need for Assistance: Supervision and assistance with activities of daily living must be available, although it may not be needed constantly. For example, help may be needed with parts of dressing or just getting started at the task;
  12. Sundowning: As the sun goes down, the confusion increases;
  13. Hallucinations or Delusions: There may be evidence of hallucinations or delusions toward the end of the day, in the middle of the night or with some people at any time. The experience may be unpleasant or frightening;
  14. Changes in Eating Habits: The person may experience erratic eating, weight loss or gain, for example.


At this stage, recall and word recognition decrease and attention span is shortened. A person with Alzheimer’s Disease may change the subject often. You may need to repeat the same question or sentence many times and in different ways before it’s understood.

Tips and Techniques

  1. Give stimulation that can be sensed emotionally, like music and touch;
  2. Present objects with the quality of moderate novelty. Things that are familiar enough so that they do not frighten or confuse, but unusual enough so that they interest;
  3. Give touch in a systematic way. Stimulate the person’s forehead, cheeks, ears, neck, shoulders, back, forearms, hands, feet and lower legs through small circular stroking movements. Use skin lotion to protect the skin;
  4. Stimulate smell with bread, wood, soft soap, fur, camphor, yarn, etc.;
  5. Comb the person’s hair and give him or her the opportunity to look in the mirror;
  6. Stimulate taste buds;
  7. Elicit listening behavior and maintain attention by touching;
  8. If the person speaks only in single words, then you should speak in single words. However, note that the person may be able to understand better than he/she can talk;

Behavioral Problems

As the disease progresses, behavioral problems may become more frequent and severe. Some people in the Middle Stage become very paranoid and suspicious, accusing their caregivers of stealing things or being unfaithful. Some people have sleep disturbances and begin to wander from home. More detailed articles on Behavior Problems are available in the Alzheimer’s & Dementia Care Channel and the "Coping With Alzheimer’s Disease" Learning Resource Guide.

Website Resources
- Alzheimer's & Dementia Care Channel
- Skill Builders for Activities of Daily Living

- The Early Stage of Alzheimer's Disease
- Managing Behavior Problems
- Helping Your Elder Adjust to a Residential Facility
- Using Validation Therapy to Manage Difficult Behaviors
- Locks and Wandering (Part 1 of 3)
- Alarms: Precautions for Wandering (Part 2 of 3)
- Deterrents and Diversions: Precautions for Wandering (Part 3 of 3


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