What to expect

During the middle stages of Alzheimer’s, damage to the brain can make it difficult to express thoughts and perform routine tasks. You may notice the person with Alzheimer’s jumbling words, having trouble dressing, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe.

While these changes are difficult for everyone involved, resources are available to help both you and the person with dementia as the disease progresses. There will be challenging days, but there also will be good days. As your relationship with the person with dementia changes, you will find new ways to connect and deepen your bond.

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BehaviorsCommunicationCreating a Daily PlanActivitiesRespite Care

Your role as a caregiver

Being a caregiver for someone in the middle stages of Alzheimer’s requires flexibility and patience. As the abilities of the person with Alzheimer’s change and functioning independently becomes more difficult, you will have to take on greater responsibility. Daily routines will need to be adapted, and structure will become more important.

As you gain experience as a middle-stage caregiver, you will develop strategies and ways of coping that work for you and the person with dementia. When abilities diminish further, these will need to be modified. The Alzheimer’s Association offerseducational workshops and resources that can provide you with the caregiving skills needed to deal with changing needs of someone in this stage of the disease. Sharing information with other Alzheimer’s caregivers also can be a great source of information and support. Other caregivers truly understand the complex feelings associated with caring for a person with dementia.

As caregiving responsibilities become more demanding, it’s important take care of yourself. Take breaks, even if it is only for a few moments. Make sure not to isolate yourself. Learn what respite services are available in your community, and take friends and family up on offers to help. Since paying for long-term care can be a big concern and source of stress, research all your options, if plans are not already in place. To find local services, resources and programs, use our free online Community Resource Finder.

Middle-stage concerns

• Changes in behavior
  Changes in behavior can be some of the most distressing for caregivers and family members. During the middle stages, people may experience depression, anxiety, irritability and repetitive behaviors. As the disease progresses, other changes may occur, including sleep changes, physical and verbal outbursts, and wandering. Understanding what behaviors are common during this stage and how to assist the person with dementia can help.
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  BehaviorsAgitationAngerConfusionRepetitionSleep Issues
• Communication
  As people with Alzheimer’s gradually lose their ability to find words, express thoughts and follow conversations, they also have more difficulty understanding others. Communication changes during the middle stages include trouble finding the right word, repeating questions, losing the train of thought, reverting to a native language and relying on non-verbal communication. You can help improve communication by making simple changes, such as speaking slowly and distinctly in a gentle tone. If you notice sudden changes in communication, make sure to contact the doctor, since this could indicate other medical issues or side effects of medication.
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  Communication TipsWorking with the Doctor
• Daily care needs
  Eating, dressing and grooming will become more challenging as dementia progresses. This loss of independence and privacy can be a very difficult transition for the person with dementia; your patience and sensitivity will go a long way in helping him or her through it. Once your assistance is needed to complete daily tasks, think about the person’s abilities. Encourage the person to do as much as possible, but be ready to help when needed. For example, when dressing, you can give direction indirectly by laying out clothing in the order in which item is put on.
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  EatingDressing and GroomingIncontinence
• Activities that provide meaning
  In addition to enhancing quality of life, activities can reduce behaviors like wandering and agitation. You don’t need to invent new things to do. Think of activities as things we do as part of our daily living. Activities can be making dinner together, gardening, listening to music or going for a walk.
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  Creating a Daily PlanActivitiesMusic and Art

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  A Close Call: Martin hit a parked school bus today. No one was seriously hurt, but his partner, Dan, recognizes that Martin must stop driving.

  Driving
  During the middle stages of the disease, a person with Alzheimer’s will need to stop driving. When it is clear that driving is no longer safe, try to involve the person with dementia in the decision to stop. Explain your concerns by giving specific examples. Assure the person you will do everything possible to make rides available.
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  Dementia & Driving Resource Center

• Other safety concerns
  Early in the middle stages, it will become too difficult or dangerous for a person with Alzheimer’s to be left alone. Preventing wandering becomes a crucial part of care, and safety precautions will need to be taken throughout the person’s living environment. At this point, if the person is living alone, he or she may need to move in with relatives or to a residential care setting. Go to our free online tool,Alzheimer’s Navigator, to receive step-by-step guidance on topics including home safety and driving.