Alzheimer’s Disease: Stages & OT Interventions

Stage 1: Very Mild to Mild Decline

Key features include recognition of memory lapses, intact ADLs and IADLs, possible new learning, and potential anxiety or depression.

OT Focus (Support) in Stage 1

Introduce memory aids, grade new learning tasks, promote wellness/exercise, and provide positive reinforcement.

Stage 2: Mild to Moderate Decline

Key features are compromised IADLs, challenging new learning, and social withdrawal, moodiness, and denial.

OT Focus (Structure) in Stage 2

Establish consistent routines, simplify environments, provide cues, and encourage social participation.

Stage 3: Moderate to Moderately Severe Decline

Disorientation to time and place, agitation, compromised ADLs/IADLs, and onset of incontinence.

OT Focus (Safety) in Stage 3

Remove hazards, implement wandering precautions, practice familiar tasks, and train caregivers on triggers.

Stage 4: Severe Cognitive and Physical Decline

Limited speech, bedbound status, severe psychomotor decline, and total dependence.

OT Focus (Comfort) in Stage 4

Maintain bed positioning, instruct on skin inspection and safe transfers, promote comfort, and use sensory stimulation.

Core NBCOT Decision Rule

Select interventions based on current functional ability, shifting from active learning to safety and comfort as disease advances.