Dementia Stages

The 7 Stages of Dementia by Bobbi Jo Curty, B.A. in Social Work, Director of Social Services.

            The diagnosis of dementia can be vast and overwhelming. Receiving the words from your physician that you or your loved one has been diagnosed with this disease can provide a shock and sadness to your lifestyle as well as to your hopes and plans for your future. Dementia is not one particular disease; it encompasses symptoms that affect the way the brain functions regarding memory, thinking, and reasoning. The inability to function properly is demonstrated by disruption or interference with a person’s daily routine. One type of dementia is Alzheimer’s disease, which progressively destroys parts of the brain encapsulating the memory and other necessary functions. What is to be expected when we hear this diagnosis? Not one single person with the disease will progress exactly the same way, and persons with the diagnosis may not exhibit warning signs or transition to different stages at the same timeframe. However, the timeline of dementia, from pre-diagnosis to end-stage, displays apparent similarities among people with this disease. Their progression is evident in that there remain similarities on what characteristics and behaviors are most typical and what is to be expected at each stage as the progression continues.

             Some researchers recognize the disease in 3 stages defined as mild, moderate and severe. In the mild stage of dementia, a person may function independently and go on with their normal routine. They may, however, begin to notice brief moments of memory lapses and familiar people may begin to notice some forgetfulness or challenges in everyday tasks. The moderate stage can last the longest and can even go on for years. During this stage, a person with dementia has very evident symptoms of cognitive decline such as confusion with date and time and changes in their mood and personality. During the severe dementia stage, a person’s brain is no longer connecting with the body and they will require extensive care in all areas of their activities of daily living.

Although dementia can be recognized within three general stages, it can also break down into 7 detailed stages providing further identification of symptoms and disease expectations. The detailed seven stages can assist the caregiver in understanding why their loved one is acting a particular way. It can also give a sense of peace or lessen the amount of anxiety because the details of the stages have been researched and can provide an understanding of what is expected to come.

The gradual cognitive decline that occurs with dementia does not happen all at one time. Depending on when the symptoms are recognized, and when the person receives the diagnosis, it will determine what stage of the disease a person is at based on the descriptions. This can enhance your understanding of the disease and provide realistic expectations of what it may hold in the future for your loved one. The progression of dementia can be broken down into 7 distinct stages:

Dementia Stage 1: No Cognitive Decline

Of the 7 stages of dementia, this is the stage that a person does not present with any issues. The brain is still functioning at normal capacity. The person does not show any issues with memory loss, reasoning skills, or thought process. There does not appear to be any visible cognitive impairment so the day to day routine in a person’s life is ongoing with basically no interruptions. During stage one of dementia, a person is subjectively and objectively normal. They will continue living their life as independent as possible and will not experience any deficits that would interfere in their daily living.

Dementia Stage 2: Age-related Memory Impairment

At this stage of dementia, a person presents with occasional forgetfulness and lapses in memory loss. The memory impairment can be attributed to normal forgetfulness associated with aging, but this may also be one of the first possibly recognized signs and symptoms of dementia. Some examples of the second dementia stage may include: forgetting where you placed an object, occasionally forgetting an appointment or even brief memory lapses of forgetting names of people or places, but usually being able to recall it later. It is very likely that a person at a second dementia stage will score pretty well on a cognitive assessment. Their cognition will not raise any red flags to family or physicians. During Stage 2, a person will have subjective complaints of mild memory loss. A person is physically functioning as normal as they always have been. They continue to live independently and don’t require the assistance from any care facility.

Dementia Stage 3: Mild Cognitive Impairment

This is the stage of dementia where clear signs and symptoms are being noticed by themselves and by others. The signs and symptoms are ongoing and more consistent. A person in the third stage of dementia will begin to see distinguished deficits in how their brain is operating. A person may continue to function appropriately, but other people may start to take notice to occasional memory issues or notice a decline in work performance, if they are still working regularly. Some examples may include: getting lost (driving or going for a walk) and having difficulty finding their way back, forgetting names of people and places, trouble finding the right words during conversations, difficulty in the ability to maintain organization and to initiate planning. When Dementia Stage 3 signs and symptoms are continually recognized, early detection is crucial in order to receive adequate medication and treatment, which could potentially slow down the disease progression. It is recommended to be evaluated by your primary care physician. A person will go through a series of tests and evaluations. It is likely a person in the third stage of dementia will show objective deficits on the testing. It is also during this time that a person will be in denial of what is going on with their body. Due to the denial, it may increase feelings of frustration when interacting with others. During this dementia stage, the person still maintains some normal functionality and will likely remain at home attempting to stay as independent as possible.

Dementia Stage 4: Mild Dementia

At this stage of dementia, it may be difficult to distinguish the exact point when the mild cognitive impairment from Stage 3 has crossed over into Stage 4 of mild dementia. A person experiences the signs and symptoms from Stage 3, but they become much more frequent and more challenging. At Stage 4 of dementia, a person having these symptoms tends to still be partially aware that they are experiencing changes in their brain.  The signs are more easily recognized, and the person may experience anxiety from day to day due to the loss going on in their brain. They may become more withdrawn and opt to remain in their familiar home environment instead of socializing where others may observe their impairments. A person in stage of dementia may also be in denial of the changes and may become defensive or use humor as a defense mechanism. A person may exhibit the inability to follow current events in the news. It may become more challenging as they attempt to handle personal/family matters. They display difficulty recalling personal history, handling finances, and have trouble with face-recognition. At the fourth stage of dementia, the person is still able to function appropriately in their familiar environment and surroundings, but they would have a problem if they need to adapt to a new routine such as an emergency road closure on a route they travel daily or if their physician orders different medications at new times. A person may still live independently, likely due to the denial they are experiencing. They may be open to accepting a little help from outside resources that would provide additional support to the person in their home.

Dementia Stage 5: Moderate Dementia

Moderate dementia is the stage when a person requires additional cues and reminders during their day to function adequately. At this point, a person with dementia is no longer able to recall basic, yet relevant, information about themselves such as their street address or phone number. They may no longer be able to remember the number of grandchildren they have or their names. They rely on a caregiver or family member to assist with medication reminders, to assist with paying monthly pills and writing out checks, to help prepare or cook meals. A person at the fifth stage of dementia becomes frequently disoriented to person, time and place. They may continually repeat themselves even after hearing the answer to their question being said only a few minutes before. Their decision-making ability is impaired and they will often display poor safety awareness such as walking onto a busy highway, or not adhering to physician’s recommendations of using their walker at all times.

Often at this time, a person with moderate dementia is still able to maintain their activities of daily living such as using the toilet and getting dressed. Their brain is still able to process those ingrained tasks, so their physical function level presents them as appearing physically healthy. Generally, a person is still able to function with their activities of daily living, but they may need some cueing or reminding along the way. At this point, it is recommended for a person at this stage to have ongoing support from family members by either living with their caregiver in their home or the caregiver living with them in their own home. This may not always be a feasible option. A person at this stage of dementia would also benefit to live in a dementia care facility such as an assisted living or personal care home. There, they can receive the reminders needed, but will also be able to function on a somewhat independent level. An assisted living or personal care home would provide routine and structure to their lives on a consistent basis, as well as the option of added direct care staff if and when needed.

Dementia Stage 6: Moderately Severe Dementia

In the sixth stage of dementia, a person is typically unaware of their surroundings, unable to recall recent events and may even have distorted memories of their personal history. A person will forget the names of people most familiar to them, such as their spouse, children or primary caregivers. They may begin to lose control of their bladder and bowels and will likely require hands-on assistance with activities of daily living. Because of this level of impairment from dementia, their needs require full-time care. Some examples to be aware of include wandering since they no longer are aware of their surroundings. Their sleep patterns may change in that they may mix up awake and sleep times, and a person may often display difficulty falling asleep. A person with moderately severe dementia may present with behaviors that are difficult for family members or caregivers to witness such as delusions, hallucinations, anxiety, agitation and aggression. At this stage, a person should be residing in a complex care facility where their needs can be met around the clock.

Dementia Stage 7: Severe Dementia                                    

During the seventh and final stage of dementia, the brain has lost its connection to the function of the body. In the earlier stages, a person required added support by use of cueing and reminders and even some minor hands-on physical care. Now, a person no longer benefits from reminders or cues. The brain cannot process direction. A person with severe dementia will lose their motor skills ability and likely lose the ability to speak. They may be able to utter some words or phrases, but they do not have the insight to process what is really being said. Often, a person will experience all loss of verbal abilities and may eventually lose their ability to swallow. They have progressed to the point that they no longer have any control over their bladder and bowels. A loved one or caregiver will be required to anticipate and perform all activities of daily living such as ambulating, feeding, and toileting. Dementia is a degenerative and progressive disease. This is the final stage of their brain deteriorating as they are nearing death.

            Understanding the seven stages of dementia can serve as a helpful resource for families and caregivers. A person being diagnosed with dementia, as well as their family, are experiencing an unknown territory full of fear and uncertainty. The unfortunate reality is that there is no cure for dementia at this time. Research and awareness remain ongoing. Enabling yourself with an education of the seven stages of dementia will provide you with a sense of reassurance as the uncertainty of the disease progresses.

Resources:

https://alz.org/alzheimers-dementia/stages

https://www.dementia.org/stages-of-dementia

About the Author:

Bobbi Jo Curty earned her Bachelor's Degree in Social Work from Eastern University in 2008. Bobbi has 10 years of experience working as a social worker in a continuing care retirement community and has helped many patients with dementia and Alzheimer's disease. She currently works as a Director of Social Services for a retirement community in Manheim, PA and oversees social workers for more than 100 community residents.