Recognize The Stages Of Dementia

Dementia is a degenerative brain disorder that can unfold for years. However, the course of dementia often depends on what type of dementia an individual is living with. Knowing what to expect in the months and years following diagnosis can have several benefits, whether you or a loved one is living with this condition.

Experts have developed two models of dementia progression. One identifies three stages of dementia, while the other recognizes seven. These differ depending on the type of dementia you or a loved one has (e.g., Alzheimer’s disease, dementia with Lewy bodies). Although it can be essential to speak with a doctor to understand your unique case, reading through these stages may prepare you as symptoms progress and you notice a change in mental abilities.

Charts and tests for identifying stages of dementia

A stage of dementia chart lists the seven stages of dementia, a phrase that describes each step and the main symptoms that occur in each. 

Symptoms are often organized into an easy-to-read format on these charts for convenience. They're used by healthcare professionals, caregivers, and others who could benefit from a quick reference. The dementia stage chart is also sometimes called the Brief Cognitive Rating Scale.

The Functional Assessment Staging tool is an assessment conducted by a doctor or other healthcare provider. This test identifies which of the seven stages of dementia a client might be in by posing questions about their cognitive and physical functioning abilities. Timelines like the vascular stages of dementia timeline estimate how long you might stay in each stage. 

Seeking the advice of a medical professional is often recommended if certain risk factors apply to you, or if you're starting to experience signs of memory and cognition loss. Try to avoid self-diagnosis through these tests. A doctor can help you find a way to move forward with your diagnosis and receive prompt treatment.  

Why is it important to know the stage of dementia? 

Knowing the stages of dementia can help you plan for treatment, whether you or someone you care for might be living with the condition. Knowing what may and may not happen during the next stage of Alzheimer’s or dementia might also offer you a greater sense of control and decrease anxiety and fear. 

Health professionals like therapists and counselors use these when formulating a treatment plan and communicating with others about their symptoms. Insurance companies may use it to identify your needs and approve or deny insurance claims.

The three-stage and seven-stage models of dementia progression outline what individuals may expect from the time symptoms appear until the final stages of the condition.

Although these will give you information on what is common during each phase, everyone is unique. What happens to someone else during the early stage of dementia might not happen for you until the end or at all. Consider that they are general guidelines and not a specific prediction about what symptoms you or someone you love may face during each specific stage of Alzheimer’s disease or dementia. For specific guidance, reaching out to your treating physician can be essential. 

The early stages of each type of dementia 

Below are the types of dementia someone may be diagnosed with and what may occur during the early stage of each. Each type has unique symptoms, so the progression of each can differ. Although the type of a person’s dementia can tell you more about what to expect, other factors will also impact the way their disease progresses. 

Alzheimer's dementia

Early-stage Alzheimer's dementia may include forgetfulness, losing items, struggling to find the right words, and difficulty recalling recent conversations. Although these symptoms can happen to anyone, they may become more frequent and interfere with daily living in early-stage Alzheimer's. For most people, symptoms begin to appear after the age of 60. Brains of people with Alzheimer’s are characterized by amyloid plaques and neurofibrillary tangles, but researchers don’t know if these abnormalities are causing the symptoms or a result of the disease. 

Lewy Body dementia

A difference between early-stage Alzheimer's and early-stage dementia with Lewy bodies is that your attention and awareness may fluctuate. In some cases, people with dementia with Lewy bodies may seem to regain cognitive function, only to lose it again as symptoms progress. In addition to memory loss and other forms of cognitive impairment, people with dementia with Lewy bodies may begin to experience trouble with moving and walking. In addition, some people with Lewy body dementia may experience vivid visual and auditory hallucinations. 

Vascular dementia

Early-stage vascular dementia can involve several symptoms related to a stroke. Early-stage vascular dementia symptoms can include vision, speech, and weakness challenges. The cognitive challenges in early-stage vascular dementia may have more to do with difficulty in decision-making and planning than forgetfulness, which will typically be more pronounced in the middle and late stages.

Frontotemporal dementia

With frontal lobe dementia, your memory and thinking skills are affected much less than in vascular dementia, Lewy body dementia, or Alzheimer's dementia. Instead, behavior and emotions are affected more. People with early-stage frontotemporal dementia may become impulsive, apathetic, or uninhibited. Speech problems that might occur include difficulty recalling names and understanding and using language.

The three levels of dementia theory 

The three levels of dementia theory, sometimes used by healthcare professionals, divides the progression of dementia into early or mild dementia, middle or moderate dementia, and late or severe dementia. This theory is the simplest classification option. 

Early-stage dementia

People with mild dementia may know they are experiencing symptoms, but they can often compensate for or cover them up initially. It may be easier to hide the disease from family members at this point. The early stage of dementia varies more for different types of dementia because each type of dementia has a unique cause. 

Middle-stage dementia

Middle-stage or moderate dementia causes symptoms severe enough to make daily living challenging. If you have Alzheimer's, you might become disoriented quickly, not knowing or being sure of where or who you are or what day or time it is. For other types of dementia, symptoms progress from mild to moderate. 

Whatever symptoms you experience in early-stage dementia become more pronounced in the middle stage. You may struggle to live independently at this stage. If you do, you may require support. Depending on the unique course of your condition, people in this stage may require frequent support with daily activities that involve self care like dressing, bathing, and grooming.

Late-stage dementia

Late-stage or severe dementia can be similar in all types of dementia. Your physical abilities deteriorate along with your cognitive function. You may lose the ability to communicate effectively, eat and swallow competently, walk, or use the bathroom. People in this stage often require full-time, constant support from a caregiver at home or a nursing facility. Late-stage dementia is fatal. 

What is the global deterioration scale?

Dr. Barry Reisberg developed the global deterioration scale and began using it in his clinic to help individuals with dementia and those who care for them. The seven-stage ranking scale identifies the decline and a lengthier description of symptoms during each stage. This scale is often most used to identify the stages of Alzheimer's dementia, but it can also provide information about the clinical stages of other types of dementia.

The seven stages of dementia

The seven stages of dementia track dementia progression, beginning with when symptoms are less noticeable. Through each stage of dementia, cognitive, emotional, and physical declines happen in an often-predictable order until the last stages of dementia before death. The stages of Alzheimer’s disease or dementia are as follows: 

• Stage One: No cognitive decline

• Stage Two: Extremely mild cognitive decline or impairment

• Stage Three: Mild cognitive decline or impairment

• Stage Four: Moderate cognitive decline or dementia

• Stage Five: Moderately severe cognitive decline or dementia

• Stage Six: Severe cognitive decline or dementia

• Stage Seven: Highly severe cognitive decline or dementia

The first three stages encompass the early stages of dementia. Stages four and five describe more advanced dementia. Stages six and seven are the final stages of dementia before death.

1. No cognitive decline 

In the first dementia stage, individuals may not complain about memory issues. In addition, a diagnosis of dementia may not be made, as a health professional may not notice any decline symptoms. This stage exists because dementia can begin before someone notices symptoms. Although the decline is occurring physically, the symptoms do not occur yet. 

2. Extremely mild cognitive decline or impairment 

During the second stage of dementia, an individual may notice memory problems and a slight change in their thinking ability. They may forget names they know well and where they put their items. Still, a clinical interview may reveal no evidence of a diagnosis, and one's ability to function at work and in social situations may not have deteriorated. This stage can sometimes be confused with Mild Cognitive Impairment (MCI), which is a condition that shows symptoms falling between the natural symptoms of aging and dementia. 

3. Mild cognitive decline or impairment

Stage three is the last of the early stages of dementia. In this stage, individuals may experience the following symptoms: 

• Getting lost in unfamiliar places

• Difficulty finding the right word or name

• Retaining little after reading

• Difficulty recalling names one has learned 

• Losing a valuable item 

• Struggling to concentrate

• Difficulty working

• Difficulty in social situations

• Denying one's memory problems 

One may be diagnosed with dementia at this stage as a mental decline becomes more apparent. However, it is possible that the diagnosis isn't made until the mid-stages of dementia. 

4. Moderate cognitive decline of dementia

Stage four dementia is more manageable for healthcare providers to recognize when interviewing clients. They might notice any or all of the following symptoms:

• Decreased knowledge about current events or recent events in one's life

• Difficulty recalling one's history

• Difficulty concentrating on serial subtraction tasks, such as counting down

• Difficulty traveling to unfamiliar locations 

• Difficulty handling finances

• Flat affect, such as talking in a monotone

• Difficulty choosing proper clothing for the weather

• Denial of one's symptoms 

• Withdrawing from difficult situations

With moderate Alzheimer’s disease, people may not have trouble traveling to familiar places, knowing where they are or what time it is, or recognizing people they know well. 

5. Moderately severe cognitive decline of dementia

In stage five of dementia, people often start to require caregiving. They may have trouble recalling a name or address they once knew well, the names of close family, or the name of a school they graduated from earlier in life. They may not know the date, day of the week, season, or year. 

Even if an individual is well-educated, once they reach the stage of moderately severe dementia, they may struggle with serial subtraction tasks, like counting backward from 40 by 4s. The individual may still know their name, the name of their spouse and children, and the faces of people close to them. They may not require support with eating or toileting but could have difficulty grooming or getting dressed in proper clothing. 

6. Severe cognitive decline 

Stage six is one of the last stages of dementia. In this stage, memory problems are so severe that a person may forget their spouse's or children's names. They may be unaware of their surroundings and recent events. In addition, they may not know the week or year. Counting backward from 10 may become difficult or impossible.

In this stage of severe Alzheimer’s disease, individuals may become incontinent. Their behavior and personality might change, and they may become delusional, obsessive, anxious, agitated, and uncharacteristically violent. They might also lose the ability to direct their actions because they struggle to hold the thought in their mind long enough to carry it out. Sleep and waking cycles are affected, and one may sleep several times during the day. People often require assistance to live productively in this stage.

In stage six, a few abilities may remain. For example, one may know their name and recognize whether someone is familiar to them. They may still remember details of their life, but these memories are vague and unreliable. As these final stages of dementia progress, one may require more extensive care

7. Highly severe cognitive decline

End-stage dementia marks the end of dementia. In this stage, a person may lose all verbal abilities. They may be incontinent and require feeding. In addition, motor skills may no longer work, and one may become rigid or bedridden. In the final parts of this stage, dementia ends in death. However, how people die from dementia can vary, depending on the type. Sickness, especially pneumonia, is often a contributing factor.   

The seven stages of vascular dementia

Vascular dementia is caused by a medical condition that disrupts blood flow to the brain. A stroke can be a cause of vascular dementia. The seven stages of vascular dementia may look slightly different from other types of dementia. 

In the first stages, your brain may work well, not causing unusual memory problems. However, as the early stages progress, you may have difficulty with motor abilities. You may be a bit forgetful, but not more than average. If you've had a stroke, you may struggle to move, walk, and speak. However, your doctor may not be able to fully say whether this symptom is due to dementia or a physical consequence of the stroke.

In the middle stages of vascular dementia, you may think more slowly, have trouble concentrating, and sometimes become confused. You may have difficulty planning and organizing tasks and activities and experience mood swings. In the middle stage, some people become increasingly emotional and have difficulty functioning cognitively. Additionally, they could become more forgetful, confused, and disoriented. Reasoning and communication abilities may continue declining.

Later in the vascular stages, you might be irritable and agitated and experience delusions. Late-stage vascular dementia follows the general descriptions of stages six and seven above. 

The seven stages of Lewy body dementia

Lewy body dementia develops when Lewy body proteins build up in nerve cells in parts of the brain that involve movement, thinking, and memory. The main difference between Lewy body dementia and other types of dementia regarding the stages is that the symptoms change from one day or moment to the next. Someone with this type of dementia might have more trouble with cognitive problems one day and seem much better the next, only to have issues again another day. For someone with Lewy body dementia, the span between the appearance of obvious symptoms and death is typically between four to eight years.

Early in the seven stages of Lewy body dementia, cognitive symptoms are the most prevalent. Many people with dementia with Lewy bodies experience symptoms like hallucinations, delusions, and restlessness. You may act out dreams while sleeping and experience minor movement problems. You may have urgent urges to urinate and become incontinent. Despite the confusion you may experience, your memory may continue to function well. 

In the middle Lewy body stages, physical problems appear or become more prominent. You may fall often or have difficulty moving your body or walking. Some symptoms, such as difficulty speaking and problems swallowing, are like those of Parkinson's disease. You may become more paranoid, have increasing delusions, become confused more often, and have difficulty paying attention.

During the later stages of Lewy body dementia, your physical symptoms may increase as you begin to experience a severe decline in your ability to perform daily life activities. Your muscles can become rigid and sensitive to touch. People in this stage may require support with daily activities like feeding, bathing, grooming, toileting, getting in and out of bed, and controlling their bladder and bowels. In these Lewy body stages, one may lose the ability to speak and can get pneumonia and other infections quickly.

The seven stages of frontotemporal dementia

Frontotemporal dementia is related to brain changes in the brain's frontal lobe and can also cause different symptoms than other forms of dementia. 

The seven stages of frontotemporal dementia start with difficulty in planning and judgment. Often, individuals can still manage their household and care for themselves without much support. In these early stages, an individual may still be able to work at their regular job. They may have difficulty managing money, become socially withdrawn, and lose interest in hobbies. If the damage is to your right frontal lobe, you may become less empathetic and unaware of the emotions of others. 

Behavioral symptoms, mood swings, obsessive behavior, apathy, and loss of inhibitions mark the middle frontotemporal stages. The previous challenges one was experiencing in the first stages may worsen during this stage. Individuals may require some support with everyday tasks. During these stages, one may experience memory problems, but they may still remember their name and their children's names.

Memory problems often aren't prevalent until the late frontotemporal stages. At this point, one may forget the names of their spouse, children, and caregivers. Full-time care may sometimes be recommended, as a person can lose touch with their environment. People in the last frontal lobe stages tend to wander. They may have severe problems with sleeping, communicating, and daily living activities. 

Support options 

If you or a loved one shows signs or symptoms of dementia, consider seeking mental health support with a therapist. As you go through this process, talking about your emotions can help you understand what it means outside of a medical context. The National Institutes on Aging emphasizes the fact that caretakers for dementia patients need support and other self-care, especially as patients near the end of their life. 

If you struggle to get to appointments in person, try an online therapy platform like BetterHelp. You can set up a session online quickly and conveniently from the comfort of your home. You can choose between phone, video, or live chat sessions, depending on what you feel most comfortable with. Whether you're a caregiver seeking encouragement or want to learn more about dementia, a licensed therapist can work with you. 

According to research, caregivers of those living with dementia may benefit from online counseling. In one study, researchers found that an internet-based counseling intervention successfully reduced symptoms of depression and anxiety in caregivers. They note that online interventions keep support for family caregivers reachable and affordable.