The Stages Of Dementia: Symptoms and Cognitive State

In general, dementia can be broken down into seven stages, beginning with no cognitive decline and leading up to very severe cognitive decline, also known as late dementia. After a dementia diagnosis, life expectancy typically ranges from eight to 10 years, although it can vary greatly. Treatments are often available to manage symptoms, although there is currently no cure for dementia. Regular exercise, a healthy diet, and keeping your brain busy may be helpful in preventing the development of dementia. If you or a loved one has recently received a dementia diagnosis, you may be experiencing many challenging emotions. A licensed therapist may help you work through them and learn effective coping skills.

What is dementia?

Dementia can be defined as a cognitive symptom characterized by memory loss and impairment of other mental functions. There can be many types of dementia, including vascular dementia, Lewy body dementia, and frontotemporal dementia, caused by various illnesses, such as Alzheimer’s disease and Parkinson’s disease. 

There are several risk factors that can increase the likelihood that an individual will develop a form of dementia. Dementia is thought to have a strong genetic component, and several genes are associated with an increased risk of its development. For example, according to the National Institute on Aging, the gene variants APP, PSEN1, and PSEN2 have been connected to Alzheimer’s disease. 

People with mild cognitive impairment (MCI)—a condition marked by deficits in memory and other facets of cognition—are also at higher risk of experiencing dementia. Lifestyle factors, such as smoking and alcohol use, are also thought to contribute to certain forms of dementia, including Alzheimer’s disease and vascular dementia. Additionally, women are diagnosed with dementia at higher rates than men. 

Diagnosing Alzheimer’s disease and other dementias 

In general, there is no one single way to diagnose Alzheimer’s disease or other types of dementia. Most people first experience mild symptoms of the condition and then undergo diagnostic tests to identify the cause of their symptoms. If someone starts experiencing symptoms of dementia, their doctor will normally conduct physical and neurological tests in order to determine whether dementia is at play.

Some common dementia diagnosis tests can include questionnaires to measure cognitive functioning and other mental exams. A professional may also administer self-report exams and interview the individual to determine whether their symptoms call for a diagnosis of Alzheimer’s disease, Lewy body dementia, or other dementias. Following physical evaluations, interviews, and other assessments, a professional may then provide a diagnosis of Alzheimer’s disease (or another form of dementia). It can be important to remember that memory problems and cognitive difficulties do not always signify dementia. Discuss any changes to your physical or mental health with your doctor to best manage any health conditions that may arise.

Stages of dementia

Stage 1: No cognitive decline

The first stage of dementia can be seen as having no dementia at all. Someone who has no memory difficulties and is otherwise mentally healthy generally has no dementia and is in Stage 1. Most people in the general population tend to fall into this category.

Stage 2: Very mild cognitive decline

Before anyone enters the early stages of dementia, they are likely to experience a very mild cognitive decline that can be expected with aging. Occasional forgetfulness is not usually a cause for worry and is not necessarily indicative of dementia. The friends and family members of someone with very mild cognitive decline will likely not notice any changes in the person's behavior or mental abilities.

Stage 3: Mild cognitive decline

Mild cognitive decline or mild cognitive impairment (MCI) is a condition that can be common amongst the older population. While not everyone who experiences MCI will develop dementia, it tends to be the first hint of dementia for many people who go on to develop it later in life.

Symptoms of MCI may include problems with memory, as well as broader information processing difficulties, such as difficulty solving a math problem and other challenges with problem-solving capabilities. Unlike people who experience mild forgetfulness or cognitive difficulties as part of aging, the decline of someone with MCI is usually apparent to friends and relatives and may impact the way someone behaves.

Like dementia itself, the cause of MCI is not completely understood. Brain damage that later leads to dementia, such as plaques and tangles, the presence of Lewy bodies, damage from strokes, or shrinkage of certain areas, may all be present in people with MCI, but they’re not usually as severe as those with dementia. MCI can last quite a long time, with an average duration of approximately seven years.

Stage 4: Moderate cognitive decline

Someone with MCI may go on to experience a moderate cognitive decline in which the symptoms of MCI intensify. They may have trouble concentrating or finishing complex tasks, but for the most part, they can live independently and carry out their normal life on a day-to-day basis. However, at this point, the person may begin to withdraw from friends and family because socialization tends to become more difficult. At this stage, physicians may begin to detect signs of dementia.

Stage 5: Moderately severe cognitive decline (mild dementia)

Moderate cognitive decline often progresses into mild dementia. The main difference between the two is usually that mild dementia begins to impact the individual's daily life. Common symptoms of mild dementia can include short-term memory loss, trouble with directions, a tendency to get lost, and, perhaps most notably, personality changes. The person may need assistance with more complex daily tasks, like cooking. The average duration of this stage of dementia is approximately one and a half years.

Stage 6: Severe cognitive decline (middle dementia)

Once someone progresses from mild to moderate dementia, they may no longer be able to carry out their daily tasks independently. Memory deficiencies can become more severe, while basic self-care activities, like bathing or dressing, may require some assistance.

While mild dementia can cause problems with short-term memory, moderate dementia normally includes memory loss of events from the distant past as well as more recent events. Personality and behavior changes can become more pronounced, and those at this stage of dementia tend to feel suspicious or wary of people or situations, even those they are familiar with and who are part of their regular life.

Many people with moderate dementia also have trouble sleeping or experience irregular changes to their sleep patterns, and they may sleep throughout the day while feeling energized or restless at night. This stage of dementia typically lasts approximately two and a half years.

Stage 7: Very severe cognitive decline (late dementia)

Severe dementia normally causes further declining cognitive abilities as well as changes to one's physical abilities. People with severe dementia usually lose their ability to carry out tasks independently and often require full-time assistance with personal care. They may eventually lose their ability to communicate, as well as their psychomotor abilities, such as walking and swallowing.

People in this stage of dementia also tend to be more susceptible to dangerous infections like pneumonia. The duration of this final stage of dementia lasts an average of two and a half years.

Stages of Dementia: Factors that affect life expectancy

Although researchers can determine the average duration of each of the seven stages of dementia, everyone can experience symptoms at different speeds and levels of severity. Someone may experience MCI for decades and never progress into the more severe stages of dementia, while someone else may only experience MCI for a year before their condition worsens. This means that it can be hard to predict the life expectancy of an individual diagnosed with dementia. 

There are several factors that affect life expectancy in people with dementia. Although the average life expectancy following a dementia diagnosis is typically eight to 10 years, the time can vary greatly based on the type of dementia, the stage the disease was diagnosed, the individual's general health, and many other factors. For example, research suggests that the existence of comorbidities—such as cancer—can further affect life expectancy. 

Life expectancy in stages of dementia

Age can play a significant role in the life expectancy of a person with dementia. In a study titled “Dementia After Age 75: Severity in Different Severity Stages and Years of Life Lost”, researchers examined survival time based on cases of incident dementia from the Kungsholmen Project—a long-running study on dementia and aging. They found that the time of survival following a dementia diagnosis was 4.1 years for individuals over 75. 

In another study of life expectancy and mortality rates, researchers found that the median life expectancy for people diagnosed with dementia at age 60-69 was 6.7 years. They also found that the risk of death was high in the first year following diagnosis, providing further evidence of the importance of early diagnosis.   

In general, the earlier the condition is detected, the better the prognosis, since the person can start getting help and treatment sooner. Because research for treating dementia is ongoing, early detection may give the individual the opportunity to participate in clinical trials for novel treatment methods that may improve their quality of life and life expectancy.

Treatment options for dementia at any stage

While there may currently be no way to cure dementia, new treatments continue to be developed to alleviate its symptoms. Doctors can prescribe various medications and recommend different types of therapy to limit the effects of dementia. It can be vital to consult your doctor before starting, stopping, or changing any type of medication. 

Therapy options may include occupational therapy and talk therapy, among others. Maintaining a structured routine and making changes to a person’s environment to promote safety can also be helpful. If you’d like to learn more, the National Institute on Aging has several resources with helpful information on dementia symptoms, treatment, and prevention. You can also sign up to have newsletters on relevant topics sent to your email inbox. 

Preventing dementia with correct behavior: What the research shows

While dementia cannot be prevented completely, its risks can be mitigated through various strategies. In a cohort study that included over 2,400 participants, researchers found that individuals who practiced at least four healthy habits experienced a reduced risk of Alzheimer’s disease. These lifestyle factors included physical activity, cognitive exercise, limited alcohol use, balanced diet, and abstinence from smoking. If dementia runs in your family and you're worried about how it may affect you, the following are steps you can take at home in order to significantly reduce the risk of developing dementia.

Exercise regularly

In a review conducted by Sweden’s Aging Research Center, researchers suggested that physical activity can reduce the risk of dementia. Activities like walking, gardening, and swimming can make all the difference in your health. Exercise can be good for the heart and blood circulation, and it may keep your mind and body healthy. 

Keep your brain busy to combat cognitive decline

According to experts in geriatric medicine, one of the best ways of keeping dementia at bay can be keeping your mind keen and active, which may be why puzzles like sudoku, quizzes, learning a new language, and reading to expand your knowledge base are highly recommended.

Cut back on unhealthy habits and behavior

If you haven't done so already, try to eliminate or reduce your frequency of smoking and consumption of alcohol and caffeine. You might also eat as healthily as you can. The food you eat can fuel your body and impact your physical and mental health. 

How therapy and proper communication can support you

As discussed in the main content of the article, a diagnosis of dementia, or even just the emergence of early symptoms of cognitive impairment, can be a significant burden for someone to manage, especially without proper communication with their caregivers. There can be evidence of comorbidity between dementia and mental health conditions like depression and anxiety. Mental health care can help an individual with dementia address both the cognitive and emotional challenges of the condition. 

Dementia can also have an impact on the people in the diagnosed individual's life. Watching a loved one go through the stages of cognitive decline can be challenging, and symptoms of depression or anxiety may occur. This can be especially true among caregivers of people with dementia and Alzheimer's disease. It is not uncommon for them to experience stress and burnout. 

Whether you are struggling with early symptoms of dementia yourself, or you have a loved one going through dementia or another age-related condition, a licensed therapist can help you navigate this difficult period. 

Benefits of online therapy for cognitive decline, behavior, and caregivers

Online therapy platforms like BetterHelp can be advantageous for those experiencing cognitive decline, in addition to their caregivers, because meeting virtually with a licensed therapist doesn’t usually require anyone to leave their home. Depending on the stage of one’s cognitive decline, changes to routine can prove more disruptive than normal. Meeting from a safe, familiar location may help a patient with dementia feel more comfortable seeking support. 

Effectiveness of online therapy

A 2022 study focusing on online cognitive behavioral therapy for caretakers of people with dementia found that it could decrease distress and help caretakers better manage distressing thoughts. Whether you’re living with dementia or caring for someone who is, online therapy may prove to be a valuable tool.