Do You Know How to Recognize Dementia Stages?

A person suffering from a form of dementia doesn’t start out with significant memory loss or other signs of cognitive decline. Dementia is usually progressive, meaning there are multiple dementia stages. In the earliest phases, a person might seem to be in good health. By the final stage, a person will usually be unable to care for him or herself. Recognizing the stages of the condition can help you get help for a loved one sooner rather than later.

Understanding Dementia

When people say that an older person has dementia, they can mean that a person has one of many different types of diseases.

Dementia isn’t a disease. Instead, it is a group of symptoms that affect a person’s ability to function in the everyday world on his or her own. Memory loss is often associated with dementia, but not all types of memory loss are caused by dementia.

Generally speaking, dementia disorders are classified into two groups, progressive and reversible. Often, reversible forms of dementia are caused by fixable problems such as a hormone imbalance, medication or nutritional deficiency.

The most common type of dementia is Alzheimer’s disease, which is a progressive disease. It’s thought that Alzheimer’s affects as much as half of the population of people over age 85. A person’s risk of developing Alzheimer’s doubles every five years after the age of 65.

Other progressive diseases that cause dementia include vascular dementia, which often occurs after a stroke, and Lewy body dementia. Lewy bodies are protein clumps that affect cognitive function. They have been found in the brains of people diagnosed with Alzheimer’s, as well as in people with Parkinson’s disease.

It’s also possible for people to have more than one form of dementia. A combination of Alzheimer’s and vascular dementia would be an example of this.

What Are The Stages Of Dementia?

There are several ways that medical professionals classify the stages of dementia. One measure doctors use is the Global Deterioration Scale. Developed by Dr. Barry Reisberg and others in 1982, the scale features 7 stages of dementia.

Pre-dementia: Stages 1 Through 3

  • Stage 1: No Cognitive Decline. During the first stage of dementia, a patient seems to be in completely good health and shows no signs of memory loss or other cognitive issues.
  • Stage 2: Age-Related Memory Loss. During the second stage, a person might occasionally forget things, such as where he or she put an object or the name of someone well-known to him or her. At this stage, it can still be difficult to tell that a person has any form of dementia.
  • Stage 3: Mild Cognitive Decline. At stage 3, a person will usually begin demonstrating clearer evidence of memory loss and cognitive impairment. He or she might have trouble concentrating, might struggle to complete tasks at work and might get lost easily going from one place to another.

By the time a person has reached stage 3, he or she might begin to feel some level of anxiety as a result of his or her symptoms. Although he or she can still live independently at this stage, the dementia is starting to interfere with daily life.

Usually, medical professionals consider the first three stages of dementia the “pre-dementia” phase. It can be difficult, if not impossible, to diagnose a person with any form of dementia during stage 1, since he or she will have no symptoms.

Diagnosing a patient who at stage 2 is still challenging, as it can be difficult to discern whether the memory lapses are just that or if they are a sign of something larger. Usually, stage 3 will include a clinical interview and diagnosis.

Pre-dementia: Stages 4 Through 7

  • Stage 4: Mild dementia or moderate cognitive decline. During stage 4, a person is often aware that he or she has symptoms. It’s common for people to feel defensive about any signs of the disease and to feel worried that others will notice their condition.
  • Stage 5: Moderate dementia or moderately severe cognitive decline. By stage 5, it is unlikely that a person who has dementia will be able to live on his or her own. During this stage, it can be challenging for a person to make decisions or to remember major events in his or her life.
  • Stage 6: Moderately severe dementia or severe cognitive decline. One of the hallmarks of stage 6 is that a patient is no longer able to remember the names of the people closest to him or her, such as a spouse and children. A patient might not be aware of where he or she is and might have distorted memories of the past.
  • Stage 7: Severe dementia or very severe cognitive decline. During stage 7, a patient loses the ability to speak and loses basic motor skills, including the ability to walk. People who reach stage 7 are often incontinent and will need assistance with eating.

As dementia stages progress from stages 4 through 7, a person might display behavior that alarms or frightens his or her loved ones. For example, a person in stage 4 might seem confused or disoriented on a regular basis. He or she might have difficulty with basic math and might seem “out of it” or unaware of current events.

By stage 6, it’s not uncommon for a person to display aggression or agitation or to behave in a way that is completely unlike themselves. Since memories are becoming more and more distorted during this phase, a person might suffer from delusions and can begin to behave in an obsessive manner.

What Are The Stages Of Alzheimer’s Disease?

Although the Global Deterioration Scale identifies seven stages of dementia, the stages of Alzheimer’s disease are often grouped into three main categories, as well as a preclinical period. Like the general dementia stages, the stages of Alzheimer’s begin before a patient even begins to show symptoms.

Preclinical Alzheimer’s Disease

During the preclinical phase of Alzheimer’s, a patient will usually have no visible symptoms. But it is possible to diagnose a patient during this period, as scans of the brain can detect deposits of amyloid beta, the protein that is a signal for the disease.

Mild Alzheimer’s Disease

During this phase, a person will begin to show signs of mild cognitive impairment, such as forgetting things, having difficulty making plans, or having trouble with challenging tasks or puzzles.

Moderate Disease

Once a person reaches the moderate phase of the disease, evidence of the condition becomes more and more visible. He or she might have trouble putting sentences together or performing simple tasks. People in this phase might have trouble sleeping through the night. This phase may also include wandering and getting lost. Memory loss worsens during this stage.

Severe Alzheimer’s Disease

By the final stage of the disease, a person is no longer able to take care of themselves. People are unaware of their surroundings, can no longer walk and lose the ability to speak. It’s common for people in the final stage of the disease to have a higher risk of developing infections.

This video provides an overview of what happens in the brain when a patient has Alzheimer’s:

Getting Help For A Loved One With Dementia

It can be very challenging to sit back and watch a loved one move through the phases of dementia. Although there is no way to cure progressive forms of dementia, it is possible to give your loved one support and to help slow the progression of the disease.

Early diagnosis is paramount. Early intervention allows you or your loved one to benefit from treatment sooner rather than later. It also gives you time to plan for the person’s future and to plan for care.

As the condition progresses, you might have to change the way you communicate with your loved one to make yourself clear and understood. It’s important to continue to treat the person as an adult. You should also take the time to speak clearly and to ask questions as simply as possible.

You might find yourself in a reversal of roles, especially if you are caring for a parent with a later stage of dementia. That can be alarming at first. If you find that caring for your loved one is too difficult for you to handle on your own, especially in the more severe stages, you might consider hiring a caregiver or finding a nursing home.

The sooner you are able to recognize any of these dementia stages, the sooner your loved one can get help. Talking to a doctor is advisable if you suspect dementia is present.

Have you worked with a family member or loved one with dementia? What was your experience like? Let us know in the comments!

Sean Byers, MD

Sean Byers, MD

Sean Byers is currently a Resident in the Internal Medicine program at UTMB. He studied at the University of Queensland School of Medicine as well as received his Master’s in Public Health with a focus in epidemiology and biostatistics at the University of Southern California. His background is in biology, computer science, public health, and internal medicine.

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