Dementia Care

Stages of Dementia

Health professionals often discuss dementia in “stages”. This is referencing the progression of a person’s dementia or Alzheimer’s disease. Having guidelines that define the stages helps physicians determine the best treatments by aiding the communication between doctors and caregivers. Dementia is usually considered as having three stages: mild (or “early”), moderate (or “middle”), and severe (or “late”). A more specific stage of dementia is commonly assigned based on symptoms.

It can also be helpful to know how symptoms change over stages. Alzheimer’s and similar diseases can cause dramatic swings in mood and behavior, and the activities a person is physically able to do. They will change as dementia progresses causing stress for friends and relatives. Knowing what’s coming can help prepare for your loved one’s social, medical, and personal needs.

This article discusses the stages based on various established scales, including symptoms particular to each stage. There is also advice on caring for someone based on their stage of dementia, including technology that can help and which types of assisted living homes are most appropriate.

Scales for Rating Dementia

Rather than simply using “early-stage,” “middle-stage,” and “late-stage” dementia as descriptors, there are scales that provide a more comprehensive description. These scales help better understand the different stages of Alzheimer’s disease based on how well a person thinks (their cognitive decline) and functions (their physical abilities). These are the Global Deterioration Scale for Assessment of Primary Degenerative Dementia, the Functional Assessment Staging Test, and the Clinical Dementia Rating

Global Deterioration Scale / Reisberg Scale

The most commonly used scale is often referred to simply as GDS, or by its more formal name, the Reisberg Scale (or by the lengthy name “Global Deterioration Scale for Assessment of Primary Degenerative Dementia”). The GDS divides into seven stages based on the amount of cognitive decline. This test is most relevant for people who have Alzheimer’s disease because some other types of dementia (like Frontotemporal dementia) do not always include memory loss.

Someone in stages 1-3 do not typically exhibit enough symptoms for a dementia diagnosis. By the time a diagnosis has been made, a dementia patient is typically in stage 4 or beyond. Stage 4 is considered “early dementia,” stages 5 and 6 are considered “middle dentia,” and stage 7 is considered “late dementia.”

Duration of Stages: How Long do the Stage of Alzheimer’s / Dementia Last

No two people with dementia experience the disease exactly the same way. That means the rate of decline varies by the individual and the type of dementia. In addition, it is not uncommon for individuals to have mixed dementia, meaning they have more than one type. That said, there is a natural course of the disease, and over time the capabilities of all persons with dementia will worsen. Eventually, the ability to function goes away. Keep in mind that changes in the brain from dementia begin years before diagnosis when there are no outward symptoms. This makes it difficult to know how much time a person has left, though there are ways (like an Alzheimer’s Life Expectancy Calculator that is under development) to come close to knowing life expectancy.

Mild Dementia

In this early stage of dementia, an individual can function rather independently, and often is still able to drive and maintain a social life. Symptoms may be attributed to the normal process of aging. They might be:
– Slight lapses in memory, such as misplacing eyeglasses or having difficulty finding the right word.
– Planning, organizing, concentrating on tasks, or accomplishing tasks at work.
The early stage of dementia normally lasts between 2 and 4 years.

Moderate Dementia

In the middle stage of dementia, often the longest stage of the disease, brain damage causes a person to have difficulty expressing thoughts and performing daily tasks. Memory issues are more severe than in the earlier stage. Someone in this stage might forget their address, be unable to recall personal history, and become easily confused about where they are. Communication becomes harder. The individual may lose track of thoughts, may be unable to follow conversations, and may have trouble understanding what others are saying. Mood and behavior change and the following symptoms can appear:

– Aggressiveness
– Difficulty sleeping
– Depression
– Paranoia
– Repeating actions or words
– Hoarding
– Wandering
– Incontinence
This moderate stage of dementia, on average, lasts between 2 and 10 years.

Severe Dementia

In late-stage dementia, also known as advanced dementia, individuals have significant issues with communication. Patients may:
– Not verbally communicate
– Have their memory worsen. Your loved one might forget family members’ names or go back to a different time period altogether and revert to their childhood days.
– Have difficulty walking
– Need extensive help for daily living activities, including personal hygiene and eating.
At the end of this stage, the individual will most likely be bedridden. This severe stage of dementia lasts approximately 1 to 3 years.

Early Stage Dementia

In the early stage of dementia a person can function rather independently and requires little care assistance. Simple reminders of appointments and names of people may be needed. Caregivers can also assist with coping strategies to help loved ones remain as independent as possible. That can be doing things like writing out a daily to-do list and a schedule for taking medications. Safety should always be considered. If any tasks cannot be performed safely alone, supervision and assistance should be provided. During this period of dementia, it’s a good idea for caregivers and loved ones to discuss the future.

Middle Stage Dementia

In the middle stage of dementia, patients start losing their independence. Assistance with activities of daily living, such as bathing, grooming, and dressing is normally required. Initially, an individual may only need prompts or cues to perform these tasks, such as reminders to shower or having clothes laid out on the bed. However, at some point more hands-on assistance will be required. Establishing a routine becomes important, and caregivers need to exercise patience. Since individuals in this stage of dementia have greater difficulty communicating, caregivers need to talk slowly, clearly and use non-verbal communication. Individuals will no longer be able to drive, so transportation will be required. It is also in this stage of dementia when supervision is necessary because it becomes unsafe to leave your loved one alone.

Late Stage Dementia

A person in this last stage of dementia requires a significant amount of care. Assistance and supervision are required 24 hours per day. Dementia patients may require assistance getting in and out of bed, moving from the bed to a chair, or are bedridden and require help changing positions to avoid bedsores. Swallowing becomes an issue in late-stage dementia, and caregivers have to make sure food is cut into small pieces, is soft (like yogurt and applesauce), or is pureed. At some point, the individual will be 100% dependent on their caregiver and will no longer be able to complete any daily living activities alone. Not all families are equipped to offer this level of care. There are other options for care, such as hiring a part-time caregiver or moving your loved one to a nursing home.

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