Every dementia experience varies from person to person. However, understanding how the condition progresses can help you to plan for the future, and arrange the most suitable dementia care and support.
How important is it to understand the stages of dementia?
While it’s impossible to predict how long each stage of dementia lasts for each individual, understanding the progression of dementia symptoms can be crucial to forming the right care plan or getting your or your loved one’s affairs in order at the right time – so you can focus on enjoying time together.
While many types of dementia share common symptoms, certain forms can impact the brain and body in different ways, at different stages. For example, some dementia such as Lewy Body dementia can have a greater impact on a person’s physical capabilities – such as causing tremors. Again, it’s important to know these differences so that you can best prepare your loved ones, and the home environment to keep everyone safe, comfortable, and supported.
What are the 7 stages of dementia?
1. No change in behaviour
The very early stages of most types of dementia are typically silent – with no outward symptoms. This is because the changes in the brain that are responsible for dementia can be small and take years to impact how we think, feel, or behave.
In cases of Alzheimer’s disease, the buildup of plaque in the brain that causes dementia symptoms can begin up to 10 to 15 years before the first symptom appears. This is often referred to as pre-clinical Alzheimer’s disease.
For those who will go on to develop vascular dementia, it’s likely that at this stage there will already be damage to the blood vessels (often caused by heart disease, high blood pressure, or stroke) and that this damage will eventually lead to dementia symptoms.
Early changes in the brain can sometimes be discovered through imaging technologies such as a PET brain scan. However, without any obvious reason to perform a scan, it’s rarely used to diagnose dementia at this ‘pre-dementia stage’ when no symptoms are present.
Forgetting things is a natural part of life, particularly later life when cognition can naturally begin to slow down. For those living with early, undiagnosed dementia, this may mean forgetting things you’ve been told recently, or losing items like keys or medication around the home. At this stage, it’s usually difficult to tell the difference between normal age-related memory loss and early dementia as the differences are very subtle. For example, forgetting what day of the week it is and remembering later, is often normal. Whereas, regularly being unable to remember the date may be a sign of something else.
Forgetting things is associated to some degree with all dementia types. However, Alzheimer’s disease accounts for up to 80 percent of cases and therefore is the most common cause of memory loss, outside of aging.
For those with rarer frontotemporal dementia (FTD), this second stage may include subtle changes in overall sharpness – i.e stumbling over words, or behaviour – such as avoiding social situations.
3. Mild Decline
This is the point in early-stage dementia when you or your family may start to notice that something isn’t right. It often centres around subtle mental decline which can begin to make certain daily tasks more difficult, through symptoms such as –
- Forgetting things that have just been read or watched on television
- Asking the same question, despite getting an answer
- Difficulty making plans or keeping appointments
- Struggling to remember the names of new people
Mild decline can last for as long as seven years and may be manageable with minimal support and check-in from family, or a professional companion. You may also want to start a dialogue with your family about getting financial and legal affairs in order ahead of time before symptoms progress.
For the rarer frontotemporal dementia (FTD) which primarily affects speech, language, and behaviour, a person with this form of dementia will likely experience more language and interpersonal symptoms. Early-stage FTD can include things like forgetting certain words and phrases or saying inappropriate things.
4. Moderate Decline
This is the middle stage of dementia – when symptoms and memory issues are far more obvious to everyone. This is often the stage where people receive a formal diagnosis too. Some low-level support is usually needed to help maintain safety and quality of life.
For someone living with Alzheimer’s disease or vascular dementia, this stage is often classed as ‘mild dementia’. Symptoms mean a person is unlikely to manage complex tasks independently but doesn’t need support or intervention with all everyday tasks yet, such as personal care (washing, dressing).
This level of cognitive decline can lead to-
- Finding it difficult to keep on top of money, or pay bills on time
- Difficulty cooking – such as forgetting food is in the oven, misplacing ingredients, or forgetting to have meals completely
- Forgetting to take medication, or taking too much throughout the day
- Being unable to keep the home clean, tidy, or organised
- Changes in sleep – such as napping more during the day, or staying up later at night
This stage of dementia may last for a couple of years, however, it’s important to remember that every dementia experience is different.
5. Moderately Severe Decline
During this stage, a person with dementia is likely to need more support with daily activities like getting dressed, or remembering recent information – such as recalling a visit from a friend, or the time of day it is. They may still retain a lot of memories of important events from their lives, and their family – making reminiscence a great activity to start at this stage.
Alzheimer’s can cause people to become withdrawn at this stage. Other emotional changes can include feeling paranoid about those around them or believing things that aren’t true.
At this stage, different types of dementia can cause more unique symptoms. Lewy body dementia may increase a person’s risk of infections, particularly on their skin. They may also experience hallucinations which may lead them to feel confused or anxious.
Frontotemporal dementia may cause a lot of similar symptoms to Alzheimer’s but cause additional motor symptoms, such as joint stiffness or difficulties swallowing drinks.
The time period for this stage can be anything up to (or occasionally exceeding) two years.
6. Severe Decline
In these late stages, a person is likely to need 24-hour care or considerable help with daily life. Most forms of dementia will cause people to experience severe memory loss at this stage, as well as mood swings and short bursts of anger.
For those living with Alzheimer’s this advanced stage is sometimes broken down further into five additional stages. –
6a – difficulty with coordination – e.g putting clothes on properly
6b – Needs support with personal care – e.g judging the temperature of the water when bathing, brushing teeth correctly
6c – Needs help with using the toilet
6d & e – May start to experience regular incontinence and issues with bowel function. They may forget major events from their life, or struggle to recall the names of family members.
Late-stage dementia for those with frontotemporal dementia may also cause problems with balance and reflexes – which can increase the risk of falls around the home.
7. Very Severe Decline
People with dementia will experience severe loss of speech and need dedicated support with moving and feeding at this final stage of the condition.
Usually, the best place to receive this level of care will be in a hospice, a specialist dementia care home, or in their own home – provided trained dementia carers can provide round-the-clock support. This is because when the body begins to shut down due to the damage caused in the brain, it can leave people more susceptible to serious health conditions like pneumonia.
A person with dementia may pass away before reaching this stage.
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What if the person has a sudden change in symptoms?
Whether you’ve been diagnosed with dementia yourself or are caring for someone who has, a sudden change in symptoms, such as acute confusion, memory loss, or delirium can be really worrying.
It’s crucial to speak to a doctor or medical professional as soon as possible. Even though dementia is a progressive condition and changes are expected, they’ll be able to rule out or treat any underlying issues that may be making dementia symptoms worse. They’ll also be able to offer advice on how to manage these changes moving forward.
We’ve covered more in our guide to the sudden worsening of dementia symptoms.
This article is for informational purposes only and not to be taken as medical advice. For medical advice, always consult your GP.
Learn more about dementia care
Take a look at more Elder guides on how to support those living dementia below.
Live-in Dementia Care or Care Homes: What’s the Difference? People with dementia experience many problems, both with memory and with cognition. Alzheimer’s disease is
Dementia Live-in Care: How to Find a Carer If you have a loved one who is living with dementia, you will want to ensure