7 Stages of Dementia

What is dementia?

All forms of dementia involve damage to the brain. Acetylcholine is a neurotransmitter (acts as a messenger between nerve fibers) that plays a vital role in cognitive functioning, including memory. Research has shown that people with dementia have impaired acetylcholine (cholinergic) functioning. ^[3]

Dementia symptoms are mild at first because the damage occurs to a small portion of the brain. Over time (usually several years), the damage worsens and spreads to other areas of the brain. This worsens the initial symptoms and causes new, more severe symptoms to appear. As damage spreads and symptoms worsen, an individual will eventually become incapable of living independently or caring for oneself. ^[5]

The four main types of dementia are Alzheimer's Disease, frontotemporal dementia, Lewy body dementia, and vascular dementia. ^[5] Each type is associated with a particular set of symptoms and is linked to different changes happening in the brain. Although, someone can experience overlapping symptoms.

What are the 7 stages of dementia?

Since dementia cannot be cured, it can be difficult to accept when a loved one receives a dementia diagnosis. However, early diagnosis and medical care can slow down the progression of some types of dementia. ^[6] The severity of symptoms gradually progresses, typically over the course of several years.

Dementia is classified into seven stages to help guide diagnosis and treatment.^[5] These stages can help professionals and individuals impacted to know what symptoms to look for and prepare a future care plan for treatment.

Stage 1: Dementia is not visible

Stages 1-3 are considered a pre-dementia period. In these stages, symptoms are likely undetectable. ^[2] In fact, experts even believe that dementia may begin years before any noticable symptoms arise. ^[2][4]

In this first stage of dementia, changes occur in the brain, but people are functioning well. They may still be working, driving, and participating in social activities. ^[2][4]

Stage 2: Age-related memory problems and forgetfulness

People in the second stage experience memory loss, which may be hard to separate from everyday forgetfulness. [2,4] People at this stage commonly forget familiar names or where they have placed objects around the house. ^[6] At this stage, symptoms may still be virtually undetectable. ^[6]

The most common symptoms that people with dementia or that others notice are problems with their short-term memory, such as forgetting recent conversations or misplacing items around their house. ^[1]

Stage 3: Mild cognitive impairment (MCI)

When individuals reach the third stage, obvious problems are visible, including problems with executive functioning. ^[2] Common signs and symptoms include difficulties with planning, focusing, remembering steps and instructions, and multitasking. The individual may become disoriented or struggle to find the right words. ^[6]

Other symptoms may include difficulty concentrating and retaining the information they have read, getting lost easily, losing important documents or items, and visibly poor performance at work. ^[6]

Stage 4: Moderate Cognitive Decline – Mild Dementia

Stages 4-7 are considered the dementia stages. ^[2] Individuals in the fourth stage of dementia have progressed to mild dementia, and symptoms are now apparent. Individuals often have poor short-term memory ^[4]. Individuals may begin to withdraw from personal and social situations and exhibit personality or mood changes. ^[6]

Individuals in the fourth stage are commonly defensive and in denial of symptoms. They may exhibit behaviours such as:

• A decreased awareness or knowledge of current or recent events. ^{[4] [6]}
• Problems remembering details about their own lives and past.
• Problems paying bills or managing their finances. ^[4][6]
• Becoming disoriented. ^[6]
• Problems recognizing the faces of people less familiar to them. ^[6]

In the fourth stage, individuals can still often recognize people close to them and can travel to familiar places. ^[6] But they commonly avoid challenging situations and circumstances to prevent anxiety and/or to hide symptoms. ^[6]

Stage 5: Moderately Severe Cognitive Decline- Moderate Dementia

Stage 5 marks when the individual cannot live independently without help. ^[2] By the fifth stage, people now require assistance in their daily lives as their cognitive function continues to deteriorate. Individuals commonly show the following signs and symptoms:

• Forgetting significant personal information and details such as their address, phone number, or family member's names. ^[6]
• They are often confused and disoriented about time and place. ^[6]
• Individuals may have trouble with decision-making. ^[6]

Although symptoms in the fifth stage can interfere with the individual's daily functioning, they don't need help performing essential independent living functions such as eating or using the bathroom. ^[6] They typically still remember their name and the names of their spouse and children. ^[6]

Stage 6: Severe Cognitive Decline – Moderately Severe Dementia

By the sixth stage, Individuals show a severe decrease in cognitive abilities and require continuous attention and monitoring. ^[4] They are likely unable to recognize close family members such as their spouse, children, relatives, and friends. They have also started to forget their names. ^[6]

These Individuals are often very confused about most aspects of their life ^[2]. They experience personality changes ^[4] and tend to be unaware of their surroundings. They cannot remember recent events and have an altered memory of their past. ^[6]

Family members and caregivers should be watchful for the following symptoms: ^[6]

• Delusional behavior (believing something is true when it is not).
• Loss of self-control.
• Hallucinations (seeing or hearing something that is not there).
• Difficulty sleeping.
• Anxiety, aggressiveness, agitation, or wandering off. ^[6]

Stage 7: Very Severe Cognitive Decline- Severe Dementia

Individuals in the seventh stage are nearing the end of their lives. They have lost control of their motor skills. Eventually, as the brain loses its connection to the body, individuals will lose their ability to speak. ^[6] They will not be able to perform any basic independent daily functioning independently, such as eating, walking, or using the bathroom. ^[6]

How quickly does dementia progress?

How quickly dementia progresses can vary based on factors such as age, overall health, age of diagnosis, and type of dementia. Alzheimer's disease, Lewy body disease, and frontotemporal dementia are all caused by abnormal protein deposits and typically begin slowly and gradually progress over months or years. ^[1]

Vascular dementia is related to a stroke, or a blood clot in the brain. Since strokes usually happen suddenly, symptoms such as cognitive impairment are immediate and vascular dementia develops days or even minutes after a stroke. ^[1]

Alzheimer's disease primarily affects people in middle age to older adults, and the most common initial symptom is impaired memory followed by a progressive decrease in cognitive abilities. ^[6] People with Alzheimer's often repeat the same question multiple times. It is also common, as the disease progresses, for people to become unaware of their surroundings and get lost.

Lewy body disease usually affects people ages 50 and older. It commonly causes changes in alertness and cognition. ^[1] Frontotemporal dementia symptoms typically begin between the age of 45-64. ^[9] Symptoms include impulsive actions, inappropriate behavior, problems with speech, and semantic paraphrasis (an intended word is replaced with a different word). ^[1] People with Frontotemporal dementia may have less memory decline, versus Alzheimer's disease, where memory loss is one of the most common hallmark signs of the disease. ^[1]