How To Recognize Dementia Stages For Different Kinds Of Dementia
By Julia Thomas
Updated February 26, 2020
Reviewer Prudence Hatchett, LPC, NCC, BC-TMH
Dementia is a devastating condition that can unfold for up to 20 years or more. The course of dementia depends in large part on what type of dementia you have. Knowing what to expect in the next months and years of your life can have many benefits whether you have dementia or your loved one has it. To this end, experts have developed two different models of dementia progression. One identifies three dementia stages while the other recognizes seven stages of dementia. These stages are different depending on the type of dementia you or a loved one has.
What Are Dementia Stages?
The dementia stages are steps in the progression of dementia. Both the 3-stage and 7-stage models of dementia progression outline generally what you can expect from the time you first have symptoms of dementia until the final stages of the condition.
Although the dementia stages give you information on what is most likely during each phase, it's important to remember that everyone is unique. What happens to someone else during the early stage of dementia might not happen for you until the end stages. In fact, it might not happen to you at all. As you read about the dementia stages, keep in mind that they're general guidelines and not a specific prediction about what symptoms or problems you or your loved ones will face.
The 3 Levels Of Dementia
The three levels of dementia sometimes used by healthcare professionals divide the progression of dementia into early or mild dementia, middle or moderate dementia, and late or severe dementia. This is the simplest and easiest-to-remember classification system for dementia progression.
Early Stage Dementia
People who have mild dementia typically know something is going wrong, but they're able to compensate for or cover up their symptoms. The early stage of dementia varies more for different types of dementia than other stages do. This is because each type of dementia has its underlying cause.
Early stage Alzheimer's dementia may include forgetfulness, losing things, trouble finding the right words, and difficulty remembering recent conversations. Although any of these things can happen to anyone, whether they have dementia or not, they become more frequent and begin to interfere with daily living in early-stage Alzheimer's.
Lewy Body Dementia
One of the main differences between early-stage Alzheimer's and early-stage dementia with Lewy bodies is that your attention and awareness fluctuates often. You may begin to have more trouble with moving and walking. Also, people with Lewy body dementia may have vivid visual and auditory hallucinations during the mild stage of dementia.
When you have early stage vascular dementia, you may have several symptoms related to a stroke. These can include vision problems, speech problems, and weakness. As for the cognitive problems in early stage vascular dementia, they tend to have more to do with the difficulty in decision-making and planning than with forgetfulness.
In frontal lobe dementia, memory and thinking skills are affected much less than in vascular dementia, Lewy body dementia, or Alzheimer's dementia. Instead, behavior and emotions are affected more. People with early-stage frontotemporal dementia may become selfish, impulsive, apathetic, or uninhibited. Speech problems that might happen include difficulty recalling names and understanding and using language.
Middle Stage Dementia
When you have a middle stage or moderate dementia, symptoms are severe enough to make daily living challenging. If you have Alzheimer's, you might become disoriented easily, not knowing or being sure of where or who you are or what day or time it is. For other types of dementia, symptoms progress from mild to moderate. Whatever symptoms you experienced in early-stage dementia become more pronounced in the middle stage.
You may or may not be able to live independently at this stage. If you do, though, you'll need a lot of help and support. Depending on the unique course of your condition, you might need help with daily activities like dressing, bathing, and grooming.
Late Stage Dementia
Late stage or severe dementia is similar to all types of dementia. Your physical abilities deteriorate along with your cognitive function. You may lose the ability to communicate effectively, eat and swallow well, and walk, and you may become completely incontinent. You'll likely need full-time, constant help from a caregiver, either in your home or at a nursing facility.
What Is The Global Deterioration Scale?
Dr. Barry Reisberg developed the global deterioration scale and began using it in his clinic to help patients with dementia as well as those who take care of them. The 7-stage scale identifies the main decline during that stage as well as a lengthier description of symptoms that happen during that stage. This scale is most useful for people who have Alzheimer's dementia, but it can also provide information about other dementias.
The 7 Stages Of Dementia
The seven stages of dementia track dementia progression are beginning with early-stage dementia when symptoms, if present, aren't even noticeable. Through each of the stages of dementia, cognitive, emotional, and physical declines happen in a somewhat predictable order until the last stages of dementia before death.
These are the 7 stages of dementia in general terms:
- Stage 1: No cognitive decline
- Stage 2: Very mild cognitive decline or mild cognitive impairment
- Stage 3: Mild cognitive decline or mild cognitive impairment
- Stage 4: Moderate cognitive decline or mild dementia
- Stage 5: Moderately severe cognitive decline or moderate dementia
- Stage 6: Severe cognitive decline or moderately severe dementia
- Stage 7: Very severe cognitive decline or severe dementia
The first 3 stages can be considered the early stages of dementia. Stages 4 and 5 describe more advanced dementia. Stages 6 and 7 are the final stages of dementia before death.
Stage 1 Dementia
In stage 1 dementia, you don't have any complaints about memory issues. When a health professional interviews you, they don't notice any problems with your memory, either.
Stage 2 Dementia
During stage 2 dementia, you begin to notice memory problems. You may forget names you know well and where you put things you use frequently. Still, the clinical interview reveals no evidence of memory problems, and your functioning at work and in social situations hasn't deteriorated.
Stage 3 Dementia
Stage 3 is the last of the early stages of dementia. In this stage, you start having trouble with two or more of the following symptoms:
- getting lost in unfamiliar places
- finding the right word or name
- retaining little after reading
- trouble remembering names you've just learned
- losing something valuable
- Having problems concentrating.
- coworkers notice you're having memory problems
- difficulty with working
- problems with social situations
- denying your memory problems
Stage 4 Dementia
As the first stage of mild dementia, stage 4 dementia is easier for health care providers to recognize when interviewing you. They might notice any or all the following symptoms:
- you have decreased knowledge about current events or recent events in your life.
- You have problems remembering your history
- You have difficulty concentrating on serial subtraction task (counting down from 100 by 7's, for example)
- You have trouble with traveling
- Handling your own finances becomes difficult
- Flat affect (showing decreased emotional expressiveness, such as talking in a monotone)
- Strong denial of problems
- Withdrawing from difficult situations
However, even in stage 4 dementia, you typically don't have trouble traveling to familiar places, knowing where you are or what time it is, or recognizing people you know well.
Stage 5 Dementia
When you reach stage 5 on the global deterioration scale, you can't survive without some help. You may have trouble remembering a name or address you once knew very well, the names of close family members, or the name of a school you graduated from earlier in life. You may not know the date, day of week, season, or year. Even if you are well-educated, you may have trouble doing simple serial subtraction tasks, like counting backward from 40 by 4s.
You still know your name, your spouse's name and your children's names very well. You don't need help with eating or toileting, but you may have trouble grooming yourself or choosing to clothe.
Stage 6 Dementia
Once you get to stage 6, you've entered the last stages of dementia. Memory problems are so severe that you may even forget your spouse's name at times. You're unaware of your surroundings and recent events. You probably won't know what week or year it is. Counting backward from 10 becomes difficult or even impossible.
You may become incontinent. Your behavior and personality start to change as you become delusional, obsessive, anxious, agitated, and possibly uncharacteristically violent. You may also lose the ability to direct your actions, simply because you can't hold the thought in your mind long enough to carry it out. You need assistance to live. Your sleep/wake cycles are affected, and you may sleep several times during the day.
You usually have a few abilities left. You know your name. You still recognize whether someone is familiar to you or not. You may still remember details of your own life, but these memories are vague and unreliable. As these final stages of dementia progress, you become more and more helpless.
Stage 7 Dementia
End-stage dementia is the bitter end of this difficult journey for you or your loved one. You may lose all your verbal abilities until you can't form words at all. You're incontinent or require help toileting. Someone has to feed you. You may lose your ability to walk along with other motor skills. Your body is rigid. End-stage dementia, you're nearing death day by day.
7 Stages Of Vascular Dementia
Vascular dementia is caused by a medical condition that disrupts the flow of blood to the brain. Stroke is one cause of vascular dementia. The 7 stages of vascular dementia look a bit different from other types of dementia. Following is a summary of each of the 7 stages of this disease.
At first, you're healthy. Your brain is working as well as it ever did, and you don't have any unusual memory problems.
In early vascular dementia stages, you begin having trouble with motor abilities. You're a bit forgetful but not much more than most older adults. You may have problems moving, walking, and speaking ifyou've had a stroke. However, at first, your doctor probably can't tell yet whether this is a symptom of dementia or merely a physical consequence of the stroke.
In the middle stages of vascular dementia, you think more slowly, have trouble concentrating, and become confused at times. You have trouble planning and organizing tasks and activities.You have mood swings and become increasingly emotional. You begin to have trouble with cognitive functioning. You start to become more forgetful, confused, disoriented, and your reasoning and communication abilities continue to decline.
Later in the vascular dementia stages timeline, you may be irritable, agitated, and delusional. Late-stage vascular dementia follows the general descriptions of stages 6 and 7 above.
7 Stages Of Lewy Body Dementia
Lewy body dementia develops when Lewy body proteins build up in nerve cells in parts of the brain that involve movement, thinking, and memory. The main difference between Lewy body dementia and other types of dementia regarding the stages is that the symptoms change from one day or moment to the next. Someone with this type of dementia might have more trouble with cognitive problems one day and seem much better the next, only to have problems again on another day.
Early in the seven stages of Lewy body dementia, cognitive symptoms are the most prevalent. You might have symptoms like hallucinations, delusions, and restless. You may act out dreams while you're sleeping. You may have some minor movement problems. You may have urgent urges to urinate and may become incontinent. Despite the confusion you may experience, your memory is still functioning well.
In the middle Lewy body dementia stages, physical problems begin to appear or become more prominent. You may fall often or have trouble moving your body or walking. Some of the symptoms, such as difficulty speaking and problems swallowing, are like those of Parkinson's disease. You may become more paranoid and have increasing delusions. You're confused more often and have trouble paying attention.
During the later stages of Lewy body dementia, your physical problems increase. Your muscles become rigid, and you become very sensitive to touch. You need help with the Activities of Daily Living, which include feeding, bathing, grooming, toileting, getting in and out of bed, and controlling your bladder and bowels. In these Louie body dementia stages, you can barely speak if at all. You get pneumonia and other infections easily.
7 Stages Of Frontotemporal Dementia
Frontotemporal dementia is related to brain changes in the frontal lobe of the brain. The 7 stages of frontotemporal dementia start with difficulty in planning and judgment. You can still manage your household and take care of yourself without much help.
In these early frontal, temporal dementia stages, you may still be able to work at your usual job. You may have problems with managing money, become socially withdrawn, and lose interest in hobbies. If the damage is to your right frontal lobe, you may become less empathetic and unaware of other people's feelings.
The middle frontotemporal dementia stages are marked by behavioral problems, mood swings, obsessive behavior, apathy, and loss of inhibitions. All the problems you were already having get worse. You need some help with everyday tasks, but you still do well enough with self-care. You might have some memory problems, but you can still remember your name and the names of your children.
Memory problems aren't prevalent until the late frontotemporal dementia stages. At this point, you may forget the names of your spouse, children, and caregivers. You need full-time care. You lose touch with your environment and can't remember things that happened to you recently.
People in the last frontal lobe dementia stages tend to wander. They usually have severe problems with sleeping, communicating, and the Activities of Daily Living.
Dementia Stages Tests And Tools
There are several charts, tools, and timelines to identify the stage of dementia you or a loved one is in.
Charts And Timelines For Identifying Stages Of Dementia
A stage of dementia chart lists the seven stages of dementia, a phrase that describes each stage, and the main symptoms that occur in that stage. It's all put into an easy-to-read format for convenience. It's used by health care professionals, caregivers, and others who need a quick reference on dementia stages. This tool is also called the Brief Cognitive Rating Scale.
The Functional Assessment Staging tool is an assessment usually conducted by a doctor or other healthcare provider. This test identifies which of the seven stages of dementia you're in by posing questions about your cognitive and physical functioning abilities.
Timelines such as the vascular dementia stages timeline give a rough estimate of how long you might stay in each stage.
Why It's Important To Know The Dementia Stages
Knowing the dementia stages can help you plan for the future, whether you know you have dementia or someone you might need to care for does. You can also benefit from knowing the stages because the knowledge of what is and isn't likely to happen next can give you a greater sense of control and decrease anxiety.
Health professionals, including therapists and other mental health professionals, use the stages when planning your treatment and communicating with other members of your team about your symptoms and treatment. Insurance companies use it to identify your needs and approve or deny insurance claims.
Getting Support Through All The Dementia Stages
Getting help and support through each stage of dementia can make your life or the life of your loved one much easier. With the right help, you can understand what's happening to you. You can develop ways to overcome certain problems associated with your declining cognitive and physical abilities or deal with them in the most effective way possible.
Talking to a therapist can help you deal with your emotional issues regarding your own or your loved one's cognitive and physical decline and the role you play in minimizing the effects of it. Going to a therapist's office can be inconvenient, especially for people who have limited ability or availability to travel away from home.
One solution is to start online therapy with one of the licensed counselors at BetterHelp.com. Setting up counseling is a quick, easy process. Soon, you'll have support when and where you need it to help you through your experiences with all the stages of dementia.