The Dementia Stages – A Comprehensive Clinical View

The Seven Dementia Stages – Clinical Listing

Stage 1

NO COGNITIVE DECLINE: During the first stage of the Dementia Stages there is no subjective complaints of memory deficit. No memory deficit is clear on clinical interview.

Stage 2

VERY MILD COGNITIVE DECLINE (Age Associated Memory Impairment): Subjective complaints of memory deficit, most often in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. No obvious evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern about symptomatology.

Stage 3

MILD COGNITIVE DECLINE (Mild Cognitive Impairment): During this stage of the dementia stages one might see clear-cut deficits. Manifestations in more than one of the following areas: (a) patient may have gotten lost when traveling to an unfamiliar place; (b) co-workers become aware of patient’s relatively poor performance; (c) word and name finding deficit becomes clear to intimates; (d) patient may read a passage or a book and retain relatively little material; (e) patient may show decreased facility in remembering names upon introduction to new people; (f) patient may have lost or misplaced an object of value; (g) concentration deficit will be noticeable on clinical testing. Objective evidence of memory deficit obtained only with an intensive interview. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms.

Stage 4

MODERATE COGNITIVE DECLINE (Mild Dementia): Clear-cut deficit on careful clinical interview. Deficit manifest in following areas: (a) decreased knowledge of current and recent events; (b) may show some deficit in memory of one’s personal history; (c) concentration deficit elicited on serial subtracting; (d) decreased ability to travel, handle finances, etc. Frequently no deficit in following areas: (a) orientation to time and place; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations. Inability to do complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations often occur.

Stage 5

MODERATELY SEVERE COGNITIVE DECLINE (Moderate Dementia): Patient can no longer survive without some help in the fifth stages of the dementia stages. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. Frequently some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. People at this stage remember major facts about themselves and others. They invariably know their own names and generally know their spouses’ and children’s names. They need no help with toileting and eating, but may have some difficulty choosing the proper clothing to wear.

Stage 6

SEVERE COGNITIVE DECLINE (Moderately Severe Dementia): May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and, sometimes, forward. Will need some help with activities of daily living, e.g., may become incontinent, will need travel assistance but occasionally will be able to travel to familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently are able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include:

  • delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror;
  • (b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities;
  • (c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur;
  • (d) cognitive loss of willpower because the patient cannot carry a thought long enough to decide a purposeful course of action.

Stage 7

VERY SEVERE COGNITIVE DECLINE (Severe Dementia): Here in the last stage of the dementia stages all verbal abilities are lost over the course of this stage. Frequently there is no speech at all, only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psycho-motor skills, e.g., ability to walk, are lost are lost as this stage progresses. The brain appears to no longer be able to tell the body what to do during the last stage of the dementia stages. Generalized rigidity and developmental neurological reflexes are often present.

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