The reality of what life is like while progressing through the dementia stages is one of the most painful situations a person and their loved ones can experience (Especially during the later stages). Being prepared and knowing what to expect is an important part of learning to cope with what is ahead. How a person progresses in the stages of dementia depends on many things such as:
- The extent of the dementia
- The age of the person when dementia first takes hold
- Whether other health problems exist
- The amount of care or treatment received
- The cause of dementia, vascular dementia, Parkinson’s disease …etc.
An individual’s path through the dementia stages will differ from person to person. The signs and symptoms that a person may develop at one stage could develop at another stage for another person.
The Global Deterioration Scale
The Global Deterioration Scale (G.D.S.) is the foremost grading system used today for the assessment of the dementia stages. It is the brainchild of Dr. Barry Reisberg MD, whose research over the last thirty years has enhanced our understanding of the effects of Alzheimer’s
and dementia. The Global deterioration Scale gives families and caregivers a glimpse into what to expect as a person progresses through the dementia stages by dividing the symptoms into seven different stages. Each stage is given a brief title accompanied by a comprehensive list of the signs and symptoms for that stage. A loved one or caregiver can roughly assess what stage of dementia or Alzheimer’s an individual is at by comparing their symptoms with the G.D.S.
For the full comprehensive clinical version of the Global Deterioration Scale and the Seven Dementia Stages See Bottom of Page
The Seven Dementia Stages Simplified
During the first stage a person will show no evidence of problems with memory. A mental screening finds no indication of the signs or symptoms of dementia present. Memory and mental function are normal.
Stage #2 – Very Mild Decline in Mental Performance
This stage can also be attributed to the effects of old age. At this stage an individual will complain of memory problems most commonly in areas such as the following:
- Forgetting where they put something
- Not remembering names of people they know well
- Locking their keys in their car.
At this stage of the dementia stages there is still no sure sign of dementia but there is concern about memory problems when
screened by a medical professional.
Stage #3 – Mild Decline in Mental Performance
During the third stage a person might experience noticeable declines in mental function. Some of the signs and symptoms might be as follows:
- The affected person may get lost while driving to a familiar place.
- Performance at work will begin to suffer.
- Friends and relatives may begin to see a decline in the ability to find the right word or remember the name of a location or store…etc.
- Person will remember very little of a passage that they have just read.
- A decline in the ability to remember the name of someone they just met will become evident.
- Will sometimes lose or misplace items of value.
- Upon testing a noticeable change will be obvious.
A decrease in performance of important job related work or social events will become noticeable. During this stage of dementia anxiety and denial will become a noticeable aspect of their personality.
Stage #4 – Moderate Decline in Mental Capabilities
According to the Global Deterioration Scale there are obvious deficiencies in mental performance when a person is tested at this stage of dementia. During this stage a person might experience these changes:
- A lack of recollection concerning recent events.
- Problems with traveling long distances or managing money, etc.
- May not remember certain aspects of their own life or personal history.
- Has clear obvious problems trying to do complicated subtraction such as counting backwards from 100 in increments of 4, Or has major problems saying the alphabet backwards.
- Will at times shy away from complex or challenging situations
During the fourth stage of the dementia stages person may still be able to accomplish tasks in these areas:
- They are able to keep track of the time and where they are.
- They will still recognize people by face and at times will have no problem remembering their names.
- A person will still be able to travel to well known places.
Denial will become a very obvious aspect of a person’s personality at this stage of the dementia stages. They will not believe that they have a problem and do not want anyone else thinking they do. Family members may want to start planning ahead for care-giving possibilities.
Stage # 5 – Moderately Severe Decline in Mental Capabilities
At this stage of dementia a person will not be able to function without some help from a caregiver. Some signs and symptoms of this stage could be:
- During a clinical interview the person will not be able to remember important aspects of their daily lives, such as a phone number or address they’ve had for several years
- They will not remember the names of close family members or grandchildren. Or the name of their high school or college.
- Will show signs of confusion about what time of day it is or where they are or even what season it is.
- At this point it can be difficult to count backwards from fifty by 5’s or from 40 by 4’s
- May have problems picking out the right close to wear.
During the fifth stage a person may still be able to do the following:
- A person may still recollect important aspects about themselves or others close to them.
- They will remember their own names and usually recollect their immediate families names.
- The person should not need any help using the restroom or eating.
Stage #6 – Severe Decline in Mental Capabilities
During this stage a person will be somewhat oblivious to what is going on around them and may forget their spouses name even though they are totally dependent on them. They will remember some parts of their past life but their recollection of things that have happened recently escapes them. They may need help with day to day living and may become incontinent. Therefore the persons daily clock will sometimes get confused in such ways as wanting supper at 9 am or putting pajamas on for a trip to the store. They will know their name almost all the time. They will usually be able to tell the difference between a stranger and a family member or close friend but will have problems knowing names.
It is at this stage of dementia that certain changes in a person’s personality may surface. These changes may vary but could include the following:
- The person may show signs of being delusional. You might see them carrying on a conversation and no one else is in the room. They may see themselves in a mirror and think it is another person in the room. They might think that their spouse is a stranger in the house.
- In this stage a person can show signs of obsessive behavior. They might be observed doing them same thing over and over.
- Anxiety can manifest itself in this stage. Even though person may have never had violent tendencies before they may start to show now.
- Their willpower will begin to fade. The reason for this is that the person cannot keep their mind one thought long enough to act upon it.
Stage #7 – Very Severe Decline in Mental Capabilities
During the course of the last stage of the dementia stages a person will lose all ability to communicate verbally. Most of the time there will be no speech whatsoever. At times there will be words or phrases that make no sense at all. They will have incontinence of urine and will need help using the toilet and eating. Normal things we take for granted such as walking become harder and harder as this stage progresses. Communication between the brain and body seems nonexistent. Smiling, sitting up or holding their head up become a major accomplishment. The body starts to become rigid and the ability to swallow becomes tedious at best.
The Seven Dementia Stages – Clinical Listing
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.
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.
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.
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.
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.
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 they 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.
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.
Other Useful Tools for Assessment of the Dementia Stages
The Functional Assessment Staging Scale (Fast) is another tool used in diagnosing the Dementia Stages
Note: A person can be at a different stage cognitively (GDS stage) and functionally (FAST stage).
Clinical Dementia Rating (CDR) Scale
This is the most widely used staging system in dementia research. Here, the person with suspected dementia is evaluated by a health professional in six areas: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care and one of five possible stages is assigned.