Stages of Dementia

In years past, we assumed that mental decline was a natural consequence of aging. But as medical science has progressed, many of the symptoms associated with mental decline in old age have been linked with specific cognitive disorders. Though it is possible that symptoms can present suddenly, as may be the case after a stroke, it is common for the deterioration to present itself gradually and progress through stages of what doctors call dementia. Contrary to common belief, dementia and Alzheimer’s Disease are not the same.

The term dementia simply refers to decreased memory and cognitive function that impacts one’s life. Alzheimer’s Disease is a form of dementia that has a progression through defined stages of cognitive function and scales developed to track the advance of the disease are often used as a general test for the progression of dementia, though other forms will show key differences at certain stages. In the case of Alzheimer’s, the Global Deterioration Scale (GDS) also known as the Reisberg Scale, is a seven-stage diagnostic tool used for determining the level of severity and the course of treatment appropriate. Since vascular dementia, related to strokes and coronary disease, is the second most common form of dementia and has a a similar but distinctive progression. Use these two guides to the stages of the two most common forms of dementia, Alzheimer’s Disease and vascular dementia, to better diagnose and seek treatment early.

Alzheimer’s Disease

Stage 1: No Cognitive Decline
The normal baseline and the patient shows no symptoms of dementia.

Stage 2: Very Mild Cognitive Decline
Not yet dementia. Normal forgetfulness associated with names and misplaced familiar objects. Symptoms are hardly noticeable to family or doctor.

Stage 3: Mild Cognitive Decline
Not yet dementia. Increased forgetfulness, minor concentration difficulties, less productive at work. May get lost at times or struggle to find the correct vocabulary. Family and friends should start to notice a decline in cognitive function at this stage. Lasts on average 7 years before dementia can be diagnosed.

Stage 4: Moderate Cognitive Decline
Early stage dementia. Increased difficulty concentrating, remembering recent events, managing finances or traveling alone to new destinations. Complex tasks start to become difficult. Denial about symptoms is common at this stage and the person may distance himself from family and friends because of social difficulties. Clear cognitive problems can be detectives during a doctor-patient interview. Stage lasts on average 2 years.

Stage 5: Moderately Severe Cognitive Decline
Mid-stage dementia. Significant memory deficiencies manifest and the person needs some help to perform daily activities. Problem solving ability declines. Forgetfulness of major aspects of current life, such as their own address, phone number, time of day or present location, make the memory loss more prominent. Stage lasts on average 1.5 years.

Stage 6: Severe Cognitive Decline
Mid-stage dementia. Significant help needed to perform daily activities. It is common to forget names of close family members and do not remember many recent events. Only a few details of earlier life remain in their memory. Counting down from 10 becomes difficulty as does completing tasks. Persons at this stage begin to lose bladder and bowel control. The ability to speak declines and personality changes may manifest, such as delusions, compulsions (repeated behaviors) and anxiety. Stage lasts on average 2.5 years.

Stage 7: Very Severe Cognitive Decline
Late stage dementia. Persons at this stage have little to no communicative ability and require help to perform even simple activities such as using the toilet and eating. Motor skills such as walking are lost at this stage. This stage lasts on average 2.5 years.

Vascular Dementia

Early Stage Vascular Dementia

The early stages of vascular dementia are less characterized by memory loss and show more problems with speech and spacial perception than Alzheimer’s. Unlike Alzheimer’s Disease, it is nearly impossible to assign average durations for each stage due to the confluence of risk factors, but the total average time is around 5 years from early stage
dementia until the end of late stage dementia. The most common symptoms include:

• Difficulty with problem solving, planning and decision making
• Slowed thinking
• Inability to follow steps or instructions
• Lack of focus
• Sudden moments of confusion
• Mood changes

Patients in the early stages may also have:

• Less fluent speech
• Mild memory problems
• Difficulty with spacial perception

Middle Stage Vascular Dementia

Vascular dementia can progress gradually or in sharply defined stages of decline if caused by mini-stroke events.

• Confusion and disorientation increase
• Reasoning and communication abilities continue to decline
• Memory loss for recent events and names will worsen
• The person may need some help to perform daily activities such as cooking or cleaning
• Mood changes manifest that commonly include irritability, agitation, aggressiveness and changing sleep patterns.
• Manifest socially inappropriate behaviors
• May strongly believe certain facts to be true that are not (delusions)

Late Stage Vascular Dementia

Duration of the late stage dementia varies widely but is complicated by the risk factors causing the vascular dementia. Most common causes of death include strokes and heart attacks.

• Less aware of his environment
• Needs help walking or eating without help
• Progression of symptoms of confusion, memory loss, reasoning and communicative ability

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