The 7 Stages Of Dementia
Alzheimers disease and other common forms of dementia including vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are progressive conditions, with symptoms worsening over time as the disease progresses. Learn more about the stages of dementia and what to expect from your loved one as dementia progresses.
Although the two terms are often used interchangeably, Alzheimers disease and dementia are two different terms. Dementia is an umbrella term used to describe several conditions and it includes Alzheimers, as well as other conditions with shared symptoms. More than mere forgetfulness, an individual must have trouble with at least two of the following cognitive areas to be diagnosed with dementia:
- Reasoning and judgment
- Visual perception
The assessment tools used to determine which stage of dementia a person is experiencing are meant to be a guide and a rough outline of what caregivers can expect and when they can expect it. Some symptoms may occur later than others, others may appear in a different order than the scale predicts, and some may not appear at all. Some symptoms may appear and then vanish, while others will continue to worsen over time. Because every person is different and dementia manifests itself uniquely, the speed at which dementia progresses varies widely. On average, a person with Alzheimers disease lives 4 to 8 years after a diagnosis, but some have been seen to live as long as 20 years.
Symptoms Specific To Vascular Dementia
Vascular dementia is the second most common cause of dementia, after Alzheimer’s. Some people have both vascular dementia and Alzheimer’s disease, often called “mixed dementia”.
Symptoms of vascular dementia are similar to Alzheimer’s disease, although memory loss may not be as obvious in the early stages.
Symptoms can sometimes develop suddenly and quickly get worse, but they can also develop gradually over many months or years.
Specific symptoms can include:
- stroke-like symptoms: including muscle weakness or temporary paralysis on one side of the body
- movement problems difficulty walking or a change in the way a person walks
- thinking problems having difficulty with attention, planning and reasoning
- mood changes depression and a tendency to become more emotional
Read more about vascular dementia.
What Are The Symptoms Of Dementia
Each person is unique and will experience dementia in their own way. The different types of dementia tend to affect people differently, especially in the early stages.
A person with dementia will often have cognitive symptoms . They will often have problems with some of the following:
- Day-to-day memory difficulty recalling events that happened recently.
- Repetition repeating the same question or conversation frequently in a short space of time.
- Concentrating, planning or organising difficulties making decisions, solving problems or carrying out a sequence of tasks .
- Language difficulties following a conversation or finding the right word for something.
- Visuospatial skills problems judging distances and seeing objects in three dimensions.
- Orientation losing track of the day or date, or becoming confused about where they are.
Some people have other symptoms including movement problems, hallucinations or behaviour changes.
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Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
Place Of Care In The Last Phase Of Life
In developing palliative care for people with advanced dementia, it is important to consider circumstances of care such as place of care or where the person dies. The majority of people with early stage dementia live at home with family members caring for them. Approximately one third of people with dementia are cared for in nursing homes . A survey identified dementia in 68% of nursing home residents with only slightly more than half having recorded diagnosis and with more than half suffering from advanced dementia . People in the advanced stages of dementia spend most of their time in nursing homes . The likelihood of nursing home admission increases with age and severity of behavioural symptoms high burden of family carers is also associated with nursing home admission . People with migration background are less often cared for in nursing homes .
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What Are The Signs That Someone With Dementia Is Near Death
It is difficult to know when a person with dementia is near death. However, there are some symptoms that may indicate the person is at the end of their life including:
- needing help with everyday activities
- eating less and swallowing difficulties
- incontinence and becoming bed bound.
When these are combined with frailty, recurrent infections and/or pressure ulcers, the person is likely to be nearing the end of their life. If the person has another life limiting condition , their condition is likely to worsen in a more predictable way.
When a person gets to within a few days or hours of dying, further changes are common. These include:
- deteriorating more quickly
- irregular breathing
- cold hands and feet.
These are part of the dying process, and its important to be aware of them so that you can help family and friends understand what is happening.
When a person with dementia is at the end of life its important to support the person to be as comfortable as possible until they die
For more information, see our page, Signs that someone is in their last days or hours.
Recognise And Meet Spiritual And Cultural Needs
Care providers also need to be attentive to meeting a persons spiritual or cultural needs at the end of life. For one person, this may involve making sure they have contact with a religious leader in the last days or hours of their life, while another may want their favourite composers music to be played quietly but continuously throughout the period. This information should be recorded clearly, and should not come as a surprise to care staff who will know the person their life history, preferences and nature well. You should also discuss these aspects with the persons family or friends.
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Common Types Of Dementia
Most people who have dementia experience problems with cognitive skills, depression, indifference, and a lack of interest in doing things.
People with Lewy body dementia and Alzheimer’s disease may have similar early symptoms. Memory loss is common in both conditions, for example. Lewy body dementia also commonly causes fluctuations in arousal, hallucinations, sleep problems, and difficulty walking.
In contrast, people in the early stages of frontotemporal dementia usually don’t have memory problems. Instead, they might have obvious changes in personality and behavior.
Vascular dementia, which occurs as a result of having many strokes throughout the brain, can cause problems understanding concepts, emotional and personality changes, and memory problems. This type of dementia may accompany other types, making the decline more severe.
And chronic traumatic encephalopathy , which occurs after repeated head trauma, often begins to cause symptoms years after the traumatic brain injuries, with a significant progression of mood changes, personality changes, and a decline in memory and cognitive skills.
With Lewy body dementia, frontotemporal dementia, vascular dementia, and CTE, the memory problems may respond to cues/reminders, while in Alzheimer’s there is often a forgetting of recent events altogether.
In the final stage of all types of dementia, a person goes through a major decline in everyday functioning.
Changes In Mood Emotions And Perceptions
Changes in mood remain in the later stages of dementia. Depression and apathy are particularly common.
Delusions and hallucinations are most common in the late stage of dementia. They are not always distressing but they can explain some changes in behaviour because the persons perception of reality is altered.
People with later stage dementia often respond more to senses than words. They may like listening to songs or enjoy textures. For example, they may like the feel of different types of material.
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Psychological Changes For Dementia Patients
- Changes in mood: Frequent mood swings, increased sensitivity to change, and increased anxiety and agitation.
- Personality changes: Loss of interest in previously enjoyed activities and sometimes completely changed personality and behaviors.
- Hallucinations or paranoia: In later stages of dementia, sufferers may believe that even close friends or family are dangerous or “out to get them”.
- Neglecting safety, personal hygiene, exercise, or nutrition. May display decreased judgement skills involving money, like careless purchases or giving away large sums of money.
- Socially inappropriate behavior: Making rude or explicit sexual comments publicly or to strangers.
Physical Difficulties In The Later Stages Of Dementia
The physical changes of late-stage dementia are partly why the person is likely to need much more support with daily living. At this stage they may:
- walk more slowly, with a shuffle and less steadily eventually they may spend more time in a chair or in bed
- be at increased risk of falls
- need a lot of help with eating and so lose weight
- have difficulty swallowing
- be incontinent losing control of their bladder and bowels.
The persons reduced mobility, in particular, raises their chances of blood clots and infections. These can be very serious or even fatal so it is vital that the person is supported to be as mobile as they can.
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Let Our Care Assessment Guide You
Our free tool provides options, advice, and next steps based on your unique situation.
How quickly does this dementia progress in the elderly? Eight in 10 people with MCI will go on to develop Alzheimers disease within seven years, according to the National Institute on Aging. Since MCI can precede more severe dementia stages, its important to recognize the signs of this stage and seek medical advice.
Stage 3 dementia symptoms
- Forgetting to go to appointments or events
- Losing things and minor memory loss
- Getting lost while traveling
- Difficulty finding the right words
- Verbal repetition
- Challenges with organization and concentration
- Trouble with complex tasks and problem-solving
- Impaired bodily function
Stage : Subjective Memory Lossage Related Forgetfulness
Many people over the age of 65 complain of cognitive and/or functional difficulties. Elderly persons with these symptoms report that they can no longer remember names as easily as they could 5 or 10 years previously they can also have trouble recalling where they have recently placed things.
Various terms have been suggested for this condition, but subjective cognitive decline is presently the widely accepted terminology. These symptoms by definition, are not notable to intimates or other external observers of the person with subjective cognitive decline. Persons with these symptoms decline at higher rates than similarly aged persons and similarly healthy persons who are free of subjective complaints. Research has shown that this stage of subjective cognitive decline lasts 15 years in otherwise healthy persons.
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Provide Support For Family And Friends
Keep any family or friends informed about what is happening in a gentle, sensitive and supportive way. This will help reassure them that the person is getting the care they need. You could consider signposting them to appropriate services, such as an Admiral Nurse or local Alzheimers Society. It can also help to give them an opportunity to talk about what is happening.
Caring For A Person With Late
If you are caring at home for someone who is in the later stages of dementia the Aged Care Assessment Team can help with advice and referrals for all aspects of care. You can contact your nearest ACAT by calling the number listed in the Age Page of your telephone directory. Your doctor or hospital can also help you to contact your local ACAT.
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Stage : Moderately Severe Cognitive Decline
From this stage onward, the person may no longer be able to function without some assistance.
These are some of the symptoms of this stage:
- Difficulty recalling an important detail such as their address, phone number, or high school
- Disorientation in terms of place and time, such as confusion regarding the season, date, day of the week, or time of day
- Difficulty counting backward from 20 by 2s or from 40s by 4s
- Trouble with making decisions
In this stage, the person can likely still remember their own name and the names of their spouse and children, but they may struggle with recalling the names of their grandchildren. They may be able to eat and use the bathroom without assistance, but may need help with tasks such as deciding what to wear.
Stage : Very Mild Changes No Dementiaquality Of Life: Little To No Impact
You still might not notice any changes in your loved one. Youll see daily memory problems that look like a normal part of aging. You may see:
- Some difficulty finding the right words.
- The ability to make up for memory problems, such as substituting one word for another.
- Normal functioning in the home, community, and workplace.
How You Can Help:
As with Stage 1, start to plan now. Use our tools to help your loved one document his or her values and priorities about the type of care wanted during the various stages of dementia.
You can also watch for new signs that you may not have seen before.
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What Happens In The Later Stages Of Dementia
- Progressive loss of memoryThis can be a particularly disturbing time for family and carers as the person with dementia may fail to recognise close family members.
- Increased loss of physical abilitiesMost people with dementia gradually lose their ability to walk, wash, dress and feed themselves. Other illnesses such as stroke or arthritis may also affect them. Eventually the person will be confined to a bed or a chair.
- Increased difficulty communicatingA person with dementia will have increasing difficulty in understanding what is said or what is going on around them. They may gradually lose their speech, or repeat a few words or cry out from time to time. But continuing to communicate with them is very important. Remember, although many abilities are lost as dementia progresses, some – such as the sense of touch and ability to respond to emotions – remain.
- Problems eatingIt is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognise the food they are given. Some people become unable to swallow properly. Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period of time and their health is affected, nutrition supplements may be considered for consumption other than by mouth.
How Hospice Can Help With End
In addition to helping you in recognizing the signs of dying in the elderly with dementia, bringing in hospice care will help with the physical and emotional demands of caregiving. Nurses will be able to adjust medication and care plans as the individuals needs change. Aides can help with bathing, grooming, and other personal care. Social workers can help organize resources for the patient and family. Chaplains and bereavement specials can help the family with any emotional or spiritual needs. Additionally, family members can contact hospice at any time, and do not need to wait until it is recommended by the patient’s physician.
To learn more about the criteria for hospice eligibility or to schedule a consultation, please contact Crossroads using the blue Help Center bar on this page for more information on how we can help provide support to individuals with dementia and their families.
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All You Need To Know About End
The former Mayor of Cornelius, Oregon, Ralph Brown, went missing last May 16, 2021, and is still missing. Hes 76 years old, suffering from dementia. The family said he has early-onset Alzheimers symptoms that often lead to confusion and forgetfulness, but they never realized that he was exhibiting symptoms of late-stage dementia.
Do you have a loved one suffering from the same disease?
If you do, then you might have several questions. How can you avoid these unfortunate events? When is the right time to get assistance for your loved ones? Learn more about the final stages of dementia and when its the right time to call for professional help and hospice care.
Signs A Loved One With Advanced Dementia Is Nearing The End Of Life
A person in the final stage of dementia requires constant care and supervision from a caregiver. Toward the end, the brain appears to lose more and more control over the body and the organs begin to shut down. End-of-life signs are typically the same for those with and without dementia:
- Loss of mobility
- Increased sleep or loss of consciousness
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Final Signs And What To Do
If it has been established that the person is now dying and they become restless, this is often referred to as terminal restlessness. It is important to recognise restlessness and report it to a doctor or nurse immediately. Restlessness could be due to pain or high temperature and needs to be relieved.
If you notice the person is restless and you think they are uncomfortable, you could try helping them move into a more comfortable position. If this does not help, seek advice as they may need pain relief. Likewise, if you notice the person is hot to touch then they may need to be cooled down by a fan or cool flannel on their forehead and given rectal paracetamol by the nurse. They may also need medication to relieve the restlessness if the above does not help.
As death approaches the persons breathing pattern can change. This is caused by the person going into unconsciousness. It is often called Cheyne-Stoke breathing. The person may have periods where they have regular breathing, then stop breathing for a few seconds. Breathing usually gets faster and there can be long gaps in between. The person who is dying is unaware of this but family members may find this quite distressing. It is important that you or another senior member of staff explain to the relatives that this is what is to be expected and that the person is unaware. It is natural.