The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Life Expectancy And Alzheimers Disease
Alzheimer’s disease is the most common cause of dementia. Abnormal proteins cause steadily increasing brain damage. This initially affects thought and memory and remember and progressively causes failure of all body systems.
Alzheimers is typically diagnosed at the mild dementia stage when memory and planning problems start to affect daily life. The life expectancy for an individual with Alzheimer’s is usually between 8-12 years from diagnosis however, someone fit and healthy on diagnosis could live considerably longer. In one American study, people lived from between one and twenty-six years after first spotting symptoms, so the variation is enormous.
How Might Dementia Affect People Towards The End Of Life
Dementia is progressive, which means it gets worse over time. In the last year of life, its likely to have a big impact on the persons abilities including memory, communication and everyday activities. The speed at which someone will get worse will depend on the type of dementia they have and who they are as an individual.
The symptoms of later stage dementia include the following:
A person with later stage dementia often deteriorates slowly over many months. They gradually become more frail, and will need more help with everyday activities such as eating, dressing, washing and using the toilet. People may experience weight loss, as swallowing and chewing become more difficult.
A person with later-stage dementia may also have symptoms that suggest they are close to death, but continue to live with these symptoms for many months. This can make it difficult for the person and their family to plan for the end of life. It also makes it difficult for those supporting them professionally.
For more information on supporting someone with later stage dementia see Alzheimers Society factsheet, The later stages of dementia .
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Do You Die From Dementia
The forgetfulness, confusion and communication problems of dementia are caused by increasing damage to cells in the brain. But the brain doesn’t just control memory and thought it is also the control centre for the body. Progressive brain cell death will eventually cause the digestive system, lungs, and heart to fail, meaning that dementia is a terminal condition. Studies suggest that, on average, someone will live around ten years following a dementia diagnosis. However, this can vary significantly between individuals, some people living for more than twenty years, so it’s important to try not to focus on the figures and to make the very most of the time left.
Average Dementia Survival: 45 Years
Study of Dementia Patients Shows Women Live Slightly Longer Than Men
Jan. 10, 2008 — The average survival time for people diagnosed with dementia is about four and a half years, new research shows. Those diagnosed before age 70 typically live for a decade or longer.
In an effort to learn more about survival characteristics among patients with Alzheimer’s disease or other dementias, researchers from the U.K.’s University of Cambridge followed 13,000 people who were aged 65 and older for 14 years.
During the follow-up, 438 of the study participants developed dementia and 356 of these people died.
Overall, women lived slightly longer than men after a diagnosis of dementia — around 4.6 years vs. 4.1 years. And frailer patients died sooner than healthier ones.
But being married, living at home, and even degree of mental decline were not found to have a big impact on survival.
The research is published in the Jan. 11 issue of the journal BMJ Online First.
“When we took everything into account, the big predictors of how long people survive remain sex, age, and functional ability,” University of Cambridge professor of epidemiology Carol Brayne tells WebMD. “Functional ability was a much better marker of how close someone was to death than cognitive decline.”
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How Long Can An 80 Year Old Live With Dementia
Progressive brain cell death will eventually cause the digestive system, lungs, and heart to fail, meaning that dementia is a terminal condition. Studies suggest that, on average, someone will live around ten years following a dementia diagnosis.
What Are The Main Types Of Dementia
Alzheimers disease is the most common cause of dementia, accounting for around 2 out of every 3 of cases in older people. Vascular dementia is another common form, while dementia with Lewy bodies and frontotemporal dementia are less common.
It is possible to have more than one type of dementia at the same time. Alzheimers is sometimes seen with vascular dementia or dementia with Lewy bodies. You might hear this called mixed dementia.
The symptoms of dementia vary depending on the disease, or diseases, causing it. You can read more about the symptoms associated with different types of dementia on the Alzheimers Society website .
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Support For People With Dementia And Carers
UCL covid-19 decision aid – a tool to support carers of people living with dementia to make difficult decisions during covid-19
Alzheimers Society end of life care information for patients and families
Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia
Alzheimer Scotland specialist services for patients and carers
Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses
How Can Healthcare Professionals Help At This Stage
Healthcare professionals can explain these changes so you understand what is happening.
Healthcare professionals can also take steps to reduce the persons pain or distress, often using medication.
If the person cant swallow, then medication can be provided through patches on the skin, small injections or syringe pumps that provide a steady flow of medication through a small needle under the persons skin. Speak to a GP or another health professional about this.
Talking Point
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Check Their Advance Care Plan
You should find out if the person has an advance care plan. This document may record their preferences about the care theyd like to receive, including what they want to happen, what they dont want to happen and who they want to speak on their behalf. It may include an advance statement or an advance decision. We have information on planning ahead for patients and their families, which you might find useful.
Life Expectancy And Dementia With Lewy Bodies
Dementia with Lewy bodies accounts for around 7% of cases of dementia. Lewy bodies are tiny protein deposits that affect thought, memory and movement and are linked to both dementia and Parkinsons disease.
Hallucinations, sleep disturbance, and movement problems can be an early feature in dementia with Lewy bodies, so that diagnosis may be made at an earlier stage. Some research suggests that survival can be significantly shorter with this challenging condition, however, the Alzheimer’s Society says:
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How Can I Support Someone With Dementia Towards The End Of Life
Knowing the person will make it easier to provide person-centred care that is focused on what they need and want. It can help to know about their likes, dislikes and their wishes for how they want to be cared for. If the person isnt able to tell you about themselves, speak to their family, friends or other people who know them well.
Its a good idea to find out if the person has a copy of This is me , a document that records information about themselves. If you cant speak to the person, ask those close to them if they have a copy. They may have these details recorded in their care plan.
There are many ways to support someone with dementia at the end of life.
Do Treatments Add Time To Life Expectancy
Experts simply dont know whether treatments help a person live longer with Alzheimers disease. AD and other similar dementias progress no matter what. Treatments like medications and therapies have been conclusively shown to help manage symptoms, meaning they make it easier to live with the disease, but they do not reverse symptoms. The memory of a person with dementia who takes medications like cholinesterase inhibitors, for example, will be slightly better than the memory of someone who is not on medication. Quality of life therefore improves with treatment. This means better years with dementia, but probably not more years.
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End Of Life Dementia Care And Covid
Older adults and people with serious underlying medical conditions are at higher risk for severe illness from COVID-19. Older adults also have the highest rates of dementia. Given the risks that older adults face from both COVID-19 and dementia, its important to understand how to protect yourself and your loved one. Find more information about dementia and COVID-19 from the CDC.
When a dementia like Alzheimers disease is first diagnosed, if everyone understands that there is no cure, then plans for the end of life can be made before thinking and speaking abilities fail and the person with Alzheimers can no longer legally complete documents like advance directives.
End-of-life care decisions are more complicated for caregivers if the dying person has not expressed the kind of care he or she would prefer. Someone newly diagnosed with Alzheimers disease might not be able to imagine the later stages of the disease.
Caring For Someone With Dementia Towards The End Of Life
Please be aware – this information is for healthcare professionals. We also have information for the public.
You can use our My Learning form to reflect on how this page has helped with your continuing professional development.
People with dementia may experience problems with thinking, memory, behaviour and mobility. It can be difficult to recognise when someone with dementia is nearing the end of their life. You can support the person by communicating with them and helping them with any symptoms they have. If possible, its a good idea to plan the persons care in advance to help understand what they want from their care.
On this page:
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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.
Outlook For Vascular Dementia
Vascular dementia will usually get worse over time. This can happen in sudden steps, with periods in between where the symptoms do not change much, but it’s difficult to predict when this will happen.
Home-based help will usually be needed, and some people will eventually need care in a nursing home.
Although treatment can help, vascular dementia can significantly shorten life expectancy.
But this is highly variable, and many people live for several years with the condition, or die from some other cause.
If you or a loved one has been diagnosed with dementia, remember that you’re not alone. The NHS and social services, as well as voluntary organisations, can provide advice and support for you and your family.
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Understanding Lewy Body Dementia
Lewy body dementia symptoms are so similar to those of other forms of dementia that LBD can be misdiagnosed. This might make more sense when you consider that there are many types of dementia.
It may help to think of dementia as one large “umbrella” that slowly robs people of their ability to think, talk, remember, and use their bodies. Many diseases crowd underneath this umbrella, including:
- Alzheimers disease
- Struggle with incontinence
With dementia with Lewy bodies, cognitive changes may appear earlier than, about the same time, or shortly after any physical changes surface.
How Many Stages Of Dementia Are There
There are several different types of Dementia, with Alzheimers disease being the most common. Though when it comes to the different stages of Dementia, we can typically categorise the trajectory of the disease as mild, moderate or severe.
Although this three stage model is useful for providing an overview of early, middle and final stages of Dementia, most people prefer a seven stage model that breaks cognitive decline down into seven specific categories. The progression of Dementia will be different for everyone, but knowing where a loved one falls on this scale can help to identify signs and symptoms, whilst also determining the most appropriate care needs. So, what are the 7 stages of Dementia?
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Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
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.
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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.
How Much Time Can Treatment Add
Treatment will not prevent the progression of AD. It is also unclear if treatment can add time to a persons life. Ultimately, AD will progress and take its toll on the brain and body. As it progresses, symptoms and side effects will get worse.
However, a few medications may be able to slow the progression of AD at least for a short time. Treatment can also improve your quality of life and help treat symptoms. Talk with your doctor about your treatment options.
study identified several factors that affect a persons life expectancy. These include:
- Gender: A 2004 study found that men lived an average of 4.2 years after their initial diagnosis. Women were found to live an average of 5.7 years after their diagnosis.
- Severity of symptoms: People with significant motor impairment, such as a history of falls and a tendency to wander or walk away, had shorter life expectancies.
- Brain abnormalities: The study also detected a connection between brain and spinal cord abnormalities and the length of life.
- Other health problems: People with heart disease, a history of heart attack, or diabetes had shorter lifespans than patients without these complicating health factors.
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Sociodemographics And Clinical Characteristics
Age, gender, living alone , and migrant status at the time of dementia diagnosis were derived from the national population registry managed by Statistics Netherlands. Migrant status was categorized into non-Western migration background and Western background .
The use of care at home at any point during 2008 to 2014 was derived from a national registry from the Dutch Central Administration Office made available for research by Statistics Netherlands. From 2011, use of day care was also recorded.
Polypharmacy was defined as the dispensing of 5 or more drugs and hyperpolypharmacy as the dispensing of 10 or more drugs from different chemical subgroups in the year of dementia diagnosis. Data were derived from a nationwide database from the National Healthcare Institute and made available for research by Statistics Netherlands and contained all medicines dispensed by pharmacies for which the costs are reimbursed under the statutory basic medical insurance. This covers medicines for community-dwelling people and for people living in residential care homes, but not medicines dispensed in hospitals and nursing homes. The database does not include over-the-counter medicines.