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What Are The Stages For Dementia

What Are The Types Of Vascular Dementia

What are the different stages of dementia? The 3 stage and 7 stage models explained

We know that vascular dementia occurs as a result of issues with blood flow to the brain. But why are there issues with the blood flow in the first place?

There are a few reasons why a person may have damage to their blood vessels, which results in reduced or blocked blood flow to the brain. These reasons are considered the types of vascular dementia.

The most common types of vascular dementia are:

  • Stroke-related dementia: Occurs after a stroke when blood supply to the brain is blocked due to a blood clot
  • Multi-infarct dementia: Occurs after a series of mini-strokes, or transient ischaemic attacks
  • Mixed dementia: Occurs when the person has symptoms of vascular dementia and Alzheimers disease

Vascular dementia can appear differently for each person because of the area of the brain affected.

For example, some people may exhibit more forgetfulness, but still live a relatively independent life, while others may experience significant confusion or issues with balance.

Vascular dementia also will progress differently for each individual. The progression often is broken down into certain defined stages of dementia, which many people use as a guideline for their loved ones care needs.

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.

Stage : Very Severe Cognitive Declinesevere Dementia

At this stage, AD persons require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half-dozen intelligible words or fewer . As this stage progresses, speech becomes even more limited to, at most, a single intelligible word . Once intelligible speech is lost, the ability to ambulate independently , is invariably lost. However, ambulatory ability may be compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.

In persons with AD who remain alive, stage 7c lasts approximately 1 year, after which persons with AD lose the ability not only to ambulate independently but also to sit up independently , At this point in the evolution, the person will fall over when seated unless there are armrests to assist in sitting up in the chair.

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Some Links On Progression Of Various Types Of Dementia Diseases

Alzheimers Disease progression is sometimes described as a seven stage model. While most organizations have shifted over to a three-stage model of mild, moderate and severe, the older seven stage model is given below for reference.

  • Stage 1: No impairment.
  • Stage 2: Very mild decline.
  • Stage 3: Mild decline.
  • Stage 4: Moderate decline .
  • Stage 5: Moderately severe decline .
  • Stage 6: Severe decline .
  • Stage 7: Very severe decline .

The decline can also be understood using the Functional Assessment Staging scale. FAST was developed by Barry Reisberg and his colleagues at New York University Medical Centers Aging and Dementia Research Center. It has 16 stages and sub-stages.

A relatively recent model of staging for Alzheimers Disease, proposed in 2011 but not yet in use is based on how the brain changes due to Alzheimers Disease. This is sometimes called the the spectrum of disease model. Here,

This proposed Stage 1 to Stage 3 model is not used for doctors to diagnose dementia in India. It is not relevant for caregivers to manage the situation and support the person. All diagnosed dementia persons are at Stage 3 of this proposed model, and the typical mild, moderate, and severe dementia are all subcategories within stage 3 of this proposed model. The above description of the proposed model is only to provide clarity in case caregivers get confused by newspaper reports or websites.

Stage : Mild Dementia


At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:

  • Difficulty remembering things about one’s personal history
  • Difficulty recognizing faces and people

In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.

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What Are Specific Care Needs At Each Stage

An individual may not require care assistance after the initial diagnosis of dementia, but that will change as the disease progresses and symptoms become worse. There are about 16 million unpaid caregivers of people with dementia in the United States. While many caregivers are providing daily help for family members, they also hire someone to help. There are many options of care assistance, such as in-home care, adult day care, and nursing home care. There is also financial assistance available.

Early Stage DementiaAs mentioned above, in the early stage of dementia a person can function rather independently and requires little care assistance. Simple reminders of appointments and names of people may be needed. Caregivers can also assist with coping strategies to help loved ones remain as independent as possible, such as writing out a daily to-do list and a schedule for taking medications. Safety should always be considered, and if any tasks cannot be performed safely alone, supervision and assistance should be provided. During this period of dementia, its a good idea for caregivers and loved ones to discuss the future. For example, a long-term care plan should be made and financial and legal matters put in place.

Stage : Fulltime Care

Eventually people who are experiencing dementia become so unable to choose their own activities or make sense of the world around them that they need to have someone present at all times in order to feel comfortable. To me, this is the greatest heartbreak of memory care facilities, because their residents are left alone for hours at a time. Even people who have anosognosia will eventually welcome the full-time presence of other people.

At DAWN, we know it is time for full-time care when we arrive and find someone whos only been alone for minutes wandering from room to room, unable to relax they have lost the ability to know what they want to do. These people will say, I just dont know what Im supposed to be doing when you arrive, and Do you have to go? when you get ready to leave. This will happen long before they become bedridden or unable to communicate.

At this last stage of dementia, we make sure that someone is always present. We are careful to continue the same schedule of daily activities so they continue to receive enough sensory and social stimulation to avoid sundowning or wandering. We maintain the same evening and bedtime routines so the sleeping habits weve helped them develop can be maintained for as long as possible.

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Stage : Follow The Leader

We know someone has moved into this next stage when they start saying to us, Oh, Ill just have whatever youre having or It doesnt matter to meyou decide. Its not that theyve become more easygoing: they simply are no longer able to make decisions without assistance. They cannot track time, read clocks, or interpret calendars consistently. Their desire for independence has melted away unless anosognosia is still fully present.

At this point, we again know its time to increase our support. We watch to see whether they are losing weight due to failure to recognize food and packaging, whether they are bathing or have forgotten the purpose of soap, whether they still retain some idea of cleanliness in the home, and whether they have begun to perceive dreamed events as real. Now we expect their judgment to be consistently impaired, and watch for misinterpreted realities that could become dangerous. Their daily activities with us are gradually lengthened to include meals, cleaning, and household choresand maybe visits to our local wellness center for a supervised shower and soak in the hot tub.

What To Expect In Late

Alzheimer’s Disease (Dementia) Nursing: Symptoms, Treatment, Stages, Pathophysiology NCLEX

In the later stages of dementia, your loved one will require significant support with their activities of daily living , including assistance with eating, dressing, and using the bathroom.

The final stage of dementia is usually the shortest stage, lasting around one to two years.

The goal in the final stages of vascular dementia is maintaining comfort, routine, and indulging the senses.

Learning how to communicate and interpret your loved ones needs is essential, as they may turn mainly to nonverbal communication.

At any stage of dementia, its important to focus on what the person is still able to do, rather than the abilities they have lost.

Developing a routine will help your loved one feel more comfortable. Surround them with their favorite hobbies and items, including old photographs, and beloved movies, games, and music.

The Kensington White Plains uses cognitive-stimulating programs, music therapy, pet therapy, robo-pets, and pocket programming as some of our enhanced care programs designed to foster connection and decrease anxiety.

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How Is Vascular Dementia Diagnosed

Diagnosing dementia involves a series of tests and exams to rule out other causes, such as a medication side effect or vitamin deficiency, and zero in on the type of dementia based on medical history.

Your doctor will likely perform a neurological exam, lab work, and a brain scan to officially make their diagnosis.

Importance Of Advance Care Planning For People With Dementia And Their Caregivers

Someone newly diagnosed with dementia might not be able to imagine the later stages of the disease. But when a person is first diagnosed with Alzheimers or another dementia, its important to make plans for the end of life before the person with the disease can no longer complete advance directives and other important legal documents. End-of-life care decisions are more complicated for caregivers if the dying person has not expressed the kind of care they would prefer.

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What To Expect In Middle

In the middle stages of dementia, you can expect your loved ones symptoms to advance.

They may begin to experience changes in their behavior and develop increasing confusion and communication issues.

Symptoms of depression and anxiety may appear as your loved one grapples with moderate cognitive decline, loss of independence, and frustration with communication.

Your loved one will require an increasing level of care, emotional support, and compassion as they experience these changes.

It may be wise in the middle stage to bring on additional in-home care or make the move to an assisted living community with memory care.

The Kensington White Plains offers two memory care communities designed to meet your loved ones exact level of care.

We offer a robust life enrichment program and numerous onsite services to help residents maintain their highest quality of life through social, physical, and wellness activities.

What Are The Causes Of Vascular Dementia

stages of dementia chart

Vascular dementia most often occurs as a result of conditions that disrupt blood flow to the brain.

These conditions include:

  • Bleeding due to a ruptured blood vessel
  • Damaged blood vessels due to high blood pressure, heart disease, infections, autoimmune disorders, diabetes, or atherosclerosis

Not all of these conditions will result in vascular dementia. However, its important to watch for the symptoms of vascular dementia following a stroke or any incident where blood flow to the brain is impaired.

Sometimes, symptoms of vascular dementia appear suddenly after a stroke or surgery. Other times, it may occur after several mini-strokes or develop gradually like Alzheimers disease.

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Understanding How To Care For A Loved One With Dementia

Coming to accept a loved ones dementia diagnosis and understanding what to expect can help you feel empowered and provide opportunities to make the most of this time together. Remember that caregivers have a variety of ways to provide support to a loved one through the progression of dementia.

If the idea of navigating a dementia diagnosis alone seems overwhelming, A Place for Mom is here for you. Explore our library of caregiver resources, which contains hundreds of articles covering dementia therapies and memory care communities.

Exploring Memory Care Options

Memory care is specialized support for seniors with dementia. It includes 24-hour supervision to prevent wandering, assist with ADLs, provide meal services, and administer health care as needed. Memory care can be beneficial from the early stages of dementia through the end of life. Specially designed memory care activities, dining plans, and exercise programs address all types of dementia symptoms in elderly loved ones.

Understanding when to seek memory care will vary depending on a seniors dementia symptoms, health status, living situation, and more. Our Senior Living Advisors offer free guidance and are ready to discuss local memory care and dementia home care options with your family.

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How Quickly Does Vascular Dementia Progress

The speed of progression for any type of dementia, including vascular, varies from person to person.

Some seniors with vascular dementia may be able to live with a family member or in-home care for several years before requiring additional care.

Eventually, those with vascular dementia may require a high level of care in an assisted living or memory care community, such as the specialized, loving memory care provided at The Kensington White Plains.

To help you prepare for your loved ones care, well share the general expectations for each stage of vascular dementia, including how long the stage may last and how your loved ones symptoms may progress.

Generally, in the early stages of vascular dementia, your loved one will progress from having no symptoms to mild forgetfulness and decline.

In the middle stages of dementia, your loved one may advance to more significant symptoms and require more daily assistance.

In the late stages, your loved one may require around-the-clock care and assistance as the disease progresses and they experience severe cognitive decline.

Lets take a look at each stage.

Foods That Fight Dementia

Moderate Dementia Stage Changes
  • Leafy greens: Darker greens, such as spinach, kale, and romaine, are rich in antioxidants and vitamin K, both of which are beneficial to the brain. They are best eaten raw for maximum nutritional value.
  • Cruciferous vegetables: Broccoli, cauliflower, and Brussel sprouts are high in vitamin K and glucosinolates, both of which have antioxidant properties and fight oxidative stress.
  • Grapes: Grapes help promote cognitive function by increasing blood and oxygen supply to the brain. Raisins, or dried grapes, are also high in boron, which is a trace element that improves memory, attention, and hand-eye coordination.
  • Blackcurrants: Blackcurrants are high in anthocyanin, an antioxidant that works similar to medications used to treat mood disorders. According to cognitive tests, blackcurrant drinks can improve attention and mood and reduce mental fatigue.
  • Berries: All berries are beneficial to brain health, but blueberries are especially beneficial to the brain because they contain flavonoids, which stimulate brain pathways linked to slower cellular aging. Acai and strawberries have similar effects.
  • Beans: Beans, lentils, and chickpeas contain a combination of antioxidants, fiber, vitamins, and minerals that support brain and overall health.
  • Olive oil: When it comes to foods that help fight dementia, healthy fats are critical. Olive oil is a great cooking oil and salad dressing base, as it is high in brain-healthy nutrients like monounsaturated fats, vitamin E, and antioxidants.
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    How To Support A Loved One Experiencing Dementia Symptoms

    As your loved ones dementia worsens, it can become increasingly difficult for family caregivers to keep up with the levels of care your loved one needs.

    Creating a care plan soon after your loved ones diagnosis is the best way to address their care needs over time.

    Finding a loving community should be a part of your care plan, to ensure your loved one has a place to receive the type of advanced, loving care they need.

    The Kensington was proud to partner with Jennie Clark of Stanfords Aging Adult Services at Stanford Health Care for this virtual presentation. During this open and honest discussion, Jennie guides you through common questions that caregivers have when caring for their loved ones with dementia.

    Common Symptoms Of Vascular Dementia

    Similarly to other forms of dementia, the symptoms of vascular dementia can vary depending on which area of the brain was affected.

    Vascular dementia symptoms may be similar to other types of dementia, including Alzheimers disease. Alzheimers disease and vascular dementia also can occur at the same time.

    The main difference in the symptoms between vascular dementia and other types of dementia most often involves problem-solving and thinking skills.

    The most common symptoms of vascular dementia are:

    • Issues with balance and movement

    Symptoms may start out mild, and gradually worsen over time.

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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.


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