Change Comes With Every Season (Stages of Dementia)

By. Dr. Sharafsaleh


In this post, I will review the stages of dementia. If you have not read my blog posts in this series, please consider doing so.


At this time, we do not have a cure for dementia. All dementias progress, and eventually, the disease can lead to a person's death. The treatments that we have can help slow down the progression of the disease, but they are not a cure. The hardest part of my job is informing patients and their loved ones that they have dementia, their condition will progress and is terminal.

After a comprehensive history and evaluation, either over one or more sessions in my memory clinic, I generally provide a diagnosis, treatment options, support, and education to patients and their loved ones. I discuss how their disease will progress, changes to expect, and how to address those changes either with behavioral modifications or with medications.

Explaining the stages of dementia is often helpful to better understand the disease process and help those with the disease.

Stages of Dementia

Dementia progresses from mild to moderate to severe disease. To break the stages of dementia down even more, I use the Functional Assessment Staging Test (FAST) by Dr. Reisberg.

The FAST breaks dementia down into seven stages; stages 1 and 2 are normal cognition and no sign of dementia. Stage 3 is classified as Mild Cognitive Impairment, which is not dementia but classified primarily as memory problems with the ability to complete day-to-day tasks. (Consider reading the blog post on different types of dementia to learn more).

Mild Dementia (FAST 4)

A person with mild dementia can manage their basic personal day-to-day needs, called activities of daily living (ADL's). ADLs include; eating, transferring, toileting, bathing, and dressing. Persons with mild dementia start having difficulty processing more complex tasks such as shopping, driving, managing finances, cooking, cleaning, called instrumental activities of daily living (IADL's).


Generally, a person who has mild dementia recognizes that there is something wrong; they may feel defensive and try to hide their disease. A person with mild dementia may process information around the mental age of 8-12; they will still have some safety awareness but loved ones need to monitor closely to ensure the person is safe.

At this stage, a person with dementia may need a driving evaluation if they insist on driving. Consider reading the blog post on driving and aging, which discusses dementia and driving.

Moderate Dementia (Fast 5)


As dementia progresses into the moderate stage, individuals affected start having difficulty managing more IADLs. They may need help selecting their clothing. They may start having problems preparing meals, forgetting to take baths, and not paying attention to other personal care needs. A person with moderate dementia is generally no longer safe to stay by themselves and needs continuous supervision. Safety awareness is likely poor by this stage. Individuals with mild dementia may process information at the mental age of 5-7.

Individuals with moderate dementia may have more difficulty comprehending instruction. They may get distracted more easily. They may become more frustrated because of difficulty finding their words. Consider reading the blog post on communication strategies for patients with dementia.

Patients with moderate dementia can start to develop behavioral problems such as anger, agitation, physical or verbal abuse of family members, wandering.

Moderately Severe Dementia (FAST 6)

Patients with moderately severe dementia start needing help with basic daily needs such as putting on clothes, toileting, transferring, bathing. They may begin to experience urinary and bowel incontinence. Patients with moderately severe dementia may be processing information at the mental age of 2-5. These individuals can no longer be left alone. They need constant supervision. This is when patients start to need placement in a facility.

Severe Dementia (FAST 7)

Persons with severe dementia may no longer smile, speak, walk. They have difficulty holding themselves up in a chair, difficulty swallowing and may stop eating. In the later stages of severe dementia, patients are eligible for palliative care and hospice services due to their dementia diagnosis. Generally, patients with severe dementia are processing information at the mental age of 1-2.

Due to the progression of the disease, patients with severe dementia are at risk for dehydration, malnutrition, developing pneumonia, pressure ulcers, and infections. When there is no function to preserve, a person with severe dementia will continue to decline and eventually die because of dementia.

Conclusion

Every individual goes through the stages of dementia differently. The disease course can vary from just a few years to over a decade, depending on overall health, other disease histories, type of dementia, and likely other factors such as environmental. Providing education and support are crucial elements to supporting persons with dementia and their loved ones.

Speak to your health care provider for more information. The Alzheimer's Association, Centers for Disease Control, and the National Institutes of Health have resources available. You can also ask your provider to refer you or your loved one to a memory clinic.


I hope you found this blog post to be helpful. Please consider reading other blog posts on aging related topics on GeriAcademy.



References

Reisberg, B., Jamil, I. A., Khan, S., Monteiro, I., Torossian, C., Ferris, S., ... & Wegiel, J. (2011). Staging dementia. Principles and practice of geriatric psychiatry, 3, 162-169.


Sclan, S. G., & Reisberg, B. (1992). Functional assessment staging (FAST) in Alzheimer's disease: reliability, validity, and ordinality. International psychogeriatrics, 4(3), 55-69.