Dementia Stages and Types: A Detailed Overview

19 Jun 2021 Blog General

Dementia Stages and Types: A Detailed Overview

Close up hands of helping hands elderly home care. Mother and daughter. Mental health and elderly care concept

Many people are unaware or uninformed about the different stages and types of dementia. The number of different types may surprise you. This is because dementia is an umbrella term that describes different types of cognitive decline. Alzheimer’s disease is the most common and best known.

Read further to learn more about the topic – Dementia Stages and Types: A Detailed Overview.

Dementia progresses through these three different stages.

These three stages are categorized by the symptoms the person with dementia experiences. They are used to better understand the severity of the current disease state and what to expect as time goes on and symptoms progress.

Early (mild) stage

It starts naturally in the early (mild) stage. The sufferer may only now realize that something is wrong. Furthermore, they may try to hide their symptoms from others. The actual symptoms can vary greatly depending on which area of the brain is affected. For example it may include memory loss, behavior changes, or both. Some common examples are things like forgetting names, misplacing keys, or driving to work on a Saturday.

Intermediate (moderate) stage.

The next stage would be the middle (moderate) stage. This is the stage where people close to the person usually begin to notice the changes. Examples of common symptoms include unusual frustration, anger, mood swings, conflict with others, uncooperative behaviors, and distrust of others.

Late (severe) stage.

In the late (severe) stage, extensive damage to the brain occurs. The person becomes solely dependent on others for all activities of daily living (ADL). Specifically, their mobility decreases, they sleep most of the time, furthermore, their ability to speak and find the right words decreases, and their overall health deteriorates, making them extremely vulnerable.


The seven stages of decline

The seven-stage model of dementia breaks down cognitive decline. Most doctors use this model to evaluate dementia. The progression can vary widely, depending on the type of dementia and the person in general. Understanding these stages can help us identify the type of care that will be needed as the disease progresses.

First stage

In this stage, there is no severe memory loss or impairment.

Second stage

The affected person’s memory now declines very slightly. Many people commonly associate these symptoms with the normal aging process.

Third stage

At this point, there is mild cognitive decline. This is often the time when family and friends begin to notice that something is wrong.

Fourth stage

This is the time when there is moderate cognitive decline. At this point, a neurologist may make a diagnosis of dementia. He may ask the patient to solve a simple math problem or ask a question to test his ability to answer correctly. Common questions include asking for the address or the date and time. The person usually cannot figure out what the answers are.

Fifth stage

Symptoms progress to moderately severe cognitive decline. First of all, the person becomes increasingly disoriented and confused. Secondly, the person typically needs help with activities of daily living that he or she could previously do easily on his or her own. This is the time when they may need more attention from others in their home to be properly cared for.

Sixth stage

This is the time when severe cognitive decline undoubtedly occurs. Examples include:

  • Worsening memory loss
  • Difficulty recognizing immediate family members
  • Severe personality changes
  • A tendency to become aggressive
  • Weight loss due to a slowing of food intake. They may have trouble swallowing or dislike the texture of foods they once loved.
  • Lastly, they may get sundowners. This is a term used to describe when symptoms worsen starting around 4 p.m. and last all night. They often become fidgety and confused.

Stage Seven

In this final stage, very severe cognitive decline occurs. Examples include:

  • They have a hard time understanding anything that is going on around them.
  • Sometimes they become nonverbal and when they do speak, it usually doesn’t make much sense
  • It’s no longer possible to walk anymore, they become completely bedridden, which can increase their risk of falling
  • It might be, that they may no longer want to eat and if they do, it is usually only things like pudding, jello, soup or thickened drinks. These are administered to keep them from aspirating and usually need to be fed to them.
  • At this stage, many people want hospice to be involved in their care. They help keep them clean and turn them over every few hours to prevent bedsores. If they are in pain, they give them medication to calm them down.
  • The last of the five main senses they lose is their hearing. For this reason, you can still talk to your loved one and tell them you love them. By lying next to them or holding their hand, you comfort them as they transition to the next level of care.


Different types of dementia

These terms describe the cause and various symptoms associated with each type of the disease.

Alzheimer’s disease

This occurs when brain cells and their connections degenerate and die. This type of dementia is the most common, accounting for 60% to 80% of cases. Symptoms include:

  • Not being able to remember recent conversations
  • Inability to remember the name of a familiar object
  • Not being able to remember that someone has visited them
  • Poor judgment
  • While these symptoms are not uncommon in old age, they become more worrisome when they become much more common.

Alzheimer’s is not reversible…it is degenerative and at this point incurable. No blood test, brain scan or physical exam can definitively diagnose the disease. Because there are so many diseases that can cause similar symptoms, it is difficult to draw that conclusion. Sometimes it is just a guess until an autopsy of the brain after death confirms the diagnosis. Life expectancy after diagnosis is about 8 to 12 years.

Vascular dementia

This occurs when the person has brain damage caused by multiple strokes. The early stages of this disease are slightly similar to Alzheimer’s disease.

Instead of the primary signs of memory loss, the symptoms show up more in the area of planning, decision making and following steps. There is often a general slowing of thinking speed and concentration. There is usually an increase in anxiety, depression and mood swings. Physical symptoms may occur, such as worsening speech, decreasing vision, and increasing weakness of the limbs.

Lewy body dementia (LBD).

This occurs when Lewy bodies, abnormal deposits of a protein called alpha-synuclein, increase in certain areas of the brain. Symptoms can be similar to Alzheimer’s disease, even in the early stages, but there are key differences.

When they are in the early stages, their attention may fluctuate from day to day and even moment to moment. They may have visual hallucinations that they can describe to you in great detail. Parkinson’s type motor skills are also seen in these individuals, such as tremors, slowness and rigidity.

Frontotemporal Dementia (FTD).

Pick’s disease is another term that is commonly used. This is caused by degeneration of the frontal or temporal lobes or both lobes of the brain. One of the symptoms is semantic dementia (SD), which affects the ability to remember names and understand language.

It does not show memory or cognitive symptoms in the early stages. Instead, it shows more behavioral and emotional problems. The person becomes very selfish and apathetic. Overeating may also become a problem. They may behave inappropriately in social places, such as impulsive actions and a lack of manners.

Mixed dementia

This describes a combination of two or more types. Forty-five percent of dementia patients have signs of both Alzheimer’s disease and vascular dementia.

Creutzfeldt-Jakob disease (CJD).

This is an extremely rare cause of dementia. Fewer than one in a million people get diagnosed each year. It occurs when the prion, a natural protein found in the brain, becomes toxic to brain cells.

Symptoms are the same as other types of dementia, but the person has muscle stiffness and twitching. To sum up, it progresses much faster and the person usually dies within a year of diagnosis.

Normal pressure hydrocephalus (NPH).

This is another rare cause of dementia. Only about five percent of dementia patients are diagnosed with this. Usually over the age of 65. It is caused by excessive fluid buildup in the brain’s ventricles, which leads to brain damage. Importantly, symptoms include forgetfulness, difficulty walking, loss of bladder control and memory loss.

Huntington’s disease (HD).

This disease often leads to dementia. It is caused by a defective gene that causes premature death of nerve cells in the brain. Symptoms often include difficulty thinking and reasoning and an inability to learn new things. The impairment often causes swallowing to become more difficult.


Final thoughts and comments

In conclusion is to say, the best approach to dealing with any stage and type of dementia is proper education, communication, engagement, support and loving care. Learn all you can, seek support groups, and make a care plan. Get your loved one’s affairs in order. Seek out a senior advocate and have your loved one establish a power of attorney.

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