Stages of Dementia
Dementia can be divided into seven stages which are similar
to those in Alzheimers
disease. The seven stages of dementia include:
I. No impairment of normal function: No signs of memory
loss are visible to a medical professional nor does the patient experience
II. Very mild cognitive decline: People may experience
some loss of memory such as forgetting familiar words, names, or location
of their wristwatch, eyeglasses or any similar objects of daily use. Family,
friends or colleagues may observe these signs.
III. Mild cognitive decline: Early stage dementia can
be diagnosed only in some individuals with the following symptoms:
The patient has trouble remembering words or names.
The patient loses the ability to remember names of individuals
newly introduced to him or her.
Difference in performance can be easily noticeable in
work environment, social environment by family, friends or colleagues.
Less retention from articles or stories read in a magazine
The patient misplaces or loses valuable objects.
Decreased ability to plan or organize.
cognitive decline: This is a mild or early stage of dementia
with the following symptoms being observed:
# The patient fails to recollect recent incidents or current
# The patient cannot perform some challenging mental arithmetic
such as counting backwards from 100 by 7s.
# The patient is not able to plan or organize complex tasks
such as arranging a party, planning a picnic, etc.
# The patient would remain socially withdrawn and silent in
V. Moderately severe cognitive decline: Moderate or
mid-stage dementia stage involves major gaps in memory and deficits in
cognitive function. Assistance with daily activities may be required and
the following symptoms are observed:
The patient fails to recall their home address, telephone
number and name of the college or school from which they graduated.
The patient is in a confused
state of mind with regards to their current
location, date, day of the week, season etc.,
The patient fails to perform even lesser challenging
mental arithmetic such as counting backwards from 40 by 5s.
The patient requires help in
choosing the appropriate clothing for a
particular season or occasion.
Generally, the patient retains
substantial knowledge and can tell his/her own
name, names of their spouse or children.
The patient does NOT require any assistance for eating
or using toilet.
VI. Severe cognitive decline: This is the next to the
last stage and is also called moderately severe or mid-stage dementia
and includes memory difficulties continuing to worsen, personality changes
emerging substantially, and the patient requiring a considerable amount
of help for carrying out their day-to-day activities. The following symptoms
are observed in patients with this stage of dementia:
The patient loses track of some
of the most recent experiences, events and even
their surroundings. The patient cannot recall
personal history exactly, though she/he can
recall her/his name perfectly. The patient can
distinguish familiar faces from unfamiliar faces.
The patient requires help to
dress appropriately, since they tend to create
errors such as wearing shoes on the wrong feet
The patient experiences a
disturbance in normal sleep/waking cycle.
The patient would require the
help for handling details of toileting such as
flushing toilet, wiping and proper disposal of
There are increasing episodes of
urinary or fecal incontinence.
Changes in behavior including
suspicion and delusions such as suspecting the
care giver as an impostor, hallucinations,
repetitive behavior such as hand wringing etc.,
The patient tends to wander and
VII. Very severe cognitive decline: This is the last
stage of dementia and is called Severe or late-stage dementia and includes
symptoms such as: the patient losing the ability to respond to the environment,
unable to communicate orally, and unable to control movements.
Often, patients in this stage lose the ability to communicate
in a recognizable speech though they utter phrases occasionally.
Patients need assistance in eating and toileting with
general incontinence of urine being common. (9)
Patients gradually lose the ability to walk without support, to sit,
to smile and hold their head up. Muscles become rigid and reflexes abnormal
with swallowing becoming impaired. (9)
Article by Kona Vishnu, MS
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