There are a few models of staging for dementia, and some of the best care minds think it can’t be fully described and applicable at all, as so many people cross over all the different stages. Each person with the dementia journey reacts differently and other health problems and diseases such as cancer, infection, blood pressure, stroke and heart disease can affect the speed and rate of progress.
Alzheimer’s and other Dementias tend to have a different beginning and rate of deterioration, so these are in general terms rather than a specific guide to the seven stages of dementia model.
There is another model that is more geared around early, moderate and end stage, but for many of us, a more detailed breakdown is helpful.
The seven stages were brought to the press by Dr Barry Reisberg from New York University and is a well-known guide to the stages themselves.
This is my interpretation from my experiences with dementia in the family.
Stage 1 – No Impairment or Decline
At this stage, dementia is not able to be detected and there are no signs of other memory problems or dementia. This doesn’t mean that dementia may be in the very early stages, but is an indicator and where the rest of us would be.
Stage 2 – Very Mild Decline
At this point your loved one of yourself, might notice minor issues with memory, or you might lose things more easily than in the past. The tests from GP’s which ask questions to test memory can usually still be passed with ease, and many times, family and medical staff may not yet have recognised there is an issue. May have enough intelligence to disguise and cover up the early symptoms.
Stage 3 – Mild Decline
With mild decline, some deterioration of memory or confusion may become noticeable to friends and family, but they might put it down to the normal ageing process. With memory tests at a doctor’s surgery, they may or may not be able to function cognitively.
Difficulties in daily life might happen around:
- forgetting appropriate worlds when in conversation
- managing to plan their day
- organising medical appointments and managing their bills and finance
- they may begin to forget new things they have come into contact with, such as new names, addresses, TV programmes
- taking medication may become an issue as the forget if they have already taken it
- lose or give away personal possessions
Stage 4 – Moderate Decline
Decline is more transparent to people around them. Simple tasks may begin to become challenging.
They may struggle with:
- counting money in a shop
- ordering or paying for groceries
- find making phone calls or using a computer difficult
- forget how to use a TV remote
- forget they’ve just eaten or gone to the toilet, or bathed
- forget family members they see rarely and begin to lose more medium term memory, forgetting events
- be very vulnerable to predators on the doorstep or who sent mailings asking for money, or scam phone calls
- wandering may begin
- pacing may begin
Stage 5 – Moderately Severe Decline
Many sufferers will likely remember close family members and friends and some of their long term memories, but also may be struggling with basic life skills.
- previously calm people may become combative and anxious
- depression and increased confusion may occur
- difficulty dressing
- difficulty using a toilet
- difficulty bathing and cleaning
- difficulty remembering important things for life, such as address, telephone number or who to call in an emergency
- some obsessive behaviours may be apparent
Stage 6 – Severe Decline
There is significant difficulties in the life of a person around stage 6. They will need care round the clock and often professional help. Some of the troubles may be dangerous to both the person with dementia and the families trying to care for them.
- confusion over home
- unaware of where they are
- forgetting many people
- forgetting much of their life history
- beginning to lose bowel and bladder control and need assisting for toileting
- lose ability to bathe and dress, requiring full help
- for some, combative or aggressive behaviour and increased obsessions
- dangerous wandering and may try to leave the home, and want to go home to a place further back in their memory.
- full assistance with shopping, bills and money
Stages 7 – Very Severe Decline
At the last stages, people with dementia are moving towards the end stage and death.
- be unable to make their wishes known by gesture or voice
- speak few words or have mixed up words.
- may know what they are trying to say, but cannot get the words out
- be unable to say what they need, ie soiled themselves and need changed, tell us about pain, say if they are hungry or thirsty
- not know where they are
- need full control taken of all bodily functions and ability. Will need given food and drink which will need to be thickened as swallowing becomes more difficult.
- be unable to walk, and become unable to roll side to side or move arms and legs without help
- at the end they may lose the ability to swallow fully