Unfortunately, most types of dementia are irreversible and progressive.
As the dementia symptoms worsen, the patient’s memory loss gets worse. The patient finds it increasingly difficult to perform the activities of daily living (often abbreviated as ADL) required every day, such as bathing, dressing, cooking, eating, taking our medicines, managing our money, shopping. Caregivers have to help patients more. As confusion progresses, the patient begin wandering and get lost. Agitated, aggressive patients may hurt themselves and people around them. Or, patients neglect themselves, such as forgetting to wear warm clothes during winter, or forgetting to eat their meals. Finally, patients become bed-ridden and totally dependent, unable to speak or respond.
Patients need more support in later stages of dementia. Understanding which stage the patient is in, helps caregivers plan better for the care they need to give.
A simple classification of dementia is a three-stage classification:
Early stage dementia.
Impairment is mild in this stage, but some support is needed.
- Patients are confused about the date
- They have problem with names of people and things
- They are not able to remember recent events, such as whether they have had lunch
- When asked to copy a simple picture, they find it difficult and are not able to do it
- They are less able to analyze things
- They may withdraw socially
- They seem irritable and have mood swings
- They have problems managing money
Early dementia symptoms are often difficult to notice, because patients cover them up, and are apparently normal
Mid stage dementia.
The patients are visibly confused by now, and often get frustrated and agitated. Caregivers have to pay more attention to the patient, and also cope with behavior challenges.
- Patients are confused about where they are, and may get lost in familiar places
- They are not able to understand things
- They are unable to learn new things, such as operate a new device or learn a new subject
- They are no longer able to do arithmetic or count
- Cooking, shopping, banking become problems, and they cannot handle these themselves
- They are prone to delusions, agitation, and aggression
- At times, they seem restless, anxious, or depressed
- They find it difficult to wear their clothes, brush their teeth, comb, and have their bath. They may need help for most of these.
Late stage dementia
By this time, patients are dependent for all their activities, and become increasing helpless and uncommunicative.
- Their speech becomes very difficult to understand. They may even stop speaking
- The memory is severely impaired
- They can no longer write or draw
- They can no longer perform their daily tasks
- They are not able to control their bladder and bowel movements
- Towards the end, they become bed-ridden
It is clear from the above that, broadly speaking, caregivers will have to increase their effort as the dementia progresses. Dementia stretches over years, and caregiving for a dementia patient is a long journey.
While some people deteriorate faster than others, an indicative timeline is that early stage dementia lasts for the first one or two years, mid stage dementia lasts for another two or three years, and after five years or so, the patient is in late stage dementia.
Each patient is unique. Patients differ from others in terms of which activity they face more difficulty in. Care, therefore, has to be tuned to individual patients. Different abilities deteriorate at different rates, depending on which parts of the brain are more impacted by the disease that is causing the dementia.
An understanding of the overall progression is also available as a seven stage model, described at the Alzheimer’s Association site. The seven stages are:
- Stage 1: No impairment
- Stage 2: Very mild decline
- Stage 3: Mild decline
- Stage 4: Moderate decline (mild or early stage)
- Stage 5: Moderately severe decline (moderate or mid-stage)
- Stage 6: Severe decline (moderately severe or mid-stage)
- Stage 7: Very severe decline (severe or late stage)
The decline of people with dementia can also be understood using the Functional Assessment Staging (FAST) scale, developed by Barry Reisberg and his colleagues at New York University Medical Center’s Aging and Dementia Research Center. The FAST scale has 16 stages and sub-stages. Read more about the stages in these articles: The Stages of Alzheimer’s (Eldercare Online) and FAST Scale Administration (UT Health Center) .
