As you watch dementia change your parent from the person you’ve known your whole life, you’re probably looking for some sort of consistency or predictability — anything to anticipate their needs.
Learning about the stages of dementia can help you answer some important questions: When might Mom need even more help around the house? How much could Dad’s personality change as his condition progresses? When will I need extra assistance to keep my loved one safe?
Dementia progresses differently for everyone, and each type of dementia takes a unique path. But researchers have devised ways of tracking the stages of Alzheimer’s disease and other conditions to help guide care decisions.
What are the stages of dementia?
There are three basic dementia stages: mild, moderate, and severe. Sometimes, you’ll hear them called early, middle, and late.
- Early-stage dementia: Symptoms are mild and most notably include memory problems, difficulty thinking, and mood changes. It usually lasts about two years.
- Middle-stage dementia: Moderate dementia symptoms, including hallucinations, difficulty speaking, and challenging behaviors, appear during this stage. Usually, it continues for two to four years.
- Late-stage dementia: In the final stage of dementia, patients need full-time care. Physical problems with tasks like eating and walking become most apparent. It typically lasts one or two years.
Health care providers use a more detailed method of tracking Alzheimer’s and other progressive types of dementia. It’s called the Global Deterioration Scale (GDS), and it includes seven stages. The first three stages are considered to be pre-dementia. Stages four through seven are when someone has dementia.
Stage 1: No cognitive decline
In the first stage, people don’t have any decline in thinking skills or physical ability. They also don’t appear to have any problems with memory loss.
What it looks like: Your family member continues everyday life as normal. They’re still able to work, do chores around the house, take care of themselves, and participate in favorite activities.
Duration: The first stage lasts as long as a person doesn’t have signs of a decline in brain health.
Stage 2: Very mild cognitive decline
The second stage shows glimpses of cognitive decline, but they’re subtle. In fact, doctors can’t definitely diagnose memory problems at this point. Seniors with these symptoms say they can’t remember names as easily as they did five to 10 years earlier.
What it looks like: Mom could lose familiar items like her keys or occasionally forget the names of people she knows well. Still, she can maintain her job performance and seem normal during social interactions.
Duration: The stage of very mild cognitive decline lasts an average of about 15 years.
Stage 3: Mild cognitive impairment
Stage three is the first time you’ll notice your loved one having trouble with day-to-day life. They’re likely having difficulty concentrating, and there are notable signs of memory loss. This could be an early sign of Alzheimer’s, but it’s important to rule out other possible medical conditions.
About 10% to 20% of people who have mild cognitive impairment after age 65 will go on to develop dementia in a year, according to the National Institutes of Health.
What it looks like: Your loved one may not find the right words while speaking and their job performance could suffer. They might retain little material from reading and start to struggle during social outings. Learning new skills like using a new phone or operating a new tool becomes harder.
Duration: Mild cognitive impairment typically lasts about seven years, but symptoms might not become evident until the last half of the stage.
Stage 4: Mild dementia
In the fourth stage, people have mild dementia and are showing clear signs of a problem. If someone has Alzheimer’s disease, they can be diagnosed with strong certainty by this point. Symptoms of this early stage of dementia include:
- Inability to perform complex tasks
- Difficulty remembering parts of their own life
- Trouble concentrating
- Declining awareness of current or recent events
What it looks like: Dad can probably still drive to familiar places around town and recognize family members, but managing his finances or traveling to new places is becoming difficult. He might be in denial of these changes and withdraw from situations that could expose his symptoms.
Duration: The mild dementia stage is about two years in length for most people.
Stage 5: Moderate dementia
With moderate dementia, a person can no longer live without some help from others. They’re entering the middle stage of dementia, when thinking skills are more severely affected and personality changes appear.
Here are some signs that your loved one’s dementia is getting worse, to the point they need assistance:
- Inability to remember significant parts of their life
- Difficulty choosing proper clothes
- Disorientation of time and place
- Trouble remembering names of relatives
- Lack of expressing emotions
What it looks like: It’s possible your relative frequently can’t remember the day of the week or the season of year. Although they can eat and go to the bathroom by themselves, they might have trouble choosing clothing that is clean or appropriate for the season. They likely know their own name and usually their spouse’s, but they may forget the names of their grandchildren or other relatives.
Duration: Moderate dementia usually lasts about one and a half years if the person is otherwise healthy.
Stage 6: Moderately severe dementia
A person who has moderately severe dementia is squarely in the middle part of the condition. They require help with activities of daily living such as bathing or dressing, and they may become incontinent. Personality changes could include delusions, agitation, and even violent behavior.
What it looks like: Your loved one might forget your name, even if they’re relying on you to be their caregiver. They might accuse their spouse of being an imposter or talk to imaginary people. They could show obsessive tendencies, like repeatedly cleaning a part of the house.
Duration: A person will likely have moderately severe dementia for about two and a half years.
Stage 7: Severe dementia
In the final stage of dementia, individuals lose speaking abilities, become incontinent, and require assistance with eating. Their body eventually loses basic physical abilities and becomes rigid.
What it looks like: Your family member will no longer be able to walk as this stage progresses. They may speak unintelligible phrases, with the occasional word you thought they forgot.
Duration: The final and most aggressive stage of a dementia can last six years or longer. People with severe dementia most commonly die of pneumonia, infections, or another condition.
How quickly does dementia progress?
Dementia is progressive, meaning it worsens over time. Just as dementia affects everyone differently, the length of each stage will vary for your loved one. Some people live independently for a while after they’re diagnosed, while others need immediate assistance. How long someone lives with dementia depends on the type they’re experiencing and their overall health.
Alzheimer’s disease
People with Alzheimer’s usually live eight to 10 years after they’re diagnosed, but their life expectancy can range anywhere from another three to 20 years.
The age when someone is diagnosed also affects how long they might live. Someone diagnosed with Alzheimer’s at age 65 typically lives for another eight years, while someone diagnosed at age 90 might live another three years or so, according to Johns Hopkins Medicine.
Alzheimer’s also progresses differently depending on whether someone has early-onset or late-onset dementia. Early-onset refers to people who develop Alzheimer’s before age 65. Their disease is often more aggressive than people who have late-onset dementia.
Lewy body dementia
Someone with Lewy body dementia typically lives between two and 10 years after diagnosis, with the most typical life expectancy being another six years. Although every Lewy body dementia patient progresses differently, people with mild dementia commonly develop severe dementia in five years. Physical symptoms from Lewy body dementia also put your loved one at higher risk of infections and falls as the disease progresses.
Vascular dementia
Vascular dementia doesn’t have defined stages like other types of dementia. The condition can happen for various reasons, so it progresses in significantly different ways. A loss of blood flow to the brain from a stroke is a common cause of vascular dementia.
After a serious stroke, your loved one may recover some of their cognitive abilities. More improvement is unlikely after the initial recovery period. Then, they could either remain stable or experience ongoing cognitive decline.
On average, people with vascular dementia die five years after they’re diagnosed. This life expectancy is shorter than Alzheimer’s because they have a greater chance of dying from another stroke or heart attack than from dementia.
Frontotemporal dementia
Frontotemporal dementia is a term that includes several conditions and each affects people differently. The stages of frontotemporal dementia differ, depending on the type they’re experiencing.
- Behavioral variant frontotemporal dementia is the most common type of frontotemporal dementia. It accounts for about half of all cases. In the early stages, you’ll likely notice your loved one displaying significant personality changes, such as loss of inhibition and lack of empathy. By the later stages, these behavioral changes often diminish and your family member may become more apathetic. Symptoms similar to Parkinson’s disease may appear in the final stages.
- Primary progressive aphasia is another type of frontotemporal dementia. It gradually affects someone’s speech. So, while a relative will be able to take care of themselves, they may have trouble using the telephone, understanding words, and forming sentences. In later stages, their loss of language skills will remain the most significant symptom, but other areas of cognitive decline will appear.
People with frontotemporal dementia typically live about six to eight years. Their life expectancy can be two to three years after diagnosis if they also have motor neuron disease, which is known to overlap with frontotemporal dementia.
At what stage does someone with dementia need a caregiver?
Your loved one will likely need someone to care for them by the middle stages of dementia. At this point, they’ll probably have trouble with simple tasks around the house like dressing themselves or cooking dinner. Their safety also becomes a bigger concern. They might leave the kitchen stove on or wander outside their home.
Remember that everyone progresses through the stages of dementia differently. Sometimes, the changes can be gradual while other times they’re sudden.
If you and your loved one find yourselves needing more support as their condition progresses, home care may be a good fit. These services enable seniors to keep living in their homes and provide caregivers with much-needed respite. The familiarity and comfort of home can be especially helpful for someone living with dementia.
However, it could become increasingly difficult to keep a loved one at home in the later stages of dementia. If that happens, memory care communities are specially designed to support the needs of people with Alzheimer’s and other types of cognitive decline.
Sources:
The progression and stages of dementia (https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/progression-stages-dementia)
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia (https://www.fhca.org/members/qi/clinadmin/global.pdf)
Clinical Stages of Alzheimer’s (https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/)
Clinical features and diagnosis of Alzheimer disease (https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-alzheimer-disease)
Early-onset dementia in adults (https://www.uptodate.com/contents/early-onset-dementia-in-adults)
Prognosis and treatment of dementia with Lewy bodies (https://www.uptodate.com/contents/prognosis-and-treatment-of-dementia-with-lewy-bodies)
The later stage of dementia (https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/later-stages-dementia)
Etiology, clinical manifestations, and diagnosis of vascular dementia (https://www.uptodate.com/contents/etiology-clinical-manifestations-and-diagnosis-of-vascular-dementia)
Frontotemporal dementia: Clinical features and diagnosis (https://www.uptodate.com/contents/frontotemporal-dementia-clinical-features-and-diagnosis)
The information contained in this article is for informational purposes only and is not intended to constitute medical advice or diagnosis. Always seek the advice of your physician or other qualified health care provider regarding any medical condition or treatment, and never disregard professional medical advice or delay treatment based on anything you have read on this site. Links to third-party websites are only for the convenience of the reader; AgingCare does not endorse the contents of the third-party sites.