When a loved one is diagnosed with dementia, such as Alzheimer’s disease, it is crucial that you educate yourself on the various stages of memory loss, so that you can understand the changes in behavior and abilities they may go through as the disease progresses.
The only way to ensure that you are choosing the most effective course of action for your loved one’s treatment and care, is with personal knowledge of the various stages of dementia, as well as the help of doctors and caregivers. By taking the time to educate yourself, your loved one can enjoy a better quality of life, and you can relax with peace of mind knowing they are receiving the level of care required for the stage of memory loss they are in.
In this article, we will cover the 7 stages of memory loss in dementia patients, what signs and symptoms to look out for, and how you can best help your loved one suffering from dementia.
The following stages of memory loss are based on the Reisberg Scale, developed by Dr. Berry Reisberg of New York University. Keep in mind, the exact stage your loved one is in should be determined by their doctor through tests and examinations.
Stage 1: Normal / No Cognitive Decline
- Diagnosis – No Dementia
During this stage, the person will be functioning normally and won’t exhibit any signs of memory loss, he or she is mentally healthy and clear. People without dementia, and who are able to take care of themselves and function independently, belong in this stage.
Stage 2: Very Mild Cognitive Decline / Normal “Aging Forgetfulness”
- Expected Duration of Stage 2 – Unknown
- Diagnosis – No Dementia
In stage 2, it is common for the patient to start showing signs of short-term memory loss, such as names and where familiar places are, or where objects they use frequently belong. The behavior displayed during this stage is often associated with normal aging, or age-related memory loss. Generally speaking, symptoms of dementia are not evident to the patient’s physician or loved ones.
Stage 3: Mild Cognitive Decline
- Expected Duration of Stage 3 – Average duration is between 2 and 7 years
- Diagnosis – No Dementia
When a patient is in stage 3 of memory loss, they will start to exhibit signs of an increase in difficulty concentrating, increased forgetfulness, and decreased ability to work and perform at work. You may begin to notice the patient is having a hard time coming up with the right words when speaking, and may start to get lost or “wander” more frequently. This is the stage when loved ones and the physician of the patient will start to notice a decline in cognitive ability, or cognitive impairment.
Stage 4: Moderate Cognitive Decline
- Expected Duration of Stage 4 – Average duration is 2 years
- Diagnosis – Early Stage Dementia
In stage 4, patients will have a difficult time concentrating, decreased ability to remember things – including recent events, and struggle with tasks such as managing finances or traveling alone to new locations. Often times, patients show trouble completing complex tasks accurately or efficiently, and may be in denial about their symptoms and/or condition. During stage 4, a patient can start exhibiting withdrawing behaviors, avoiding family or friends due to the fact that socialization has grown to be much more difficult. Physicians are able to detect a clear cognitive problem when patients are interviewed or examined during an appointment.
Stage 5: Moderately Severe Cognitive Decline
- Expected Duration of Stage 5 – Average duration of this stage is 1.5 years
- Diagnosis – Mid-Stage Dementia
Major changes in one’s ability to remember things, or recite memories, is often found in stage 5 of memory loss. Assistance in completing activities of daily living (ADLs) such as bathing, dressing, grooming, cooking, etc. is likely needed during this stage. Signs of memory loss are significant, and patients may start to forget highly relevant aspects of their current lives, such as their address or telephone number. They may also struggle to remember what day it is, what time of day it is, or where they are.
Stage 6: Severe Cognitive Decline
- Expected Duration of Stage 6 – Average duration is 2.5 years
- Diagnosis – Mid–Stage Dementia
Extensive assistance is required in order for people with dementia to complete their Activities of Daily Living in this stage of memory loss. They won’t have a clear memory, if any, of recent events. The names of close friends and family members will diminish. The vast majority of patients in stage 6 will not be able to remember anything from their earlier years. Simple things like counting down from 10 will be too difficult for patients, and finishing tasks will seem nearly impossible. It’s common for incontinence (loss of bladder control) to manifest in dementia patients during this stage. Communication skills and the ability to speak will decline. Personality changes, as well as emotional changes will occur, and delusions, compulsions, or bouts of anxiety may also take place.
Stage 7: Very Severe Cognitive Decline
- Expected Duration of Stage 7 – Average duration of late-stage dementia is 1.5 to 2.5 years
- Diagnosis – Late-Stage Dementia
Those in stage 7 of memory loss will have little to no ability to communicate or speak. They will require assistance in order to complete the majority of activities and daily tasks. It’s common for patients to lose psychomotor skills in this stage, such as the ability to walk.
Care Requirements by Stage
As we mentioned before, at the first diagnosis of dementia, the patient often times will not require any care assistance and will be able to live independently. However, as their dementia progresses, care will eventually be needed. In fact, by the time a patient reaches middle-stage to late-stage dementia, they will no longer be able to care for themselves at all.
While there are many American families who take care of their elderly loved ones who’ve been diagnosed with dementia, many people also hire a trained caregiver to provide care, or supplement the care they are already providing. It’s important to realize that once dementia symptoms worsen, it becomes nearly impossible to care for the person suffering from it all by yourself. This is particularly true if you are not a trained caregiver who specializes in caring for seniors with memory issues.
That said, there are many options out there for care assistance, such as adult day care, in-home care, and nursing home care. Financial assistance for these services can be obtained through Medicaid’s benefits, Veterans’ programs, state non-medical programs, tax credits and deductions for Alzheimer’s / dementia, and more.
Early Stage Dementia
As we mentioned above, patients in the early stage of dementia require no additional assistance, and should be able to function and take care of themselves properly and independently. They may need the occasional reminder of when doctors appointments are, or when to take a certain medication. But overall, early stage mild dementia doesn’t carry much in regards to negative symptoms. Keep in mind, patients in this stage should be made to live as independently as possible. It’s a good idea for family members and/or caregivers to discuss the future and expected plans with a patient in this stage, as they are still thinking clearly and able to make sound decisions. Hold important conversations, such as long-term care plans and both financial and legal matters while the patient is in this stage, before they progress to the middle stages of dementia, or start to exhibit dementia-like symptoms.
Middle Stage Dementia
During the middle stage of dementia, patients exhibit increased cognitive problems and are no longer able to function as independently as they were in the early stages. It’s likely they’ll need assistance with Activities of Daily Living (ADLs), which include grooming, bathing, dressing and cooking, etc. When middle stage dementia is just starting to manifest itself, patients may only need a reminder or prompting to perform these types of tasks. That said, there will come a point as their dementia symptoms progress, where a more hands-on approach will be necessary. Caregivers should do their best to establish a solid routine for dementia patients in the middle stage of memory loss, and will need to exercise more patience during this stage. Due to the fact that individuals in this stage of dementia experience long-term memory loss, they will have an increasingly difficult time speaking, it’s imperative that their caregivers talk clearly and slowly, even using non-verbal communication when necessary. Middle stage dementia patients will no longer have proper cognitive function, therefore they won’t be able to drive safely, so readily-available transportation will be required. Unfortunately, leaving a patient alone during this stage of dementia is no longer safe, which means that around-the-clock supervision becomes mandatory.
Late Stage Dementia
Once a person reaches the late stage of dementia, the amount of care they require significantly increases. At this level of memory loss, also known as severe dementia, dementia patients need 24/7 supervision and assistance in completing nearly all, if not all, daily tasks. These include getting in and out of bed, maneuvering from the bed to a chair, or help moving positions within their bed to avoid developing bedsores if they’ve become bedridden. All foods they consume must be cut into very small pieces and should be soft, such as yogurt or applesauce, as swallowing will be a major issue for late stage dementia patients. It isn’t uncommon for individuals in this stage to consume a diet consisting entirely of pureed foods. As the dementia progresses, the individual will reach a point where they will be 100% dependent on their caregivers and will no longer be able to perform any daily living activities on their own. Most families are not properly trained and do not possess the necessary skills required to offer care to a patient in the last stage of dementia. There are many dementia care options available to people struggling with memory loss, these including: hiring a part time or full time caregiver, or moving the patient into a nursing home or memory care facility.