Nobody can predict what will happen with your older adult’s cognitive ability, behavior, or preferences or when these changes will happen.
But understanding the 3 stages of dementia – early, middle, and late – gives a sense of what to expect and can be used as guidelines to plan for the future.
We explain the 3 dementia stages, common symptoms in each stage, and why your older adult’s symptoms don’t always fit into these stages.
The 3 stages of dementia
But it’s important to remember that someone with dementia may not always fit in a specific stage or go through every stage because the progression of dementia is unique and different for each person.
Early – mild dementia In the early stage, a person with dementia might still be able to live independently. They might still be able to drive, work, and socialize.
However, they will probably have memory lapses, like forgetting familiar words or the location of everyday objects.
Other people may start to notice that the person is having difficulty, experiencing memory loss, or that something “seems off.”
In a thorough medical exam, doctors might be able to detect problems in memory or concentration.
Symptoms may include:
Struggling to find the right word or name, finding it difficult to do everyday tasks in social or work settings, forgetting something that they just read, frequently losing or misplacing things, increasing trouble with planning or organizing, or making decisions with uncharacteristically poor judgement
Middle – moderate dementia The middle stage of dementia is usually the longest and can last for many years.
As dementia progresses, the person will need an increasing level of care.
In this stage, you might notice that they get words mixed up, are often frustrated or angry, or act in unexpected ways, like refusing to bathe.
Damage in the brain can make it difficult to express themselves and do everyday things.
Symptoms may include:
Forgetting things that happened recently or major events in their life.
Being moody or withdrawn, especially in social situations or when something requires too much thought.
Not being able remember significant things like their address, telephone number, high school, etc.
Getting confused about where they are or what day it is.
Needing help choosing appropriate clothes for the season or occasion.
For some, trouble with incontinence.
Changing sleep patterns, like sleeping during the day and being restless at night.
An increased risk of wandering and getting lost.
Personality and behavior changes, including paranoia, delusions, and compulsive, repetitive behavior like hand-wringing
Late-stage dementia In the final stage of dementia, people progressively lose the ability to engage in the world, to hold conversations, and to control their muscles.
They may still be able to talk, but communicating and expressing thoughts becomes difficult – even for something basic like pain.
Their memory and cognitive skills continue to get worse and you might see significant personality changes or the fading of personality altogether.
At this stage, people with dementia typically:
Need 24/7 help with daily activities and personal care. Have increasing difficulty communicating. Lose awareness of recent experiences and their surroundings. Gradually and progressively lose physical abilities, including the ability to walk, sit, and swallow. Become more likely to develop infections, especially pneumonia
A person with dementia doesn’t always fit into one stage
Dementia affects each person in a unique way and changes different parts of the brain at different points in the disease progression.
Plus, different types of dementia tend to have different symptoms.
For example, someone with front temporal dementia may first show extreme behavior and personality changes. But someone with Alzheimer’s disease would first experience short-term memory loss and struggle with everyday tasks.
Researchers and doctors still don’t know enough about how these diseases work to predict exactly what will happen.
Another common occurrence is for someone in the middle stages of dementia to suddenly have a clear moment, hour, or day and seem like they’re back to their pre-dementia abilities. They could be sharp for a little while and later, go back to having obvious cognitive impairment.
When this happens, some families may feel like their older adult is faking their symptoms or just isn’t trying hard enough.
It’s important to know that this isn’t true, it’s truly the dementia that’s causing their declining abilities as well as those strange moments of clarity – they’re truly not doing it on purpose.
Knowing the stages of dementia helps you plan
Even if the stages aren’t exact and symptoms can still be unpredictable, being able to plan ahead is essential.
The truth is that Alzheimer’s and dementia care is expensive and time-consuming. Being financially prepared for increasing care needs is a necessity.
On an emotional level, having an idea of what symptoms to expect helps you find ways to cope with challenging behaviors.
It also gives you a chance to mentally prepare yourself for the inevitable changes in your older adult.
Please check out the Alzheimer's website for more information: www.alz.org