The Stages of Dementia

 

What is dementia?

Dementia refers to a category of diseases that cause loss of memory and deterioration in other mental functions. Dementia occurs due to physical changes in the brain and is a progressive disease, meaning it gets worse over time. For some people, dementia progresses rapidly, while it takes years to reach an advanced stage for others. The progression of dementia depends greatly on the underlying cause of the dementia. While people will experience the stages of dementia differently, most people with dementia share some of the symptoms.

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Types of dementia

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The symptoms and progression of the disease depend on the type of dementia a person has. Some of the most commonly diagnosed forms of dementia are:

Alzheimer’s disease

Alzheimer’s disease is the most common form of dementia. It accounts for 60 to 80 percent of cases. It’s usually a slowly progressing disease. The average person lives four to eight years after receiving the diagnosis. Some people may live as many as 20 years after their diagnosis.
Alzheimer’s occurs due to physical changes in the brain, including a buildup of certain proteins and nerve damage.

Dementia with Lewy bodies

Dementia with Lewy bodies is a form of dementia that occurs due to clumps of a protein in the cortex. In addition to memory loss and confusion, dementia with Lewy bodies can also cause:

• sleep disturbances
• hallucination
• imbalance
• other movement difficulties

Vascular dementia

Vascular dementia, also known as post-stroke or multi-infarct dementia, accounts for about 10 percent of all cases of dementia. It’s caused by blocked blood vessels. These occur in strokes and other brain injuries.

Parkinson’s disease

Parkinson’s disease is a neurodegenerative condition that can produce dementia similar to Alzheimer’s in its later stages. The disease more commonly leads to problems with movement and motor control, but it also can cause dementia in some people.

Frontotemporal dementia

Frontotemporal dementia refers to a group of dementias that often cause changes in personality and behavior. It can also cause language difficulty. Frontotemporal dementia can occur due to a range of conditions, including Pick’s disease and progressive supranuclear palsy.

Mixed dementia

Mixed dementia is dementia in which multiple types of dementia-causing brain abnormalities are present. This is most commonly Alzheimer’s and vascular dementia, but it can include other forms of dementia as well.

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How is dementia diagnosed?

No single test can determine whether you have dementia. Diagnosis is based on a range of medical tests and your medical history. If you exhibit symptoms of dementia your doctor will perform:

• a physical exam
• a neurological exam
• a mental status tests
• other laboratory tests to rule out other causes of your symptoms

Not all confusion and memory loss indicate dementia, so it’s important to rule out other conditions, such as drug interactions and thyroid problems.
Some common tests used to diagnose dementia include:

Mini-mental state examination (MMSE)

The MMSE is a questionnaire for measuring cognitive impairment. The MMSE uses a 30-point scale and includes questions that test memory, language use and comprehension, and motor skills, among other things. A score of 24 or higher indicates normal cognitive function. While scores 23 and below indicate that you have some degree of cognitive impairment.

Mini-Cog test

This is a short test for helping your doctor diagnose dementia. It involves these three steps:

1. They’ll name three words and ask you to repeat them back.
2. They’ll ask you to draw a clock.
3. They’ll ask you to repeat back the words from the first step.

Clinical dementia rating (CDR)

If your doctor diagnoses you with dementia, they’ll also likely assign a CDR score. This score is based on your performance in these and other tests, as well as your medical history. The scores are as follows:

• A score of 0 is normal.
• A score of 0.5 is very mild dementia.
• A score of 1 is mild dementia.
• A score of 2 is moderate dementia.
• A score of 3 is severe dementia.

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What are the stages of dementia?

Dementia progresses differently in everyone. Many people will experience the symptoms associated with the following stages of Alzheimer’s disease:

Mild cognitive impairment (MCI)

MCI is a condition that can affect older people. Some of these people will go on to develop Alzheimer’s disease. MCI is characterized by losing things often, forgetfulness, and having trouble coming up with words.

Mild dementia

People may still be able to function independently in mild dementia. However, they’ll experience memory lapses that affect daily life, such as forgetting words or where things are. Common symptoms of mild dementia include:

• memory loss of recent events
• personality changes, such as becoming more subdued or withdrawn
• getting lost or misplacing objects
• difficulty with problem-solving and complex tasks, such as managing finances
• trouble organizing or expressing thoughts

Moderate dementia

People experiencing moderate dementia will likely need more assistance in their daily lives. It becomes harder to perform regular daily activities and self-care as dementia progresses. Common symptoms during this stage include:

• increasing confusion or poor judgment
• greater memory loss, including a loss of events in the more distant past
• needing assistance with tasks, such as getting dressed, bathing, and grooming
• significant personality and behavior changes, often caused by agitation and unfounded suspicion
• changes in sleep patterns, such as sleeping during the day and feeling restless at night

Severe dementia

People will experience further mental decline as well as worsening physical capabilities once the disease progresses to the point of severe dementia. Severe dementia often can cause:

• a loss of the ability to communicate
• a need for full-time daily assistance with tasks, such as eating and dressing
• a loss of physical capabilities, such as walking, sitting, and holding one’s head up and, eventually, the ability to swallow, to control the bladder, and bowel function
• an increased susceptibility to infections, such as pneumonia

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What is the outlook for people with dementia?

People with dementia will progress through these stages at different speeds and with differing symptoms. If you suspect you may be experiencing early symptoms of dementia, talk to your doctor. While no cure is available for Alzheimer’s and other common dementias, early diagnosis can help people and their families make plans for the future. Early diagnosis also allows people to participate in clinical trials. This helps researchers develop new treatments and eventually find a cure.

Dementia is not a specific illness or disease. It involves a variety of symptoms associated with impaired thinking, memory, and communication.
To have a diagnosis of dementia, the decline in functioning must affect a person's ability to perform everyday activities.
This article will look at several types of dementia, and how they change as the condition progresses.

Contents of this article:

1. Types of dementia
2. How do symptoms of dementia change over time?
3. How do treatment options change over time?
4. Diagnosis and outcome
5. Living with dementia in the later stages

Types of dementia

Beta-amyloid plaques may be found in the brain of people with Alzheimer's disease.

Dementia may have different causes. Changes to the brain depend on the type of dementia a person has. Common types of dementia include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and mixed dementia.

Alzheimer's disease

The most common cause of dementia is Alzheimer's disease. According to the Alzheimer's Association, between 60 and 80 percent of dementia is caused by Alzheimer's.
It is not entirely clear what causes Alzheimer's, but clumps of a protein called beta-amyloid are found in the brain of people with this type of dementia.

Vascular dementia

Vascular dementia may occur when there is reduced circulation to the brain due to a stroke or other conditions, resulting in damage to the blood vessels in the brain.

Dementia with Lewy bodies

Dementia with Lewy bodies happens when abnormal proteins develop in the brain, called Lewy bodies. The protein deposits may be found throughout the brain, including the cerebral cortex, the area involved in language and thinking.

Mixed dementia

Mixed dementia involves more than one cause. Blood vessel problems may be present along with abnormal proteins in the brain, for example.

How do symptoms of dementia change over time?

Regardless of the cause, symptoms of dementia tend to worsen over time.
The rate of progression varies from person to person. Genetics, age, and overall health may play a role in how fast the disease progresses.

Early symptoms

Dementia often, but not always, starts with a mild decline in the ability to think. For example, someone may forget a recent conversation or the name of a familiar object.
At this point, the decrease in memory may not greatly affect a person's ability to function daily.
Early symptoms may also include a decreased ability to perform certain tasks, such as paying bills or following a recipe. Subtle changes in personality may also be noticed by people close to an individual with dementia.
At this stage, a person with dementia may start to realize something is not right, but they may choose to hide their symptoms.

Moderate dementia symptoms

Dementia may start with a decrease in memory.

As dementia progresses, symptoms become harder to hide. More noticeable symptoms may develop. Help with self-care or everyday activities may be needed.
Personality changes may become more noticeable. The person may experience paranoia or fear. Symptoms may include increased confusion and memory loss.
People with moderate dementia commonly forget their address or other personal information, including their phone number. Sleep patterns and mood may change.

Late-stage or severe dementia symptoms

Gradually, dementia can progress and become severe. Memory is often significantly affected. Someone with dementia may not recognize family members.
During late-stage dementia, symptoms may include an inability to communicate, walk, and control bowel and bladder function.
A person with late-stage dementia may have muscle rigidity and abnormal reflexes. Full-time personal care is usually needed for eating, bathing, and dressing. People with severe dementia are vulnerable to infections, including pneumonia and bed sores.

How do treatment options change over time?

Currently, there is no cure for dementia, including Alzheimer's disease, but there are treatments. Treatment usually aims to decrease symptoms and manage behavioral changes.
Treatment may also change over time. Different classifications of medication may be prescribed, based on the stage of the disease.
Medications may reduce symptoms by affecting chemicals that carry messages to the brain cells.
These drugs are called cholinesterase inhibitors. They are often prescribed for people with mild to moderate symptoms. Cholinesterase inhibitors treat symptoms associated with confusion, communication, and memory.
In people with moderate-to-severe dementia, treatment may also include memantine. Memantine is a drug that may help improve language, thinking, and memory.
Memantine works by regulating glutamate, a chemical in the brain that is involved in memory and learning. Memantine may delay the progression of symptoms temporarily for some people.
Treatment options may include medications that reduce behavioral changes, such as anxiety and sleep problems.
In later stages, different medications may be needed, as symptoms develop. Particular drugs may be recommended to treat specific symptoms, such as fear, restlessness, and hallucinations.
As dementia progresses, treatment may also focus on improving the quality of life. For example, occupational therapy may be useful to teach people with dementia how to use adaptive equipment or to improve fine motor skills.

Diagnosis and outcome

A person with an early diagnosis of dementia may want to communicate their wishes for future care as soon as they can.

No single test can determine if a person has dementia. Tests will focus on the ability to think and neurological evaluation.
Tests evaluate skills such as reasoning, language, and memory. Movement, balance, and visual perception are also examined.
A medical history and blood tests can help to rule out other causes of symptoms.
Imaging studies, such as a CT or PET scan, can determine if a specific protein is deposited in the brain, or if there is any interruption to the blood flow to the brain.
Dementia scales can help to decide if dementia is present, and how far it has progressed.
The Global Deterioration Scale may be used to determine the severity of overall dementia.
Ratings range from one to seven, where seven indicates the most severe stage. A combination of tests may be used to make an assessment.
The outlook for people with dementia varies. Age at diagnosis and response to treatment affect how the condition progresses.
People with Alzheimer's dementia often live for about 10 years after diagnosis, according to the Mayo Clinic.
However, everyone is different. Some people with dementia survive 20 years or more after diagnosis.

Living with dementia in the later stages

It may be helpful for a person with dementia to be involved in decisions about their care before they become unable to communicate their wishes.
Advanced care planning allows an individual with dementia to state what they want and do not want, such as living in a nursing home or being cared for at home.
Living with late-stage dementia can often be challenging for patients and caregivers. As symptoms progress, more care is required.
Strategies that may help someone with late-stage dementia include techniques to jog memory, such as visual clues or notes.
Assistive technology devices include communications aids, automatic shutoff devices, and computerized recall devices.
Caregivers should create an environment that is calm and safe. It is important to identify and correct safety concerns. This includes removing tripping hazards and making sure rooms are easy to get around.
Caregivers should also ensure that medication is taken correctly, and that nutritional needs are met. Late-stage dementia can also be a difficult time for caregivers. Having a strong support system and allowing time to recharge is essential.