During doctor visits you will often hear talk about in what stage of dementia the patient finds themselves. This can be helpful to estimate how far along the disease has progressed, but it can also be somewhat reductionist in its approach. Every person and patient is unique and has their own journey through life. The same is true about how patients experience dementia; there are no two people who will have the exact same experience. But for the sake of thoroughness let us explore what the stages doctors refer to actually entail.
Dementia is a progressive condition; it will always get worse over time. You can slow its progression but never halt it. As a result, statistically, all patients will follow a certain pattern of progression. As stated above, how this is lived out will change patient to patient, but the general progress will be the same. There are two scales that can be used to understand the stages, a broader scale that has three stages, and a more specific scale that has seven. Let’s look at both of them individually.
The three overall stages:
This is a very broad strokes approach to understanding the level of progression dementia follows. In it you will find “Early-stage dementia”, also sometimes know as “Pre-dementia”; though that phrase can cause a certain amount of misunderstanding which we will go into further. The next level is “Middle-stage dementia” or “Moderate dementia”. Lastly there is “Late-stage dementia” or “Severe dementia”.
Early-stage dementia is very difficult to diagnose. There are little to no noticeable symptoms, which is what has led to this stage sometimes being referred to as pre-dementia. This reference is problematic as even if there is nothing visibly wrong, the disease is already present and working in the background. There’s nothing that would stop the patients from being able to live physically independent lives so likely no one would pick up anything wrong.
Middle-stage dementia is when the disease actually becomes noticeable. This is likely when a patient will be diagnosed and it is also generally the longest of the stages. While some minor cognitive decline could already be noticed in the early stage, by now it’s not only quite recognizable but is often accompanied with some personality changes. Physically, the patient also begins needing more and more assistance with daily tasks.
Late-stage dementia is categorized by the patient needing full time care and assistance. They are fully reliant on others for all physical needs.
The seven specific stages:
This next list is similar to the last, but provides more detailed insights. This seven staged scale is known as the Global Deterioration Scale (GDS) by medical professionals.
- No cognitive impairment
Patient appears completely normal, all changes and symptoms are invisible.
- Very mild cognitive impairment
Symptoms at this stage can often be mistaken for “age-related forgetfulness.” According to the GDS this stage is oven known as “age-associated memory impairment.”
- Mild cognitive decline
The cognitive decline is now recognisable as symptomatic of dementia. The patient starts manifesting symptoms like verbal repetition, getting lost while travelling, forgetting events and appointments, etc. On their own, many of these symptoms can be excused, but the frequency will increase as well as the severity.
- Moderate cognitive decline
Here, the symptoms mentioned in the previous stage have advanced to the point that there is very clear cognitive decline; it can no longer be explained away as simply getting older. Some changes in personality will also start showing, as well as moodiness and increased social withdrawal. This is the most common stage for a patient to receive a diagnosis.
- Moderately severe decline
This is often referred to as the mid-point by doctors. Patients at this stage will require more and more assistance for daily living and can’t live completely independently anymore. They aren’t at the point of requiring full time care though.
- Severe cognitive decline
Now they are at the stage of requiring full time care. Basic life functions, like hygiene and toilet habits, will require assistance to maintain. Personality changes become even more pronounced and they can lose the ability to recognise loved ones and care-givers.
- Very severe cognitive decline
At this stage the cognitive decline has reached a point that physically the patient cannot even perform basic physical functions like chewing, swallowing or even breathing completely unassisted. Many will be rendered non-verbal and potentially bed-ridden.
As stated above, these scales are guides that can tell you what you can potentially expect, but they are not set in stone definite. If caught early enough that counter-measures can be put in place, the length of time it takes for the patient to move from one stage to the next can be greatly increased. This is why it’s so important to keep an eye on yourself and those you love; the early stages are insidious in their subtlety, but if caught then already, you can make such a difference in how the disease progresses. The best way to ensure this disease doesn’t define the rest of your life, is to take charge of defining it for yourself.
