Progression and Stages of Dementia

While most cases of dementia are incurable, a prompt diagnosis can help slow the condition’s progress. Knowing the stages of dementia allows for the early identification of the symptoms. Several methods exist for measuring this progression, but most break dementia into four general categories: pre-dementia (which has three stages), early, middle, and late.

Preclinical — No Cognitive Decline

Early in dementia development, most people do not show any signs of cognitive decline. These stages are the pre-dementia states: preclinical and prodromal. During preclinical dementia, the most notable symptom is the loss of the sense of smell. This sensory dysfunction may occur up to 10 years before any cognitive symptoms.

Prodromal — Mild Cognitive Impairment

Following the preclinical stage are two prodromal states, one of which involves mild cognitive impairment. Notable cognitive issues appear, including a drop in performance at work, forgetting names, struggling to retain information from text, losing important objects, and difficulty concentrating. As these issues develop, many people begin to experience anxiety.

Prodromal — Mild Behavioral Impairment

Some behavioral changes also manifest in the prodromal stage. Certain experts believe that these shifts are possible early diagnostic markers for dementia. The most common symptoms are dramatic increases in both agitation and impulsivity. Some people may exhibit social inappropriateness, a loss of motivation, or affective dysregulation like anxiety, dysphoria, or irritability.

Early-Stage — Moderate Cognitive Decline

After several years, dementia may progress into its early stage: moderate cognitive decline. Symptoms that were mild or infrequent worsen and occur more often. Complex chores and assignments become more difficult to accomplish. While a person in this stage may still be capable of caring for themselves, they may forget tasks that were habit, like taking pills or doing laundry.

Early-Stage — Executive Functions

In addition to the symptoms of general cognitive decline, people in the early stages of dementia begin to have issues with their executive functions. These are a set of cognitive processes that allow us to plan, focus attention, and multitask. At this stage, an individual may have trouble planning and organizing. Managing finances becomes particularly difficult.

Early-Stage — Specific Types of Dementia

Different types of dementia may present with different symptoms or an alternative progression. For example, Lewy body dementia may cause personality changes and loss of executive functions before any other sign of cognitive decline. It can also manifest with atypical sleep behaviors. Frontotemporal dementia typically causes early social withdrawal and lack of insight.

Middle Stage — Moderately Severe Cognitive Decline

As dementia progresses into its middle stages, daily activities become extremely difficult. Many people require assistance with bathing, dressing, and using the bathroom. Forgetting major aspects of their lives, like their own address or phone number, is extremely common. Individuals within this stage may also forget the time or date, as well as their current location.

Middle-Stage — Severe Cognitive Decline

After roughly a year, moderately severe cognitive decline typically worsens to severe cognitive decline. Daily activities become impossible to perform alone. Memory loss affects major events in the person’s history, as well as their knowledge of close family and friends. Delusions, hallucinations, and compulsions may also occur. Anxiety is typical at this stage.

Middle and Late-Stage — Eating Changes

Cognitive awareness is necessary for eating, drinking, and swallowing, meaning that middle and late-stage dementia often involves eating changes. A person with dementia may refuse to eat, choke frequently, or aspirate food and drinks. Help with feeding often becomes necessary and caregivers may find it helpful to serve soft foods or liquidized meals.

Late-Stage — Very Severe Cognitive Decline

The final stage of dementia affects overall function and mobility. Many people at this stage struggle to speak or communicate, while others completely lose their abilities to do so. Personality changes may be so severe that it feels like interacting with a different person. A loss of motor skills is common, often resulting in an inability to walk. Tasks requiring fine control, such as using utensils, are incredibly challenging and often require assistance.