The 7 stages of Dementia, as described in the Global Deterioration Scale, are:
- Stage 1: No Cognitive Decline
- Stage 2: Very Mild Cognitive Decline
- Stage 3: Mild Cognitive Decline
- Stage 4: Moderate Cognitive Decline
- Stage 5: Moderately Severe Cognitive Decline
- Stage 6: Severe Decline
- Stage 7: Very Severe Cognitive Decline
If you or a loved one are struggling with Dementia, I understand how daunting and difficult it is.
For over a decade, I have worked directly with patients and their caregivers, and I know how devastating and how much of a strain this terrible disease can be on all involved.
It’s a progressive disease that affects not just one’s memory but their functional ability (ADLs and IADLs) as well.
There are 5 distinct forms of dementia:
- Alzheimer’s disease (AD)
- Vascular dementia (VaD)
- Parkinson’s Disease Dementia (PDD)
- Lewy Body Dementia (LBD)
- Frontotemporal Dementia
I explain these in detail in my article here (I highly recommend reading it).
In this article, I will review the 7 stages of dementia as described in the Global Deterioration Scale (GDS) developed by Dr. Barry Reisberg.
Before we begin, I want to make an important point:
Dementia is a fluid disease, and everyone progresses through it differently.
Some people may stay at Stage 3 or 4 for several years, while others may progress through them within a year or two.
Some older adults may seem to revert to a previous stage, and then experience cognitive and functional decline quickly.
Also, these seven stages do not really apply to frontotemporal dementia because this particular type of dementia tends to progress very quickly.
However, in general, barring these nuances I have mentioned, all people with dementia will progress through stages 1-7.
It’s important to understand that dementia isn’t a sudden condition but rather a gradual progression through different stages of dementia.
Let’s get into the details.
The 7 Stages of Dementia
The 7 stages of dementia are broadly divided into 4 categories: Pre-clinical, Mild, Moderate, and Severe.
In the early stages of dementia, you might notice very mild cognitive decline, such as slight forgetfulness or trouble locating familiar objects.
As the progression of dementia continues, these signs of dementia become more pronounced.
There’s increased memory loss, and daily activities become more challenging.
By the time moderate cognitive decline sets in, a dementia diagnosis is often made.
Symptoms intensify, disrupting daily life and even altering personality.
With the progression comes an increased need for assistance with routine tasks.
In the final stages of dementia, cognitive decline is severe, with significant loss of memory and the ability to communicate.
Full-time assistance is required for daily living.
Getting a grasp on the stages of dementia, the signs to watch for, and the progression of the disease is crucial.
It aids in early diagnosis, allows for better planning, and informs care strategies.
Next, let’s delve into the seven stages of dementia in more detail…
Stage 1: No Cognitive Decline
Diving into the first stage of dementia, you’ll find that cognitive decline is virtually non-existent at this point, with no dementia symptoms to hint at the disease’s presence.
This is one of the seven stages in the spectrum of dementia, and it’s also referred to as the ‘no cognitive decline’ phase.
At this early stage of dementia, you’ll find that:
- There’s no noticeable memory loss or cognitive decline
- Daily life activities aren’t impacted
- There are no obvious signs and symptoms to hint at dementia
- There’s no need for assistance with daily tasks
- Diagnosis of dementia isn’t possible at this stage
I also want to comment on something that I have learned through my clinical practice and from conversations with researcher and physician colleagues:
This stage is commonly called the “pre-clinical” stage in clinical circles.
The only person that suspects something is amiss is the individual themselves.
They feel that something is “off” with their memory but can’t quite put their finger on it.
This phase can last decades before dementia progresses.
I talk about this, the other types of dementia, and their management in my comprehensive article here.
However, just because there are no overt, glaring symptoms doesn’t mean you shouldn’t take preventive measures.
Regular physical activity, a healthy diet, and mental exercises are key to delaying the early stages of dementia.
Stage 2: Very Mild Cognitive Decline
Let’s now focus on the second stage, characterized by very mild cognitive decline.
This stage is also called “age-associated memory impairment.”
In stage two, subjective forgetfulness becomes apparent.
You might notice your loved one forgetting where they had placed familiar items.
Or, they might forget the names of people they used to know very well and could have trouble finding the right words in conversations.
These symptoms are easy to overlook, but they’re significant.
Again, these are subjective, noticed by loved ones and the individual.
However, objective testing in the doctor’s office may not pick up any cognitive deficits just yet.
Your loved one may become frustrated or embarrassed by their forgetfulness, so offering support and understanding is essential.
Encourage them to share their feelings and reassure them that asking for help is okay.
Stage 3: Mild Cognitive Decline (Mild Cognitive Impairment-MCI)
Moving into stage three of dementia, you’ll begin to notice a more pronounced memory loss, including an out-of-character forgetfulness and decreased ability to concentrate.
During this early-stage dementia, you may begin to notice:
- Difficulty in finding the right words during conversations
- Getting lost while driving to an unfamiliar location
- Increased forgetfulness, especially of recent events or conversations
- Reading a book or passage and quickly forgetting the information
- Forgetting names of new people they were introduced to
- Difficulty in managing tasks at work or home (balancing checkbooks, forgetting to take medications, co-workers noticing the person’s poor performance, etc)
- Misplacing valuable items more frequently
- Struggling with decision-making and problem-solving skills
- Individual begins to deny the changes they are going through, attributing them to “just getting old”
At this point, the symptoms of dementia may become noticeable to others, not just to you.
Stage 4: Moderate Cognitive Decline (Mild Dementia)
As the disease progresses into stage four, known as the moderate cognitive decline stage, the challenges become more severe and life-disrupting.
In this stage of dementia, your loved one may experience the following:
- Decreased understanding of current and recent events
- May have moments where they forget their own personal history (remembering their address, etc)
- Decreased ability to travel
- Denial of decreased ability becomes the dominant defense mechanism
- Person becomes apathetic (flat affect)
- Withdraws from challenging tasks frequently
Simple tasks such as choosing appropriate clothing for the day may also become difficult.
It’s a crucial stage when a caregiver’s role becomes more demanding, and you might need to provide more direct support.
However, the individual is still able to travel to familiar places without difficulty, is still oriented to time and place, and can recognize familiar faces and people.
Stage 5: Moderately Severe Cognitive Decline (Moderate Dementia)
Living with stage five dementia can be challenging, with noticeable changes in cognitive abilities.
Daily routines become more difficult as the decline in cognitive abilities is significant.
Once simple tasks may now require assistance.
These tasks (Activities of Daily Living or ADLs) include dressing appropriately for the weather or occasion, remembering personal details and significant events, and keeping track of time and place.
Other examples of tasks your loved onel struggles with are:
- Inability to remember major events in their life
- A phone number or address of many years
- Names of close family members such as grandchildren
- Name of the high school or college from which they graduated
- Frequent disorientation to day, time of day, season, and place
On the positive side, they may still remember close loved ones such as your name or their children’s names
Supporting your loved one during this stage can be emotionally demanding.
It is crucial to provide reassurance and create a consistent daily routine to maintain a sense of familiarity.
It is important to remember that the unusual behaviors displayed by individuals with dementia are symptoms of the disease and not a reflection of their character.
Stage five dementia requires a heightened level of care, understanding, and patience.
Seeking professional help or joining a support group is recommended to navigate this challenging time.
Stage 6: Severe Decline (Moderately Severe Dementia)
Navigating through stage six of dementia, you’ll encounter a substantial increase in memory loss and difficulty with daily activities.
Known as severe dementia on the global deterioration scale, this stage marks a significant decline in a person’s ability to perform basic tasks such as dressing or eating unassisted.
Personal memories start to fade, and recognition of close family members may begin to wane (they may occasionally forget their spouse’s name).
Your loved one will be largely unaware of all recent events and experiences in their life.
They will be generally unaware of their surroundings, the time of day, year, season, etc.
They will have difficulty counting backward from 10 and, sometimes, forward from 1.
Sleep patterns become grossly distorted, and night-time wandering and insomnia can result.
They may become incontinent of urine and bowel.
Mood and personality changes become even more pronounced and variable.
Hallucinations (for example, talking to imaginary figures) and delusions (for example, accusing you of cheating on them) may begin to manifest.
Obsessive behavior, such as excessive cleaning, may also occur.
Agitation and aggressive behavior can become constant issues during this stage.
As you’re navigating stage six, it’s crucial to have support structures in place.
It’s in these later stages of dementia that professional care may become a necessity.
You’ll need assistance with daily activities as symptoms become more pronounced.
These symptoms can be distressing, but remember you’re not alone.
Communicating with healthcare professionals who can provide guidance and potential treatment options is essential.
Remember, it’s crucial to prioritize comfort and quality of life in this late-stage dementia.
Stage 7: Very Severe Cognitive Decline (Severe Dementia)
Moving into the final stage of dementia, stage seven, you’ll confront very severe cognitive decline marked by the loss of communication and inability to walk.
As you endure stage seven, the person you care for will gradually lose the ability to respond to their environment, carry a conversation, or control their movements.
Your loved one may only utter unintelligible words.
Incontinence of bowel and urine will be complete, and full-time assistance will be needed with toileting and feeding.
The ability to walk independently is lost at this stage.
This final stage, often referred to as late-stage dementia, is a terribly challenging time; however, understanding what to expect can help you provide the best care possible.
During this period, you should focus on providing comfort and quality of life.
Here are some key points to consider:
- End-of-life care options should be discussed and arranged.
- Physical comfort becomes crucial, as your loved one may experience difficulty swallowing or may be in pain (read my article about how to assess your late-stage dementia loved one for pain).
- Emotional support for both the person with dementia and you is vital.
- Seek out qualified professionals, such as Certified Dementia Practitioners, for help.
- Monitoring for any signs of distress or discomfort is essential for timely medical intervention.
- Minimizing polypharmacy, yet getting your loved one to take their needed medications.
- Rule out delirium as a possible contributor to ongoing functional decline.
Understanding the stages of dementia can be a daunting task, but you’re not alone.
By being aware of the symptoms, you’re better equipped to face challenges head-on.
It’s imperative to remember that each person’s journey through the stages of dementia is unique.
Challenges will vary from person to person.
As a caregiver, your patience, understanding, and support are vital during this difficult time.
It can be a tough road, but your love and care can significantly improve your loved one’s quality of life.