Stages of Dementia


Under the umbrella of the disorder known as dementia are a number of symptoms, which include memory loss, loss of concentration, disorientation (who, what, where), language deficit (difficultly finding the right words), poor judgment, and trouble with sequencing, e.g. knowing that you put your socks on before your shoes.  Alzheimer’s disease is just one of many diseases that cause dementia. 

Let’s look at the different stages of dementia, their signs and symptoms. I always tell my staff, “Once you have seen a person with dementia, you have only seen one.” What I mean by that is every person’s dementia takes them on a different path; not everyone displays all of the same symptoms. Alzheimer’s disease causes damage to the brain that leads to short-term and eventually long-term memory loss. In the early stages of dementia (2-4 years typically), family and friends may not notice their loved one exhibiting signs.

It is often small behavior changes that a spouse may notice – she forgets where her purse is, can’t follow instructions with multiple-steps, or starts a task and doesn’t finish it. Personality changes (anxiety or depression) are common, as well as difficulty remembering words – she may become quieter or let others speak for her so it isn’t noticeable. A common red flag is forgetting to pay a bill, or she pays the same bill twice. Many households can have great financial hardship because nobody noticed this sign. Another clue: she stops doing activities that she typically loves to do.

Be patient during the early stages; don’t speak for her when she can’t find the words (she’ll just stop talking and let you do it for her). When she is trying to talk or complete a task, be aware of distractions that will confuse her – turn the TV off! Now is a great time to see the doctor; in the beginning stages, different medications can help slow the disease progression.

In the middle stages, (approximately 2-10 years), short-term memory loss becomes more apparent. You may start to see behavioral changes such as verbal outbursts, irritability and fear of being alone, even paranoia or delusions. She may confuse day and night, causing sleep disturbance (awake at night and sleeping during the day). She may tell you the same stories over and over again, or not make sense. As she now remembers family members the way they looked 20 years ago, she may fail to recognize them. She may begin trying to leave the condo where you live, wanting to go “home” – the home where she grew up or lived in when you were first married. As she progresses through the middle stages, she will have trouble deciphering what is real and what is not. At this point, she is no longer safe alone and needs constant supervision. 

Now is the time to take a deep breath, be patient and look to the community for support services such as adult day care or home health care. Assisted living communities are another option. There are different levels of care available, and the local Alzheimer’s Association is a great resource to find what is right for her.

Late stages of the disease may last from 1-3 years, and her needs have and will continue to change greatly. At this point, short-term and long-term memory are severely impaired; she may have very few words left in her vocabulary. She does not recognize family or even her own reflection in the mirror. Chewing and swallowing can become impaired, causing malnutrition and dehydration. She may not be able to walk or even sit up. Bladder and bowel control may be affected. In this stage, it’s important to realize that she still has feelings. Sing to her to soothe her, or read bible versus to comfort her. Talk to her about stories from the past even if you have to refer to yourself in the third person. She needs to feel that she is not alone; so hold her hand and hug her often. Tell her she will not be alone.

The Alzheimer’s Association has many support groups throughout the area, so as the caregiver, you can talk to others who are going through the same things. They can offer ideas for coping with your loved one’s continued behavioral changes as the disease progresses. 


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