A Guide to the Stages of Dementia and Alzheimers

Dementia and Alzheimer's Disease are progressive conditions. You can gain an understanding of how dementia may progress by learning about the key stages of dementia and Alzheimer’s and the common symptoms seen at each stage.

How many stages of dementia are there? Well, dementia can be broadly split into three stages:

• Early stage
• Middle stage
• Late-stage

Dementia is experienced differently by every person affected. It is a complex condition that doesn’t always neatly fall into these three stages.

Therefore, some symptoms of Alzheimer's come at different times than described in this article or may overlap. Also, they can occur in the condition's early stages but disappear later.

The symptoms are relatively mild at the start but appear to worsen with time. Using the stages of Alzheimer's as a guide, you can prepare for the future and what may lay ahead regarding needs and treatment options.

Through this journey, it's important to remain positive and focus on life as it is today. You may naturally want to know which stage of dementia you, or a person you love, are at so you can plan next steps and make necessary arrangements, but it may not be possible.

The reason why is that each stage of dementia is complex, and progression can take years.

Let's look further at the stages of Alzheimer's and dementia to learn more about the symptoms typically seen and what can be expected as the condition progresses.

Early Signs of Dementia

In the early stages of dementia, symptoms may not be noticeable. Day-to-day life may look relatively normal, with only minor memory loss and other types of cognitive decline.

At this stage, mild symptoms of dementia are experienced for an average of two years. The most common signs seen in daily living include:

• Showing signs of memory loss by asking the same questions over and over or getting lost in familiar places.
• Becoming confused, like when managing finances or following along in conversations.
• Difficulty finding words when speaking to others.
• Trouble judging distance.
• Mood changes becoming more frequent, like irritability and sadness.

With mild cognitive impairment, those with early stage dementia may:

• Keep losing their keys or glasses
• Forget important dates or events
• Be unable to follow along with a conversation
• Find climbing stairs difficult due to visual perception
• Become more anxious or scared of certain situations
• Have trouble remembering names when meeting someone new

During the early stages of dementia, making legal, financial, and end-of-life plans is best and decisions around future health and wellness can be made.

Early to Mid Stages of Dementia

In early to mid-stage dementia, one is between the first and second stages. Here, you'll start to see mild dementia with worsening cognitive decline.

At this point, those affected may experience:

• Long-term memory loss, like forgetting about being married.
• An inability to concentrate on tasks or activities like reading or watching television.
• A decreased desire to travel to favourite places or restaurants.
• Withdrawal from challenges like taking a daily walk or climbing stairs.

Symptoms will become more noticeable. Additionally, people with Alzheimer's may require more support with managing daily life.

At this stage, it may be beneficial to arrange a home caregiver to help. For example, to help with paying bills or laying clothes out.

Mid to Late Stages of Dementia

In the mid to late stage of Alzheimer's, signs of moderate dementia are seen. Here, symptoms worsen and more changes in behaviour occur.

Typically, this stage can last from two to four years. Worsening symptoms may include:

• Difficulty with memory and thinking, for example wondering and getting lost.
• Language deficits including using only a few words or not speaking at all.
• Disorientation, for example not knowing where you are physically or at what stage of life.
• Depression, crying often and withdrawing from others.
• Anxiety, causeing one to be frightened of loved ones and worry excessively.

New symptoms of Alzheimer's commonly seen at this stage include:

• Delusional thinking that something is true when it isn’t.
• Hallucinations, for example seeing something or someone that isn’t there.
• Poor emotional control like sudden outbursts of anger and violent behaviours.

Emotional outbursts can be particularly triggered by losing independence or an inability to clearly communicate needs. Both situations can be very frustrating.

Changes in behaviour can include:

• Becoming fidgety and unable to relax
• Shouting
• Exhibiting repetitive behaviours like asking the same question over and over
• Awaking more often during sleep
• Acting inappropriately like undressing in public, which is commonly seen with frontotemporal dementia

At this stage, it’s usually no longer possible to live without some assistance. Familiar faces may become unrecognisable. It may also become difficult to recall the day of the week or a home address.

Usually, a person will still be able to eat and use the toilet independently but will need assistance remembering facts about themselves and completing other activities of daily living.

Late Stages of Dementia

In the final stage of dementia, cognitive decline worsens. Symptoms you can expect to see are:

• Short-term memory concerns where someone forgets their own name and doesn’t recognise close loved ones.
• Time disorientation, for example no concept of time of day, season, or year.
• An inability to recognise loved ones.

This is the shortest stage lasting around one to two years. Other behaviours seen in late stages include:

• Inability to speak or understand more than a few words.
• Seeing and hearing things not there.
• Becoming aggressive with caregivers.
• Trouble walking and experiencing more falls.
• Needing help with eating and may lose weight.
• Losing control of bowel and bladder.
• Experiencing swallowing difficulties.

It may be upsetting to think about this difficult time. However, it's important to know that those living with Alzheimer's can feel comfortable at this stage, either at home or in a care home setting.

In the final stage of Alzheimer's, it’s common to respond more to senses than words, such as sounds or touching objects. So, turning on music or enjoying a sensory toy can ease the mind and promote a sense of contentment.

Frequently Asked Questions About the Stages of Dementia

What are signs that dementia is getting worse?

When things such as memory and one's ability to take care of themselves start to deteriorate, that is a sign that dementia is worsening. In addition, behavioural changes like yelling or unfounded suspicions are often telling.

How quickly does dementia progress?

With dementia, progressing through the stages is different for everyone. Some may move faster than others. Typically, the early stage lasts about two years, the middle stage two to four years, and the late stage one to two years.

How long does a person with dementia live?

How long someone lives with dementia depends on age, other health conditions, and how far it has progressed upon diagnosis. Staying active can help slow the progression.

When should dementia patients go into care?

We recommend that when a caregiver reaches a point where they can no longer provide adequate care at home or with the support of others, it may be time to consider moving to a care home. The most important thing is to ensure the person with dementia gets access to the care they need.

Improving Wellbeing For People Living With Dementia

The stages of Alzheimer's are similar to other types of dementia, such as vascular dementia and Lewy Body Dementia, so expect similarities when learning about the dementia stages. However, everyone living with dementia is unique and may not progress as expected.

At Relish, it’s our mission to bring joy and connection to people with dementia and their care-givers, at every stage of dementia. Browse our dementia-friendly products here. Our short questionnaire will help you identify the correct stage of dementia for your or your loved one.