Dementia is quite different from normal age-related memory loss because it doesn’t affect just memory. In fact, dementia can involve many aspects of health and well-being, including communication ability, behavioral changes, and much more. Symptoms of dementia negatively impact a person’s everyday life, impairing their ability to live independently. Whereas in the case of normal aging, although one may have bouts of memory loss, they can still live on their own and perform daily tasks.
As a caregiver, it’s important to understand the different stages of dementia in order to be prepared and make appropriate changes to the patient’s care, ensuring they are kept safe and healthy.
Dementia progression
Stage 1: No cognitive decline – Patient functions normally, no memory loss is present, and the patient is mentally happy.
Stage 2: Very mild cognitive decline – Patient experiences normal forgetfulness commonly seen in aging. For example, they may forget names, misplace items, or forget where they put things.
Stage 3: Mild cognitive decline – Forgetfulness has increased, and struggles with concentration and decreased work performance are much more noticeable. Patients may get lost or may be unable to find the right words when speaking or writing. At this stage, cognitive changes are noticeable. The average duration of this stage is about seven years.
Stage 4: Moderate cognitive decline – At this stage, symptoms include difficulty concentrating, incomplete recall of recent events, difficulty handling personal finances, and difficulty travelling alone. Patient may begin to withdraw socially and be in denial about their cognitive changes. Cognitive changes can be easily identified during a patient interview. Duration of this stage is two years.
Stage 5: Moderately severe cognitive decline – Memory deficiencies are now major, and patient requires assistance to complete daily tasks. Patient may forget where they live, the time and date, or current events. Duration of this stage is on average 1.5 years.
Stage 6: Severe cognitive decline (middle dementia) – Extensive assistance is required for the patient to carry out normal daily functioning. Patient will forget their family members and close friends. Completing tasks or even counting down from 10 may be a challenge. Other issues include bowel incontinence, speech decline, personality changes, compulsions, and anxiety. Duration is roughly 2.5 years.
Stage 7: Very severe cognitive decline (late dementia) – Ability to communicate is next to impossible, and assistance is needed for all tasks. Ability to walk along with other psychomotor skills may also become lost in this stage. Average duration is 2.5 years.
Although there is quite some time in-between the stages, the progression of mental deterioration speeds up in the latter stages. Recognizing dementia early on can help somewhat slow down the disease progression in order to preserve the patient’s memory and personal functioning. Unfortunately, because the symptoms in the early stages can be very mild, dementia goes unnoticed, which can delay diagnosis and, subsequently, treatment.
Dementia symptoms in later stages
Communication problems: As dementia progresses, patients’ ability to express themselves becomes more challenging. This can get further complicated if their ability to understand is impaired as well. As a result, patients may use their behavior as a means of communication. It’s important to remain calm and understanding when the patient appears to be acting out – it could be their way of trying to convey a message. Fighting or arguing can worsen the situation.
Loss of mobility: Changes in mobility are part of late-stage dementia symptoms. Patients are unable to perform their own tasks, so muscle loss is also greater, making the patients weaker as a result. If patients aren’t eating well, they can also grow weak. Additionally, many patients develop other conditions that can impair their ability to move, such as arthritis or a prior fall.
Eating problems and weight loss: In patients with dementia, eating problems can be quite common, which increases the risk for malnutrition and worsens other health conditions the patient may already have.
Eating and drinking is crucial for all people to stay healthy as it provides us with proper nutrition and hydration essential for healthy bodily functions. Insufficient nutrition and hydration can lead to deterioration of overall health, including mental health, as well as weight loss, dehydration, reduced communication abilities, infections, constipation, among other things.
Incontinence: Fecal incontinence or urinary incontinence is more likely in dementia patients. Incontinence may not be a result of dementia per se, but rather brought on by another underlying condition, so it’s important to address the incontinence problem with the doctor to determine the cause. Tips to improve incontinence in dementia include:
- Take the person to the toilet regularly in order to reduce accidents
- Consider dressing the person in appropriate clothing, which is easy to remove when they need to go to the bathroom
- Ensure that the toilet is easy to find and quick to get to – remove any obstacles that could be in the way
- Reduce the amount of fluids the patient consumes prior to bed
- Consider using continence aids, such as waterproof bedding, chair protectors, mattress covers, and bed and chair pads
- The person may require wearing pads or a diaper all day
- Treat any underlying cause that could be contributing to the incontinence, be an infection or a stress-related side effect.
Unusual behavior: Behavioral changes in dementia can be categorized into three main types: biological, psychological, or social. Changes in surrounding or lack of support from the environment are a large contributing factor to behavioral changes in dementia and can lead to disorientation. An environment that is hard to navigate can add extra stress to the patient.
Instead of becoming frustrated or upset about certain behavior, it’s important to take the time to understand what could be the underlying cause of the change.
Although patients with dementia share the same basic needs as everyone else, it can be difficult for them to recognize their needs, express their needs, or know how to address those needs. For example, a change in behavior may result in the patient feeling too hot because they are wearing a sweater, but they may not be able to recognize the issue or may not realize that all they need is simply take it off.
Sources:
https://www.dementiacarecentral.com/aboutdementia/facts/stages/
https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=101