The Seven Stages of Dementia

From “no impairment” to “very severe,” knowing the seven stages of dementia can help guide you as a caregiver. One of the main topics of discussion when someone is diagnosed with dementia is the “stage” of the disease — a marker of how far it has progressed.

Dementia symptoms can range from mild memory loss to more severe cognitive difficulties that make it hard to manage daily activities without help. These symptoms are broadly grouped into categories called stages that help guide doctors and families in their care of dementia patients.

“Usually we think of memory loss as a continuum,” explains Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago. “Dementia is defined as chronic memory loss, ultimately affecting quality of life.”

Dr. Shah points out that people with dementia progress along the memory loss continuum in their own individual way, and often there is no clear-cut moment when you know that your loved one has moved from one stage to another. Becoming familiar with the stages of dementia, however, is still useful for giving care. This can help guide:

• Expectations. You and your family members will have a general idea of what your loved one’s future may hold and you can make plans accordingly.
• Treatments. The medications available to help control dementia symptoms have been studied in clinical trials during different stages of dementia. Not all medications are necessarily appropriate for your family member, depending on their specific symptoms and stage of dementia.

The Stages of Dementia

The stages of dementia are as follows:

• No impairment. At this stage, there are no obvious signs of dementia and people are still able to function independently.
• Very mild. Dementia signs are barely noticeable and simply appear to be the kind of forgetfulness associated with aging — such as misplacing keys but finding them again after some searching.
• Mild. At this stage, patients are “usually able to do basic activities of daily living,” says Shah — which means they can perform their daily routines, such as getting up, going to the bathroom, getting dressed, and so on, without difficulty. Symptoms of dementia at this stage may include:
  • Some forgetfulness and memory loss
  • Repetition
  • Losing items without being able to retrace steps to find them
  • Slight trouble managing finances, such as balancing a checkbook
  • Confusion while driving
  • Trouble managing medications
  • Loss of concentration
• Moderate. At this stage patients have “trouble doing routine tasks that they always did, such as cooking, laundry, or using the phone,” explains Shah. Other dementia symptoms during this stage include:
  • Trouble holding urine (incontinence)
  • Increase in memory loss and forgetfulness
  • Inability to use or find the right words and phrases
  • Difficulty doing challenging mental math exercises, such as counting backwards from 100 by 7
  • Increase in social withdrawal
• Moderately severe. At this stage, dementia patients will need some assistance with their day-to-day activities. Symptoms of moderately-severe dementia include:
  • Increase in memory loss, including inability to remember home address, phone number, or other personal details
  • Confusion about location or chain of events
  • Trouble with less challenging mental math exercises
  • Needing help to select appropriate clothing for the climate, season, or occasion
• Severe. “Caregivers have to help a lot more with day-to-day activities” at this stage, says Shah. Dementia signs at the severe stage include:
  • Needing help to get dressed
  • Requiring help with toileting, such as wiping and flushing
  • Wandering and becoming lost if not supervised
  • Inability to recall the names of family members or caregivers, but still being able to recognize familiar faces
  • Sleep disturbances
  • Changes in personality or behavior, such as increased paranoia or even hallucinations
• Very severe. This is the final stage of the disease. Symptoms of dementia during this stage include:
  • Loss of language skills
  • Loss of awareness of surroundings
  • Requiring help to eat
  • Lack of control over urination
  • Loss of muscle control to smile, swallow, or even walk or sit without support

In order to determine your loved one’s stage of dementia, your doctor will ask a variety of questions of both the patient and the caregiver. These questions may include some mental tests. One frequently used screening tool is called the Mini-Mental State Examination, an 11-question exam that can help pinpoint cognitive decline on a scale of 0 to 30. In general, Shah says that a score between 14 and 26 points correlates to mild/moderate stage dementia and a score between 4 and 14 correlates with severe dementia.

It’s important to remember that the stages of dementia are somewhat fluid — use them to help plan for future changes and to work with your doctor to develop a solid treatment plan.

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The Seven Stages of Dementia