Signs, Symptoms and Stages of Dementia

Dementia is a collective term for conditions causing a decline in cognitive function. Although Alzheimer’s is the most common form, there are many different types of dementia, and each type has its own pattern of progression, with symptoms and signs attributed to different stages of the journey. Understanding the early signs of dementia is crucial for effective management of the condition.

Today, we’ll explore the signs, symptoms and stages of dementia and how they are categorised to index the progression of symptoms.

Stages of Dementia

Of the over 850,000 people currently living with dementia in the UK, each individual will experience symptoms in their own unique way. While the type and progression of dementia vary, a general guide to its stages will help you understand what to expect and plan for the future.

There are two primary methods for measuring the progression of dementia: the three-stage model and the seven-stage model. The seven-stage model is most suitable for identifying the stages of Alzheimer’s, while the three-stage model can be applied to most other types of dementia.

Alzheimer’s Disease Stages

There are seven stages of Alzheimer’s, ranging from no cognitive decline to very severe cognitive decline. Alzheimer’s affects everyone differently, so a detailed description of each stage of the condition helps ensure that individuals experiencing symptoms receive the best possible care, tailored to their specific symptoms.

Stage 1: No Cognitive Decline

In this stage, the person functions normally, with normal cognitive function, no memory loss and generally good mental health. As this stage is often not noticeable, it’s frequently diagnosed in hindsight.

Stage 2: Very Mild Cognitive Decline

General forgetfulness, a common aspect of ageing, is associated with stage two. Forgetfulness is mild and unnoticed by loved ones and medical professionals, frequently being diagnosed after initial progression.

Stage 3: Mild Cognitive Decline

At this stage, loved ones may begin to notice signs of cognitive decline, such as forgetfulness and slight difficulty concentrating, which begin to impact daily life. A person at stage three may also become disoriented, lost, and struggle to find the right words.

On average, a person is at stage three approximately 7 years before the onset of Alzheimer’s.

Stage 4: Moderate Cognitive Decline

At stage four, the symptoms have a significant impact on daily life. Stage four Alzheimer’s can be identified by symptoms including significant difficulty concentrating, memory loss, disorientation and inability to travel alone to new locations.

As communication problems develop, someone living with this stage of dementia may start withdrawing from loved ones and avoiding interaction. The average duration is 2 years.

Stage 5: Moderately Severe Cognitive Decline

Individuals living with stage five dementia may require assistance to complete their daily activities, such as dressing, bathing, and preparing meals. Memory loss will become more severe and may affect their ability to recall major relevant aspects of life, including addresses or phone numbers.

Someone living with stage five dementia may not be aware of the time, day, or their location. The average duration of stage five is 1.5 years.

Stage 6: Severe Cognitive Decline

Someone living with stage six dementia will require extensive support with daily life, including continence care as control over the bladder and bowel declines. The names of close family members and memories of both recent events and early life details may fade or become increasingly difficult to place.

Stage six can also be identified by personality changes, such as delusions, compulsive behaviour, anxiety and agitation, difficulty in speaking and finishing basic tasks. The average duration of this stage is 2.5 years.

Stage 7: Very Severe Cognitive Decline

Stage seven Alzheimer’s has the most significant impact on an individual’s life. People in this stage typically demonstrate minimal ability to speak or communicate, and they will require extensive support with all aspects of daily life. This may include continence care and personal care due to the loss of psychomotor skills (the ability to control movement). The average duration of stage seven is 2.5 years.

Vascular Dementia Stages

The symptoms of vascular dementia can occur suddenly, following one large stroke, or they can develop over time, after a series of mini strokes. The progression of stroke-related or vascular dementia symptoms usually follows a ‘stepped’ pattern, with a combination of longer periods of time when symptoms are stable and periods when symptoms change rapidly.

Mild Stage

Early-stage vascular dementia can often share symptoms with Alzheimer’s, with the key difference being that mild vascular dementia symptoms are usually associated with difficulties in planning, decision-making and following instructions rather than memory loss.

Other early symptoms include:

• A reduction in the speed of thought
• Difficulty in concentrating
• Loss of bladder control is common with early subcortical vascular dementia
• Symptoms attributed to the stroke

Moderate Stage

As vascular dementia progresses, the earlier symptoms will become increasingly evident.

Since vascular dementia affects various aspects of thought processes such as problem-solving, concentrating, reasoning and communication, someone living with moderate vascular dementia may experience:

• Periods of sustained confusion
• Memory loss
• The development of unusual behaviours

Advanced Stage

Someone living with vascular dementia will become increasingly dependent on the support of medical professionals and care providers to assist them with most aspects of everyday life, such as eating, bathing and dressing.

In the later stages of vascular dementia, the individual may:

• Become decreasingly aware of what is happening around them
• Experience delusions and hallucinations

Frontotemporal Dementia (FTD) Stages

The rate at which FTD progresses varies greatly, and research has found that the differences between different types of this dementia become less obvious as dementia progresses.

Those who originally exhibited symptoms of behavioural variants may eventually experience language difficulties and similarly, a person originally diagnosed with a language variant of FTD will typically develop behavioural problems.

Mild Stage

Unlike Alzheimer’s, the early stage of frontotemporal dementia doesn’t usually affect memory or cognitive functioning. Someone with FTD may go walking without an obvious purpose but, unlike someone with Alzheimer’s, will return home without getting lost.

During the early stages of behavioural FTD, changes to personality and behaviour become noticeable.

Typical behavioural changes include:

• Becoming uncharacteristically selfish or apathetic
• Acting impulsively
• Developing obsessive or compulsive behaviours
• With language variants of frontotemporal dementia, language difficulties become apparent gradually
• Semantic dementia primarily affects the ability to understand language
• Aphasia affects the ability to produce fluent speech

Moderate Stage

The earlier symptoms of frontotemporal dementia will become increasingly evident as the condition progresses from the mild to moderate stage.

With Behavioural Variants:

Inappropriate behaviours will become more frequent and more intense.

With Language Variants:

Aphasia will continue to affect speech production.

Signs of moderate aphasia may include:

• Stuttering
• Mispronunciation
• Grammatical errors
• Impaired understanding
• Semantic dementia causes:
• Vocabulary to decline
• Confusion regarding the meaning of familiar words,
• Difficulty in finding the right word
• Difficulty with recognising familiar objects

Advanced Stage

In the later stages of all types of FTD, more brain structures become damaged.

Someone living with later stages of this form of dementia usually experiences symptoms that are similar to the later stages of Alzheimer’s disease, such as:

• A disinterest in their surroundings
• Difficulties in communication
• Inability to recognise loved ones
• Behavioural changes may cause increased aggression or agitation

At this late stage, full-time care will be necessary to meet the individual’s needs and maximise their ability to access an enriched life wherever possible.

Lewy Body Dementia (DLB) Stages

Each person living with Lewy body dementia will have a different experience, but like all types of dementia, DLB is progressive, and the abnormal proteins responsible for causing damage to brain cells, known as Lewy bodies, will continue to build up in structures of the brain.

The spread and density of Lewy bodies will vary among individuals. This means that the symptoms each individual experiences are also unique to that person, as the Lewy bodies affect different parts of the brain, which have distinct functions.

Mild Stage

Dementia with Lewy bodies also shares symptoms with Alzheimer’s in the early stage.

Symptoms include:

• Problems with attention and awareness, which can fluctuate significantly daily and even from moment to moment
• Difficulty in judging distances
• Disorientation can lead to falls and fainting
• Sleep becomes disrupted
• The ability to plan and organise is affected
• Recurrent visual and auditory hallucinations can lead to distorted perceptions and delusions of persecution

Moderate Stage

The earlier symptoms of dementia with Lewy bodies will become increasingly noticeable.

Signs that someone living with dementia with Lewy bodies has reached a moderate stage include:

• Noticeable decline in motor skills, which causes difficulties with movement
• Twitching
• Stiffness
• Slow movements
• Loss of balance or coordination

Advanced Stage

As dementia with Lewy bodies progresses into the advanced stage, symptoms include:

• Frequent and sustained confusion about days, times and places
• Significant memory decline, which may include forgetting events, names and faces
• Communication problems with speech challenges
• Behavioural changes such as compulsive rituals, repetition and agitation
• Slow movements
• Difficulties in swallowing and eating, often causing weight loss

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