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Understanding the Stages of Dementia

As dementia progresses, it can be difficult and heartbreaking for a senior and their family. Since the disease attacks parts of the brain, symptoms will only get worse over time. However, it's important to understand how the disease progresses in order to provide the best care possible.

Dementia progresses in 3 stages, each marked by distinctive complexities, signs, and symptoms. Remember that dementia progression and symptoms vary from person to person.

Early Stage

The early stage of the disease is characterized by energy loss, frustration, mood swings, and confusion. Seniors may get lost more easily, have difficulty remembering daily tasks, lose items like their glasses or wallet. Some seniors may also develop changes in personality. This stage typically lasts for 2 to 4 years.  

During this stage, seniors may be fully aware of what is happening to their minds. In fact, they may realize something is going on and want to cover up their symptoms or compensate for them. This battle for the brain can be difficult for them. However, seniors in this stage may still be able to socialize, work, and drive. Older adults and their loved ones may attribute symptoms to aging or stress instead of recognizing them as the first stage of dementia. 


To help visualize what early stages could look like in different forms of dementia, let's follow the stories of Gina, Nate, Lucy, and Bob, who each have a different type of dementia.  

Gina – Alzheimer's Disease 

Gina has noticed that something might be off. She drove to work last week and couldn't remember why she was stopping by the office on a Saturday. She has realized that it's harder to remember names lately, and she loses her keys more frequently. But she attributed these behaviors to aging. After driving to the office, however, she started to worry. 

Nate – Vascular Dementia 

Nate is a teacher who never stops, but he feels like he has been slowing down lately, which is extremely frustrating. He usually puts together a lesson plan in about an hour and a half. But he's been working on his current lesson plan for the past 4 hours. He just keeps getting distracted and can't focus. His mind keeps restarting and drifting — even during his lectures. He's started to feel anxious and depressed and fears that he won't be able to teach anymore.  

Lucy – Dementia with Lewy Bodies 

Lucy's husband has become increasingly worried about her lately. Last month, she went on a long bike ride. After she got home, she couldn't remember where she rode and just seemed confused. A few hours later, she returned to awareness and seemed upset that she couldn't remember. Lucy also started talking in her sleep, and it takes a few more minutes for her to wake up in the morning.  

Bob – Frontotemporal Dementia

Bob is only 55 and his memory seems fine. However, his wife has been feeling hurt lately because Bob has been acting selfish and apathetic. He Is usually very caring and a sensitive partner. Bob and his wife threw a dinner party earlier this week, and Bob made a very insulting comment to one of his wife's friends. He doesn't seem to be acting like himself. 

Middle Stage

The moderate stage of dementia is the longest stage, lasting between 2 and 10 years on average. By the middle stage, the symptoms of dementia are clearly visible. During this stage, a senior becomes disabled. Seniors lose the ability to perform complex tasks, experience depression, lose control of their emotions, experience withdrawal, and may even become physically violent. Seniors may stop taking showers or wander off. But they may still be able to recognize family members and discuss memories.  

Gina – Alzheimer's Disease 

Gina's memory has continued to get worse. Her husband is concerned about her safety. Last week, she left the stove on. She started occasionally calling her husband by her father's name, and she will get confused for stretches of time. Gina retired from her job years ago, but she started waking up early and insisting that she needs to go to work. It's hard for her to get dressed and shower, so her husband has had to start helping her with these daily tasks. 

Nate – Vascular Dementia 

Nate had to stop teaching because of the progression of his dementia. While he is known for being cheerful, he has become agitated and irritable during the past weeks. He has gotten more and more confused. The other day, he couldn't remember the name of a new neighbor that moved in several months ago. Memory lapses embarrass Nate, so he has been withdrawing from social interactions. He decided to move in with his daughter, who has become increasingly concerned about Nate's ability to live alone.   

Lucy – Dementia with Lewy Bodies 

Lucy fluctuates between periods of alertness and confusion, which is difficult for her husband. Yesterday, she pointed outside and claimed there was a dog in the backyard. When her husband looked, there was nothing there. Lucy insisted that there was a dog and described it in great detail. She has started to shuffle and move more slowly. She's also started to trip over ledges at home. Her husband is struggling to know how to help her.  

Bob – Frontotemporal Dementia

Bob has continued to act unusually. He has also started to exhibit compulsive behaviors. For example, he wipes down the countertops frequently although Mary insists that they are clean. He started eating a lot more than usual and has put on a bit of weight. Bob has become forgetful, and even forgot that their daughter was coming to visit last week. He has trouble following long conversations and has stopped doing his daily crossword puzzles. 

Late Stage

During the final stage of dementia, a senior may lose the ability to speak, recognize family members, control their body, and recall memories. Seniors in the final stage of dementia need constant care and attention. Seniors in the late stage are at high risk for falling and for illness. They may also have difficulty swallowing, which can put them at risk for aspiration pneumonia.  

Gina – Alzheimer's Disease 

Gina is now thin and frail. She doesn't recognize her husband or her children sometimes. She can no longer walk and relies on a wheelchair. She also has difficulty eating and has lost control of her bowels and her bladder. Gina can still speak, but she has limited vocabulary and comprehension.  

Nate – Vascular Dementia 

Nate can't walk or eat anymore without assistance. In fact, he needs assistance with most tasks of daily living because he is physically weak. He is usually confused and disoriented. He has trouble communicating his thoughts to those around him, which causes him to be agitated. 

Lucy – Dementia with Lewy Bodies 

Lucy is now constantly confused and lacks awareness most of the time. She has frequent hallucinations and has become extremely restless. She is not steady on her feet and is prone to falling at home.  

Bob – Frontotemporal Dementia

Bob has become detached and his memory has started to decline. He also has difficulty communicating. He has gotten weaker over the past few months and has difficulty walking now, but he resists assistance from anyone else.  

Seniors may pass through these stages quickly, while some may take years to get to the next stage. There is no consistent trajectory. The progression of the disease depends greatly on the type of dementia and a senior's unique circumstances.  




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