Although symptoms of cognitive impairment vary greatly among Alzheimer’s patients, stages of dementia generally follow a pattern that presents progressively worsening symptoms.
Sometimes the progression is rapid and glaringly obvious, with affected individuals going from mild short term memory loss to vivid auditory or visual hallucinations in less than six months. Others may suffer minor cognitive issues for 20 years before entering the latter dementia stages that require 24-hour care in a nursing home.
Momentum of deteriorating brain functioning depends on several factors, mainly the patient’s health and type of dementia affecting the brain. Several dementia testing examinations are available that provide physicians with an accurate assessment of the patient’s level of cognitive impairment and which of the stages of dementia the patient may be currently experiencing.
The Seven Stages of Dementia Global Deterioration Scale
Created by Dr. Barry Reisberg, who is Director of the Clinical Core of the U.S. National Institute on Aging and Professor of Psychiatry at New York University, the Seven Stages of Dementia Global Deterioration Scale provides a detailed overview of dementia stages commonly suffered by people diagnosed with dementia or Alzheimer’s disease.
Stages one, two and three are considered “pre-dementia stages”, in which patients experience mild cognitive decline. Complaints often involve misplacing object, forgetting names that were once easy to remember or inability to retain sufficient information after reading something that allows the patient to comprehend the main point of the piece. People diagnosed with one of the first three stages of dementia are well-oriented to time and place, but may exhibit the beginnings of denial accompanied with minor anxiety over increasingly discernible symptoms.
Stages four, five, six and seven represent the actual dementia stages of the disease. Stage four is labeled “moderate cognitive decline” on the SSDGDS and involves the following symptoms:
- Memory deficits regarding personal history or history of family members
- Reduced ability to manage finances and make rational decisions about spending money
- Definite problems with learning new or complicated tasks, such as putting together a bookcase even though clear instructions are provided. This is especially evident if the patient had not previously experienced problems in this area.
- Indulges in denial and withdraws when confronted with incidences of cognitive decline
- Although patient knows what day it is, year and time, he may have difficulty recalling what events occurred the previous day
Stage five is called “moderately severe cognitive decline” and indicates a patient who cannot live comfortably without some assistance. People with this level of cognitive impairment cannot recall their telephone number or address and will frequently mix-up family names and faces. Although they do not need help with personal hygiene, stage five patients exhibit difficulty choosing suitable, weather-appropriate clothing to wear. Discerning mismatched shoes from matched shoes is another common issue with stage five dementia patients.
“Severe cognitive decline” describes stage six of the SSDGDS, in which patients begin forgetting names of spouses, children, or siblings. For the most part, they will remain forgetful and unaware of recent experiences or events happening to them exclusively. They respond inaccurately and with confusion to questions about the year, season or where they are. Counting to ten both backwards and forwards is difficult and they may develop incontinency as a result of declining organ functioning.
Sleep is often disturbed, with patients often awake at night and wandering around their home without any idea of what they are doing. During these six stages of dementia, patients usually know their own name but women who have been married more than once often use previous last names when asked about their name. In addition, symptoms seem to worsen at night due to disruptions in the circadian cycle and normal body temperature, a condition referred to as “sundowning”.
Distinct personality and behavioral changes appear at this stage. Delusions, paranoia, aggression, depression, anxiety and the belief that a spouse is an imposter are common symptoms of advanced dementia. Obsessive-compulsive actions may develop that involve dusting one table for hours or wiping the same spot on a mirror repeatedly even though it is clean. OCD behavior often arises in the later stages of dementia because it relieves anxiety generated by the inability to distinguish rational behavior from irrational behavior.
The most advanced level of dementia according to the Dementia Global Deterioration Scale, is level seven, or “very severe cognitive decline”. Symptoms of patients diagnosed with level seven dementia include:
- Loss of verbal abilities (muteness or unintelligible speech)
- Inability to perform independent actions such as eating and walking
- Severely diminished neurological reflexes–rigidity or catatonia prevents the patient from moving unless someone places them in a certain position
- Rapid weight loss
Brain Imaging Scans
MRI and CT scans clearly show differences in brain architecture as the brain progresses through these seven stages of dementia. Distinct images of the brain’s outer layer shrinking, blood clot formations, ventricle enlargement and blood vessel deterioration inevitably emerge in brain scans of people suffering from dementia and Alzheimer’s disease.
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