What Are The Seven Stages Of Dementia?
Dementia progress can be gradual in stages ranging from early stage advancing to late stage dementia. Some people with dementia will advance in the dementia stages gradually, like stair steps. Others will progress rapidly through the seven stages of dementia.
Even though dementia is often associated with the elderly, it's important to remember that this severe disorder is not part of a normal aging process. In fact, according to the National Institute on Aging (NIA), around one third of adults over 85 years old are likely struggling with some form of dementia. This condition can start for different reasons— from Alzheimer’s disease, and Parkinson’s disease all the way through Lewy body Dementia,and Frontotemporal Dementia– Dementia progress can be gradual in stages ranging from early stage advancing to late stage dementia. Some people with dementia will advance in the dementia stages gradually, like stair steps. Others will progress rapidly through the seven stages of dementia.
What is the life expectancy after a diagnosis is made?
Many ask me what is the life expectancy after getting a diagnosis . There is no way to determine the exact life expectancy. Some put the average at about four to eight years after diagnosis. But I can tell you, there are types of dementia that a person can live as long as 20 years after diagnosis.
Most people do not know that brain changes start as early as 10 years prior to an official diagnosis. So they are developing dementia and dementia signs and symptoms are very subtle in what we call the early stages of dementia.
What is dementia?
Dementia is an umbrella term used to describe a wide range of neurological conditions that affect someone's ability to think, remember and reason. It can impact individuals in different ways; from mild changes such as occasional forgetfulness or personality shifts through to the most severe stages when cognitive skills severely decline. The majority of cases are caused by Alzheimer’s disease whereas other factors which may trigger dementia include vascular issues or abnormal protein buildup in the brain known as Lewy body dementia. Understanding its associated signs and symptoms remains paramount for early intervention strategies.
Because there are so many different types of dementia, I want to address a few of the different types, because the early stages of each can be different. As the dementia progresses, and brain cells start to die off, symptoms affecting memory loss and physical abilities will affect everyday tasks. By the middle stages of dementia a person living with dementia will follow through dementia stages. I am going to briefly explain these conditions here. I have dementia specific audio casts in caregiver reliefs library.
Types of Dementia
Alzheimer's Disease is the leading cause of dementia, accounting for an estimated 60-80% of all cases. Although its exact origin remains a mystery, research suggests it could be attributed to abnormal protein clumps and threads in the brain which causes damage that leads to shrinkage over time. These proteins are called amyloid plaques. These plaques and tangles cause brain cells die and the brain shrinks.
Alzheimer's Disease
Alzheimer's Disease (AD) is a type of progressive brain disorder that can affect thinking, memory and language. It most commonly seen in people over 60. It first involves the parts of the brain that control thought, memory, and language. In the beginning stages a person with Alzheimer's Disease may have trouble remember things that happened recently or the names of people that are familiar to them.
I want to make you aware of a condition called mild cognitive impairment (MCI). This causes more memory problems than usual for older adults. This is a condition that allows the individual with MCI to continue to be able to preform everyday tasks. It can advance into Alzheimer's disease. Many, but not all, people with MCI will develop AD.
Vascular Dementia
Common types of dementia include Vascular Dementia -this dementia is caused by restricted blood flow to the brain due to blocked, narrowed or damaged vessels often resulting from stroke or other trauma.The blockages commonly occur as a result of a stroke or a traumatic brain injury. Individuals that have high blood pressure may start with having mini strokes, also known as TIA's transient ischemic attacks. Causing vascular dementia can also happen gradually. Such limited oxygen supply can cause reasoning and memory problems leading to further deterioration in cognitive abilities over time.
Lewy Body Dementia
Let's talk about Lewy Body Dementia or LBD. Lewy bodies are a type of protein that can grow in abnormal amounts in the nerve cells of the brain. It can cause difficulty with movement and thinking. Those affected may experience trembling, a decrease in muscle control and an inability to process information quickly or accurately. The point I want to make is this is different than most types of dementia in the beginning stages, because (LBD) affects information processing, rather than memory. LBD is the most misdiagnosed dementia. This is because the symptoms of lewy body are symptoms similar to other mental health disorders.
To make matters worse, the causes of LBD remain unknown today making effective treatments difficult. Right now health professionals are focused solely on managing symptoms rather than curing them altogether.
Frontotemporal Dementia.
Another type of dementia is Frontotemporal Dementia. This is an uncommon type of dementia. Frontotemporal dementia affects younger people between the ages 45-65. It's caused by a buildup of abnormal proteins in two parts of the brain, the frontal and temporal lobes. These regions of the brain control language, behavior & personality. People living with this type often have language skills affected. They will also experience mood swings and changes in their behavior.
Mixed Dementia
I want to make you aware there is a condition called mixed dementia. Mixed dementia is an umbrella term that encompasses several different forms of brain diseases, with Alzheimer's disease and vascular dementia being two of the most common dementias that may occur together.
Another combination that has been found is a combination of Alzheimer’s Disease and Dementia with Lewy Bodies. There have been autopsies done on individuals that suffered from dementia. There have been cases that had a form of mixed dementia that includes Alzheimer's disease, LBD and vascular dementia.
Dementia is a complex condition, with many unique experiences that depend on the individual. No two case of dementia are the same. But it does share common characteristics as the disease progresses. The Reisberg Scale outlines seven distinct stages of dementia life expectancy, based upon how much cognitive decline has taken place.
The First Stages of Dementia
The first stage of dementia initially there is no sign at all. It is called the normal stage of dementia. Stages 1-3 of dementia progression are generally known as "pre-dementia" stages.
In Stage 1: there is No Cognitive Decline that is able to be detected. It is now believed that individuals that develop Alzheimer's, or LBD may be experiencing subtle brain changes as early as 10 years before dementia symptoms.
Some subtle changes to occur may be lethargy and a change in interest in life and those around them. I have had family members notice a change over time that impacted how they viewed their family member with dementia. The personality changes that occurred in the very early stages negatively impacted family relationships.
This is especially true of LBD, as it is often misdiagnosed as a mental health disorder. If you want to learn more about the very early signs of dementia take time to listen to my audiocast on that topic in my library.
I want to make you aware of several dementia related disorders or illnesses that will have no cognitive decline in the early stages of dementia. Individuals that have been diagnosed with normal pressure hydrocephalus, multiple sclerosis and Huntington's disease may develop dementia like symptoms as their disease progresses.
Second stage of dementia
The second stage of dementia is known as very cognitive impairment stage. In this early stage there is very mild cognitive decline - while still sharp on most days – is one of the earliest signs.
In this stage of dementia, the person starts to experience occasional memory loss, such as:
Forgetting where they keep familiar everyday objects
Having difficulty remembering recent events
Forgetting names they once knew very well
In this early stage of dementia, the dementia symptoms are unlikely to impact a person’s work or social interactions.
In fact, the symptoms may even be too mild to detect in an interview by your health care team. As the person with mild impairment may be able to adequately perform memory tests during the interview. This is when your health care provider that will do, or should do a Mini mental status exam. Please understand that a the MMSE requires a baseline. I feel that everyone should have a Mini mental status exam in their early 60's, so that changes can be detected.
I recommend that you ask your provider to perform a St Louis University mental status exam. This is a test that is able to detect minor or more subtle changes in your thinking processes. I have had so many clients tell me that they went to their doctor and have even been to a neurologist to be told they are fine. They did well on the mini mental status exam.
Our medical delivery system is broken. If you are under Medicare, doctors are allowed a 15 minute appointment. This is not enough time for a doctor to do a comprehensive mental status evaluation. When I heard that they did not do anything other to rule out reversible dementias, I understood her frustration. Everything we read and hear from health care providers is early treatment is important to improve quality of life for a longer period of time. In mild alzheimer's disease, lifestyle changes, medications and even playing games can delay the progression to develop alzheimer's disease into the advanced stages of dementia.
One client's story of getting a diagnosis
I recently had a client upset, because she her risk factors are high as she has a family history of dementia. She clearly is having periods of memory loss. She was clearly upset, scared. I was so angry and frustrated with the medical delivery system. I made my client aware of the Quest AD- Detect program. It is not presently approved by FDA. So therefore Medicare will not cover the test. You can actually call quest diagnostics for the test. This is one of two blood tests on the market to detect amyloid levels in the blood. and diagnose dementia. The other test was over $1200. For cost purposes, I recommended the Quest AD detect.
It was $500 for this test. My client didn't care. Peace of mind was important. And, early diagnosis will allow us to make a plan to slow the decline as the disease progresses.
Blood Tests for Alzheimer's disease
To help assess whether patients exhibiting signs of MCI or dementia may have AD, Quest Diagnostics offers the Quest AD-Detect™, Beta-Amyloid 42/40 Ratio, Plasma test (test code 11786). This simple blood test provides a simpler option than PET imaging and less invasive than Cerebral Spinal Fluid sampling.
My client received her results and she did have a higher than average amount of beta amyloid plaques. She was able to take her test results back to the neurologist and her PCP to show them they were wrong. We worked to start a program to delay the progression of the disease. Its ironic, once you diagnose dementia, the doctors will believe you and work to prescribe meds. I am presently working with my client on slow the progression of the disease.
Stage 3
Stage 3 of Mild Cognitive Impairment is characterized by noticeable impairments in short-term memory and cognition - from getting lost easily or forgetting names, to difficulty retaining information read or concentrating on tasks. After I am have been working with clients over the years, I am just frustrated at our medical delivery system. I cannot tell you how many times of have called geriatrician offices and neurologists offices and ask will they do comprehensive dementia testing. Most tell me, that the initial test is doing the mini mental status exam. Again, this test needs a baseline. So, when a person in stage 3 of dementia can and most likely will be told they are fine and don't have anything to worry about.
Common symptoms of dementia at this stage start to interfere in normal activities of daily living. A person may experience
- Getting lost while walking or driving, particularly in unfamiliar places
- Reading something and retaining very little of it
- Forgetting the names of people they’ve just met
- Losing items or misplacing items
- Having trouble concentrating and performing complex tasks
- Experiencing increasing difficulty in social settings
- Performing poorly at work, to the extent that it becomes evident to colleagues
With proper diagnosis at this stage patients can learn helpful coping strategies and put plans into motion that will aid them in worrying less as these symptoms become increasingly disruptive day-to-day life concerns. If you are struggling to get a dementia diagnosis, i encourage getting the blood tests. For those that cannot afford to get the blood tests take the various dementia tests you can find on caregiver relief. There are many different tests, like the clock drawing, animal naming, as well as the Mini Mental Status Exam and SLUMS test. Take these tests and keep records of your results. Take those results to your health care provider to get an accurate and early diagnosis.
At this stage, a person may start to be aware and start to feel anxious as their symptoms start to become apparent and interfere with their ability to perform routine tasks.
Middle stage of dementia
At Stage 4 of cognitive decline, is considered mild dementia stage. A person's dementia symptoms may become more apparent and noticeable than before; they may find it difficult to concentrate on complex tasks or remember events that occurred recently. . Socializing with friends and family can also be affected as people withdraw from situations due to their heightened difficulties.
Some of the symptoms of this stage may include:
- Lack of knowledge of current and recent events
- Difficulty remembering parts of their own personal history
- Trouble with organizing, planning, traveling, and managing finances
- Difficulty with problem solving
Physicians will typically detect signs of dementia at this stage through clinical evaluations.
Stage 4
In stage 4 dementia typically individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Stage 5
Patients at stage 5 is still considered a middle stage or mild dementia may struggle to remember major details, such as a close family member's name or home address. They can become disoriented regarding the time and place, while having difficulty with decision-making processes. Additionally they might not recall basic facts about themselves like their own phone number or address; however this level of dementia does not interfere with essential tasks, including using the restroom and feeding oneself. They may need help to decide what to wear. They may want to wear winter clothes in the middle of summer.
Difficulty counting backward from 20 by 2s or from 40s by 4s (provided they are educated and were once able to do this calculation)
Trouble with problem solving
While patients will generally still know who they are and be able to recognize spouses and children's' names, people living with dementia in this stage require some support for everyday activities .
Stage 6
Patients in stage 6 of dementia will require full-time care, as they have difficulty remembering even the names of their closest family members. Observe for signs such as delusional behavior, obsessive compulsions and symptoms, anxiety or aggression, paranoia, and even hallucinations.
The loss of willpower occurs is due to being unable to carry a thought long enough to complete the action. The person living with dementia may start to have wandering tendencies, and start sundowning, as they have increased sleep disturbances. Other dementia symptoms include difficulty communicating at this middle stage of dementia.
As dementia progresses, more than just short-term memory can be affected. Not only may those with moderate dementia struggle to remember past events, they often experience drastic changes in personality and behavior - feeling distrustful or anxious even around people who are familiar faces in their daily routine.
Caregivers should seek professional help if there is a sudden increase in these behaviors or indicators that would indicate further deterioration of other health conditions.
As dementia progresses to its seventh and final stage, those affected experience severe decline in cognitive status, and have increased difficulty communicating . Physical changes such as the the inability to walk with out help occurs.
The average duration of this late stage dementia is two and a half years. During which time people with severe dementia may require full-time assistance from friends and family members—and become prone to infections like pneumonia. Though it can be heartbreaking for caregivers watching their loved ones reach this difficult point in life's journey, providing patience, love & support makes all the difference for those whose lives are touched by extreme mental decline brought on by age or illness.
Living with dementia can be difficult and unpredictable. Being informed is the key to better navigating the disease progression. With in-depth knowledge on how it develops, you'll have a much clearer idea of what precautions need to be taken and ways that you could potentially slow down its effects.
