The Seven Stages of Dementia

February 23, 2021

The onset of dementia can be intimidating to patients, primary caregivers, patient advocates, and the entire family unit. As challenging as it sounds, research shows that earlier detection of dementia disorders will ultimately reduce the risk of anxiety and depression for everyone involved. The earlier the diagnosis, the more time for everyone to adapt, learn about the disease, and be aware of all options and dementia treatments and dementia therapies, like learning to practice a Healthy Brain Lifestyle.

The right attitude is crucial to success. Educating those involved about dementia and maintaining a positive and realistic attitude can make a world of difference in stress and quality of dementia care.

Approximately half of dementia patients are diagnosed with Alzheimer’s disease. This disease progresses over time. The progression and the symptoms vary by individual, but experts use “stages” to explain how a patient’s normal abilities change as Alzheimer’s progresses. Source: Global Deterioration Scale/Reisberg Scale,

Stage 1:  No Real Cognitive Impairment

During the first stage, there is no tangible or visible cognitive impairment. Unless a patient receives a specialized scan, like a PET scan, there is no physical or mental sign of any underlying issue. Identifying these early signs may be essential for clinical trials and in the future as new treatments are developed for Alzheimer’s.

Stage 2: Very Mild Cognitive Decline

Individuals with mild cognitive decline have mild changes in their memory and thinking ability. These changes aren’t significant to affect lifestyle, relationships, or even work. Early symptoms of dementia include mild memory loss in areas that are usually easy to remember. Examples include forgetting names, conversations, misplacement of objects, or recent events. The ability to judge time can also be impaired. Not everyone with a mild cognitive decline has Alzheimer’s. At this stage, professionals can diagnose Alzheimer’s disease or if the mild cognitive decline is due to something else.

Stage 3: Mild Cognitive Decline

During this stage, loved ones begin to notice dementia behaviors. There is increased forgetfulness, particularly of recent events. Individuals experience difficulty concentrating, problem-solving, and complex problems. Things like balancing a checkbook may become difficult. Organizing and expressing thoughts becomes challenging at times. Personality and behavioral changes may begin to emerge, such as being less interested or involved in family life or previously enjoyed activities, or being less inhibited in social situations.

Stage 4: Moderate Cognitive Decline

Individuals with moderate cognitive decline show increasingly poor judgment and deepening confusion. Memory loss continues to deepen and includes personal history, phone numbers, or even a current address. Typical dementia behaviors during this stage may include denial of cognitive changes and withdrawal from friends and even family. Social situations may cause anxiety or irritability. Family and friends may notice more significant changes in personality and behavior, including agitation, aggression, changing moods with periods of depression or anxiety, or social withdrawal and apathy. Other individuals may have psychotic symptoms such as false beliefs (delusions) or sensory perceptions (hallucinations).

During this stage, individuals will need some help. They may not be able to perform daily activities on their own. Tasks, like choosing the proper clothing, bathing, and preparing meals, are no longer straightforward and assumed.

Stage 5: Moderately Severe Cognitive Decline

Individuals will need more assistance with average daily tasks like those defined in Stage 4. People in this stage suffer from significant memory deficiencies. They may lose track of where they are, the day of the week, or what year it is. It will become challenging to remember the time of day.  Often people will forget where they are. This is a cause for “wandering.” Individuals who are suffering from confusion may wander around to find something or someone who is familiar.

Behavioral disturbances and psychosis continue to be relatively common symptoms seen in this stage.

Stage 6: Severe Cognitive Decline (Middle Stage Dementia)

Individuals in this stage will not be able to carry out average daily tasks without help. Memory loss is so significant that patients can forget family names. Major, meaningful past events may be overlooked entirely. Incontinence (loss of bladder control) is common, and loss of bowel control is sometimes experienced. Individuals may not be able to speak with typical ease. They might forget words or not be able to emphasize their thoughts. All these additional stressors will increase the recurrence of mood and behavioral disturbances.

Stage 7: Very Severe Cognitive Decline (Late Stage Dementia)

People suffering from very severe cognitive decline are mostly physically incapacitated and spend a lot of time sleeping. Individuals can no longer speak or communicate. Because of loss of motor skills, patients will require assistance with most activities. They will not be able to walk.

Wherever you and your loved ones may be in your journey, know there is help, continuous clinical research, and most of all, support. For caregivers, for patients, and communities.

At Miami Jewish Health MIND Institute, we believe people with Alzheimer’s and other neurocognitive disorders can continue to live with purpose and joy. Our entire practice is devoted to empathic diagnosis, brain fitness, mind exercises, innovative research, and high-touch, one-on-one care and support for individuals and their families. Every family and every individual is unique. Their treatment should be too.

Take action. Schedule a full clinical assessment today, for you or for someone you love.


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