Dementia Stages

Do You Have Dementia?

People who have a friend or family member who has suffered from dementia will often be hyper-aware of things that could be a sign of symptoms in their own activities. However, the best indicator in these symptoms is the severity of the symptom itself.

If you are ever in doubt or are seriously concerned, consult your doctor as soon as possible. Early diagnosis -or being given the all-clear- can relieve stress and worry, and allow for planning and management.

The following is a list of typical changes related to aging that often make people wonder if they have the beginnings of dementia:

1. Making bad decisions
While we all make a bad decision now and then, the frequency of doing so will increase with age. The difference between this and a person with dementia is that the dementia patient will not only make a bad decision, she will have an overall lack of ability to make a decision or will have poor judgement concerning any decision.

2. Forgetting certain words when trying to carry on a conversation
Forgetting which word to use and having to think for a moment to remember it, or having to use a synonym or describe the word, is a common change of aging. In a patient with dementia, the mere act of having a conversation will be difficult. The person will not only forget the word, he will also not be able to think of a synonym for the word, nor will he be able to describe what he’s trying to think of.

3. Forgetting what day it is
Aging brings on small “blips” in memory such that a person will forget what day it is, but they will remember it later. Sometimes only a moment or two later, sometimes a few hours or so. In a patient with dementia, not only will they lose track of the day, the information will not “come back to them” later on. They may even forget what season it is, and will not be able to identify it by looking outside.

4. Missing a monthly payment, a weekly get-together, or other regularly scheduled activity
Don’t beat yourself up if you get too busy to remember all of your regularly scheduled obligations. Stress, emotional situations, increased work load and other factors can all attribute to forgetting a scheduled activity. The difference in a patient with dementia is that they will not only forget the activity, they will be unable to deal with the activity whatsoever. For example, rather than miss one single bill payment, they will be unable to manage their budget at all. Missing a weekly get-together will be caused by confusion over all of the smaller steps of getting to the get-together; for example the person with dementia will not remember how to dress appropriately for the function, they will not remember how to get to the function (even if they have a car sitting right outside in full view of their window), and in general they will become so caught up in the confusion of managing the “smaller” aspects leading up to the activity that the activity itself becomes forgotten.

5. Losing or misplacing items
Even at a young age, we will be busy going about our day and put something down, then later will be unable to remember where we put that object. Our mind simply wasn’t focusing on it at the moment and it became “background noise” that our brain filtered out. By retracing our steps and going back over what we were doing when we last had the object, we can often find what we were looking for. For example, we may have had the checkbook in our hand, and set it down on the table as we passed by, intending to pick it up again later.
In persons with dementia, he will not remember what he was doing when he misplaced the item, and will not be able to go back and retrace his steps whatsoever. Also, the items will typically be found in places that do not make sense; with the example of the checkbook above, it may be found among the bath towels, in the refrigerator, or someplace else that doesn’t “make sense”.

Mild memory loss on its own does not mean that you have dementia. People with dementia have severe problems with two or more brain functions, such as memory loss and language, or memory loss and fine motor control. If you are at all uncertain, check with your doctor and put yourself at ease one way or the other. Living with uncertainty is no way to really live.

Being a general description of a cognitive decline, the actual dementia stages are somewhat broad. There are only three, and although your doctor may at times mention a different number, it is likely that she or he is speaking of specific stages of a specific disease. For example, Alzheimer’s Disease has seven different stages, which is basically the three stages of dementia broken down into more specific sub-categories.

When talking with your doctor, it is important to know what he is referring to. Ask your doctor directly how many stages he believes there are, and what those stages are. This will help you to determine if your doctor is following general dementia stages or the stages of a specific disease. Knowing where your doctor is coming from will help to avoid additional stress and confusion.

Stage 1: Mild Cognitive Impairment
This stage of dementia will most likely not be diagnosed until the progression is almost to Stage 2. Symptoms are commonly passed off as “typical old-age forgetfulness”. The symptoms grow in seriousness as the disease causing the dementia progresses.

• Forgetting familiar words
• Misplacing commonly used items, such as eyeglasses or a wristwatch
• Loss of retention from something the patient just read, such as a newspaper
• Loss of productivity at work
• Slightly tricky arithmetic is unable to be performed, such as counting back from 100 by sevens (100, 93, 86, etc)
• Failure to recall recent events, such as what was eaten for breakfast, what the patient did the day before
• The patient has trouble discussing current events
• The patient begins to withdraw from social situations

Stage 2: Moderate Cognitive Impairment
At this point, the dementia has progressed enough that symptoms are easily recognizable. The patient will need help performing significant tasks such as leaving their home or going grocery shopping. By the end of this stage, the patient will require daily help for common tasks such as choosing the correct clothes to wear according to the season.

• Failure to recall personal details such as home address, telephone number
• The patient will show evident confusion over what the date is, what the day of the week is, and even what their location is
• The patient may become aggressive due to their confusion and frustration, arguing with their caregiver that the caregiver is wrong or is trying to trick them
• The patient may begin wandering and will easily become lost even in familiar surroundings
• “Sundowners Syndrome” – a state in which the symptoms become significantly worse in the mid-afternoon and the situation decreases rapidly as the evening goes by
• Vision may be affected; so much so that the patient complains that the house is always “too dark” or the patient will be found turning lights on during the day. This is not their imagination, their eyesight is suffering and as the disease causing their dementia progresses it becomes harder and harder for them to see.
• The patient will forget which medicine they took or at what time, and will either not take medicine because of that or will attempt to take more medicine. Medicine should be locked away and given by a caregiver.
• The patient may begin to perform obsessive-compulsive activities, such as repeatedly flushing the toilet, turning the burners on the stove on and off, checking the contents of the refrigerator repeatedly
• Generally in this stage the patient can recall their own name, the name of their spouse and their children; however the names of relatives, friends, and grandchildren that aren’t frequently seen will most likely be forgotten

Stage 3: Severe Cognitive Impairment
This final stage of cognitive impairment brings about the most significant changes for both the patient and the caregiver. Due to loss of memory, loss of motor control and basic bodily functions, personality changes are to be expected. In the beginning of this stage the patient will require assistance with many daily activities, by the the end of this stage the patient will be completely dependent on their caregiver.

• The patient will still remember their own name, but may forget the name of their spouse, children or friends close to them. They usually can distinguish between familiar and unfamiliar faces.
• Dressing will become a challenge; daytime clothes may be put on over pajamas, shoes may be put onto the wrong feet, etc.
• The patient may require help cleaning themselves after bowel movements
• The patient will need assistance bathing, and may refuse to bathe due to fear or embarrassment that they do not remember what they are supposed to do or not being <
• able to recognize their caregiver. (Would you want to undress and bathe in front of a stranger?)
• Significant changes in sleep patterns, such as insomnia or sleeping much more than usual, will occur
• Increase in urinary incontinence and fecal incontinence
• The patient will begin to suffer delusions, such as believing they are 40 years younger, or that their caregiver is stealing things from them, or that they are being held against their will and do not know why
• The ability to hold a conversation will severely decline, until the patient is no longer able to converse at all

Eventually, the brain’s ability to control motor functions will be so impaired that the patient will require help eating, walking, and even sitting up without support. The patient becomes unable to respond to their environment, and unable to communicate – although they may vocalize a stray phrase here or there unexpectedly. The muscles slowly become rigid, and as the cognitive abilities decline even the ability to swallow becomes impaired.

Because each person’s body is different, and each disease is different, the speed at which each patient progresses through these stages will be unique to each patient. Generally though, once a patient progresses into dementia Stage 3, the decline is rapid and patients live an average of only sixteen months. However, advances in medicine have allowed doctors to slow the progression of dementia in some patients. The sooner the patient is diagnosed and begins treatment, the better. Remember also that “averages” are made by “the most” patients experiencing whatever it is that is considered “average”. There are patients who fall short of the average, and patients who far exceed the average. Just because you or your loved one has officially entered a specific dementia stage does not mean that they have exactly X years to live, or will lose the ability to do a certain thing within X amount of time. Each person is different, and each person’s journey through dementia is unique.