January 3, 2024
dementia stages


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Dementia can be such a confusing disease because there are so many slow changes to the disease.

I've had patients who have recently been diagnosed with dementia and without spending much time with them I would not know that they even had that diagnosis.

Then I've had patients who are in the later stages of dementia and obviously you can tell that communication with them is difficult. 

The best approach is to ask the person to please tell you what they can and cannot understand if they're in their earlier stages and to let you know when they are confused or thinking before they can answer.

Many folks assume that when an older adult has not answered a question right away, they did not hear, but in truth they can be thinking about the answer and recalling the information they need before they can answer.

This assumption leads to hearing aids and misdiagnosis. It could really be the first stages of dementia.

I recently read an article, "The Do's and Don'ts of Dementia" and I found it to be misleading in that it didn't address the different stages of dementia. When communicating with anyone, it takes effort to figure out at what level you are speaking to them and if emotional strain is entering the picture. 

 The overall tips were good but they might insult the person in early stages of dementia well they would be very appropriate for those in the latter stages.

 So, let's look at the stages before we delve into the do's and don'ts of dementia.

 According to Alzheimer’s Association, there are 3 stages:

  • Early Stage (Mild): In this stage, individuals may experience mild cognitive decline, often unnoticed by friends and family. Memory lapses may occur, but daily functioning is generally intact. 
  • Middle Stage (Moderate): This stage is marked by more noticeable cognitive decline. Memory loss becomes more apparent, and individuals may have difficulty with tasks such as managing finances, remembering names and faces, and organizing thoughts. Behavioral changes, such as confusion and frustration, may also emerge.
  •  Late Stage (Severe): In the late stage, individuals experience significant cognitive decline and a profound impact on daily functioning. Basic self-care tasks become challenging, communication skills decline, and there may be a loss of awareness of time and place. Individuals in this stage often require assistance with activities of daily living.

But let’s get more specific:

For mild or early stages, common difficulties include:

  • Memory loss.
  • Difficulty planning and organizing
  • Coming up with the right word or name.
  • Confusion with time, place, dates, or events.
  • Remembering names when introduced to new people.
  • Having difficulty performing tasks in social or work settings.
  • Forgetting material that was just read.
  • Losing or misplacing a valuable object.
  • Mood or personality changes.
  • Becoming more anxious or irritable at things or people they used to enjoy.


NOTE: ⚠ Remember, any of the above things can occur when we are tired or overstressed.  We have all been guilty of the above actions without having dementia. 

 For Moderate or middle stages of dementia, you might see:

  •  Increased memory loss.
  • Being forgetful of events or personal history.
  • Feeling moody or withdrawn, especially in socially or mentally challenging situations.
  • Being unable to recall information about themselves like their address or telephone number, and the high school or college they attended.
  • Experiencing confusion about where they are or what day it is.
  • Problems with recognizing objects and their use. 
  • Making decisions becomes more difficult.
  • Requiring help choosing proper clothing for the season or the occasion.
  • Wandering or even sundowning.
  • Having trouble controlling their bladder and bowels (incontinence).
  • Sleepless nights.
  • Demonstrating personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding.

This stage can last for years. It is important to have someone check in with this person every three months to see the changes as they can be quite subtle.  If you see this person on a daily basis, you may not notice the decline, but this 3-month visitor will.  Then you can make the necessary adjustments in medical care and communication.

 The third stage, severe or late stage has the following characteristics:

  • Profound memory loss.
  • Loss of language. They may still know their name or recognize music.
  • Loss of motor skills. You may need to feed, bathe, and attend to this person 24/7.
  • Lose awareness of recent experiences as well as of their surroundings.
  • May not recognize familiar people anymore. 
  • Difficulty swallowing.
  • Have difficulty communicating.
  • Changes in sleep patterns.
  • Vulnerable to infections, especially pneumonia.

In the late stages of dementia the care must be compassionate and comforting. It is a wise caregiver who recognizes this stage and enlists the help of a palliative care expert to guide them through their own self-care and safety of all.

If you or someone you care for has been diagnosed with any type of dementia, it is worthwhile to prepare for the losses before they arise.

For us seniors, we would be smart to jump on the communication bandwagon early.  By this I mean we can start conversation now.  I address this very thing in my new FREE guide, The Super Ager's Starter Guide. Look at the questions on page 12 - 13.  Let's clear any confusing conversation out of the way now so we won't have any later. 

senior starter guide at 65

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