Key Takeaways
- Dementia progresses in seven stages, from no cognitive decline to very severe cognitive decline.
- The stages range from mild memory lapses to needing help with all personal care tasks.
While everyone’s experience is different, dementia typically follows a progressive pattern. The 7 stages of dementia are 1) no impairment, 2) very mild cognitive decline, 3) mild cognitive decline, 4) moderate cognitive decline, 5) moderately severe cognitive decline, 6) severe cognitive decline, and 7) very severe cognitive decline. Knowing how the disease progresses and the changes that can happen can give you a better understanding of what to expect.
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What Is Dementia?
Dementia is marked by a severe decline in cognitive functions, such as thinking, reasoning, and remembering, to the extent that it interferes with the person’s daily life.
Dementia typically affects older adults, but it is not a normal part of the aging process. While some amount of forgetfulness is normal with age, dementia is a severe disorder that can affect a person’s ability to function on a daily basis.
According to the National Institute on Aging, about one-third of all people above the age of 85 have some form of dementia. Dementia can stem from various causes, the most common being Alzheimer’s disease. Some of the other causes include:
Dementia progresses in stages, ranging from mild to severe. In 1982, Dr. Barry Reisberg developed the Global Deterioration Scale (GDS), consisting of 7 stages, to help clinicians categorize the progression of dementia.
How Dementia Progresses
The stages are as follows:
- No cognitive decline
- Very mild cognitive decline
- Mild cognitive decline
- Moderate cognitive decline
- Moderately severe cognitive decline
- Severe cognitive decline
- Very severe cognitive decline
Stages 1 to 3 are the pre-dementia stages, whereas stages 4 to 7 are the dementia stages. Clinicians typically compare the person’s symptoms to the criteria listed for each stage and use their judgment to determine which stage the patient is at.
The seven stages of dementia are outlined below.
Stage 1: No Cognitive Decline
At this stage, the person can function normally and exhibits no signs of memory loss, confusion, or cognitive impairment. They are free of symptoms and don’t appear to have any signs of cognitive decline.
However, the structure and functioning of their brain may have started to deteriorate as neurons (nerve cells) began to lose connections with other brain cells and die.
Stage 2: Very Mild Cognitive Decline
The person starts to experience occasional lapses of memory, such as:
- Forgetting where they keep familiar everyday objects
- Forgetting names they once knew very well
At this stage, the symptoms are unlikely to affect the person’s work or social interactions. It isn’t uncommon for people over the age of 65 to experience some cognitive difficulties, and some decline in abilities is a normal sign of aging. But it may also be a sign of the second stage of dementia.
In fact, the symptoms may even be too mild to detect in a clinical interview with a healthcare provider, as the person may be able to adequately perform memory tests during the interview.
Stage 3: Mild Cognitive Decline
This is the stage at which cognitive impairment becomes more noticeable to the patient, their friends, family members, and colleagues.
The person may start to show symptoms such as:
- 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 of importance or value
- Having trouble concentrating and performing complex tasks
- Experiencing increasing difficulty in social settings
- Frequently forgetting words and the names of loved ones
- Performing poorly at work to the extent that it becomes evident to colleagues
The person may start to feel anxious as their symptoms begin to become apparent and interfere with their ability to function.
Stage 4: Moderate Cognitive Decline
In this stage, the person will exhibit a clear decline in cognitive function during a clinical interview.
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
At this stage, the person will likely still be able to recognize loved ones’ names and faces and navigate familiar places. However, they may start to avoid challenging situations to prevent anxiety and hide their distress from others.
Stage 5: Moderately Severe Cognitive Decline
From this stage onward, the person may no longer be able to function without some assistance.
These are some of the symptoms of this stage:
- Difficulty recalling a vital detail, such as their address, phone number, or high school
- Disorientation in terms of place and time, such as confusion regarding the season, date, day of the week, or time of day
- 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 making decisions
In this stage, the person can likely still remember their own name and the names of their spouse and children, but may struggle to recall their grandchildren’s names. They may be able to eat and use the bathroom without assistance, but may need help with tasks such as deciding what to wear.
Stage 6: Severe Cognitive Decline
At this stage, the person may require a high degree of care, as they may have symptoms such as:
- Difficulty remembering the names of their spouse, children, or primary caregivers
- Lack of awareness regarding all the recent events and experiences in their life
- Patchy or skewed recollection of their early life
- Difficulty counting backward or forward to 10
- Lack of awareness regarding their surroundings, as well as the time and place
- Inability to travel alone without assistance
- Tendency to wander
The person is also likely to experience emotional and personality changes, such as:
- Paranoia, hallucinations, and delusional behavior, such as talking to themselves or believing their caregivers are trying to harm them
- Obsessive symptoms, such as repeatedly performing cleaning activities
- Agitation, anxiety, and even violent behavior
- Loss of willpower due to being unable to carry a thought long enough to complete the action
During this stage, the person is likely to still remember their name and distinguish between familiar and unfamiliar people in their environment. They will probably need assistance with daily living activities and may experience incontinence and sleep-related difficulties.
Stage 7: Very Severe Cognitive Decline
In the final stage, the brain appears to lose its connection to the body and becomes incapable of telling it what to do.
The person is likely to progressively lose their motor skills and the ability to speak. They may only be able to utter unintelligible sounds or words, if at all. They will need assistance with all personal care tasks, such as eating, walking, and using the bathroom.
What to Do Next
If you believe that you or someone you love is experiencing the stages of Alzheimer’s disease, it’s important to talk to your healthcare provider. They can look for symptoms and make recommendations to help slow the progression of the disease. There is no cure for the condition, but treatments can improve functioning, slow the disease’s progression, and make it more manageable.
Medications like Leqembi (lecanemab) and Kisunla (donanemab) can help slow cognitive decline and improve functioning. Cholinesterase inhibitors may be prescribed to increase acetylcholine levels in the brain and improve cognitive functioning. Other medications may also be prescribed to address specific symptoms, such as difficulty sleeping and agitation.
