Knowing the stages of dementia can help loved ones, and those living with dementia understand what comes next and the care needs that are to be expected. This post will highlight the stages, rating scales of dementia and the different care needs that are to be expected as dementia progresses.
Stages of dementia
Understanding the stages of dementia can help in communication with health professionals and assist in selecting the best course for treatment. Stages of dementia are typically assigned based on the symptoms being displayed. It can be helpful to understand the stages as it can show how the symptoms will change over time. For those living with dementia, there can be dramatic mood swings and changes in physical ability, and these changes can be stressful not only for those living with dementia but also for the caregivers, families and friends. Being prepared by understanding what might come next can help reduce stress and anxiety.
There are two common ways to consider the stages of dementia. The first, simply mild (early), moderate (middle) and severe (late). These can be rather broad descriptors and stages. A more narrow view of the stages can be done through scales.
Rating scales of dementia
Just as the three stages of dementia, scales can assist in communication with health professionals and provide an understanding of the progression of dementia. The scales go into further detail about the cognitive and physical abilities of the person. There are three standard scales; the Functional Assessment Staging Test, Clinical Dementia Rating. The most well known and used scale is the Global Deterioration Scale for Assessment of Primary Degenerative Dementia.
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia, also referred to as GDS or Reisberg Scale, is most relevant in describing dementia progression for those with Alzheimer’s and outlines the progression into seven stages based on the amount of cognitive decline the individual is experiencing. A dementia diagnosis is typically made in stage 4 and up, as individuals in stages 1-3 generally do not display enough symptoms for a dementia diagnosis. Stage 4 is labelled as early dementia, 5 and 6 are moderate dementia, and stage 7 is considered late dementia. A completed list describing GDS can be found here.
Level of care needed in the different stage of dementia
When an individual is initially diagnosed with dementia, they most likely will not need care assistance, but as dementia progresses, they will require care. Depending on the progression of the disease and the stage of dementia the individual is in, their need for care will change.
Early-stage: When an individual is just diagnosed, typically, they are in the early stages. At this stage, the individual can function physically and cognitively rather independently. They generally do not require care assistance. The individual might have minor memory slips and could benefit from simple reminders of appointments and names of people. Even though caregivers’ physical needs are typically not seen in this stage, caregivers can still offer support. When an individual is diagnosed with dementia, it is beneficial for them to have someone there to help them cope, help them complete daily tasks, and have someone there to talk to as they come to terms with this life-changing diagnosis. In all stages, it is important to assess any safety concerns. If there is a task that cannot be performed safely alone, assistance should be available. At this stage, it is also a good time to discuss long term plans. Loved ones should understand how the individual would like their care to be managed.
Middle-stage: During this stage, some independence is lost for those living with dementia. Typically it will begin with the individual needing prompts or cues to remind them to perform certain tasks. It will then move to more hands-on assistance. They will need additional help completing activities of daily living, such as bathing or dressing. As communication in this stage becomes more difficult, having a routine in place can help limit the anxieties of what comes next in the day while assisting with their memory. It will become unsafe to leave the individual alone at this stage, and they will require more supervision.
Late-stage: In this stage, the individual will require a significant amount of care. They will need support moving from bed to a chair or become bedridden and require care to prevent bedsores. Complete care will be required as the individual progresses in this stage. Additionally, in the later stages swallowing may become challenging and caregivers may have to ensure food is cut into small pieces, is soft or pureed.
Many families are not equipped to support their loved ones as they enter later stages for dementia and will require a hired caregiver or seek out long term residential care options. The progression of dementia can be challenging to cope with for the individual as well as family and loved ones. It is important to discuss the desired care plan for the individual as early as possible to ensure all their needs, wishes, and preferences are met.