What Are The 7 Stages of Dementia?

The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, breaks down an overview of 7 stages of cognitive function in patients with dementia.

Dementia is a general term for a group of brain disorders that cause problems with thinking, reasoning, judgment, and memory. The problems must be severe enough to interfere with a person’s daily activities and independence. 

The most common kinds of dementia include:

• Alzheimer’s disease, the most common cause of dementia
• Vascular dementia, most common among people who have had a stroke or who are at risk for stroke
• Parkinson’s disease dementia, which occurs when Parkinson’s disease gets worse 
• Brain damage and head injuries

Symptoms of dementia are usually mild to begin with, and slowly and progressively worsen.  

Early symptoms of dementia may include:

• Forgetfulness
• Confusion
• Problems with language, such as being un able to find the right words for things
• Difficulty concentrating 
• Problems with reasoning
• Difficulty with everyday tasks such as paying bills or balancing a checkbook
• Getting lost in familiar place

As dementia progresses, symptoms may include:

• Episodes of anger or aggression
• Depression 
• Loss of interest in surroundings (apathy)
• Seeing things that aren't there (hallucinations)
• Believing things that aren't true (delusions)
• Inability to eat, bathe, dress, or perform other everyday tasks
• Loss of bladder and bowel control (incontinence)
• Sleep problems
• Disorientation

Dementia can be caused by several different brain disorders, including: 

• Alzheimer’s disease 
• Vascular dementia  
• Dementia with Lewy bodies 
• Parkinson’s disease dementia  
• Frontotemporal dementia (formerly called "Pick disease")
• Mixed dementia, when there is more than one cause of dementia, often both Alzheimer’s disease and vascular damage
• Other causes of dementia are caused by cumulative damage to the brain over time
  • Chronic alcoholism 
  • Repeated head injuries, such as from professional sports (chronic traumatic encephalopathy, or CTE)

Risk factors for developing dementia include: 

• Age over than 60 years; becomes very common in people older than 80
• Family history 
• High blood pressure
• Smoking
• Diabetes 
• Sedentary lifestyle or social isolation 
  • People who stay physically active, socially connected, and mentally engaged seem to be less likely to develop dementia 

Doctors usually diagnose dementia based on a patient’s history and symptoms, along with information provided by family members. 

Doctors may also perform memory and other cognitive tests to assess the degree of difficulty with different types of problems. These tests can be given again and monitored over time to observe any decline in function.

Other tests that may be indicated to help confirm dementia or rule out other conditions include:

• Blood tests to check for: 
  • Chemical or hormonal imbalance 
  • Vitamin deficiency 
• Brain scans (usually magnetic resonance imaging [MRI]) to look for other problems 
• Scans may also help identify the type of dementia, based on certain characteristic brain changes 
• Lumbar puncture (spinal tap) can also help identify the type of dementia

Treatment for dementia depends on the kind of dementia that is present. 

Treatment for dementia includes:

• Medications to manage memory problems
  • Cholinesterase inhibitors
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne)
  • Memantine (Namenda, Ebixa) works differently than cholinesterase inhibitors and may protect the brain from further damage caused by Alzheimer’s disease.
• Behavioral therapy to manage behavioral problems
  • Changing the person's environment (e.g., regular exercise, avoiding triggers that cause sadness, socializing with others, engaging in pleasant activities that a person enjoys)
• To manage depression
  • Behavioral therapy
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Brisdelle, Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro, Cipralex)
• To manage aggression
  • Determine what triggers the aggression 
  • Family members can learn strategies to help lessen triggers and confrontations
  • May be treated with therapy or medication, depending on the cause 
• To manage sleep problems
  • May be treated with medications

Behavior changes such as limiting daytime naps, increasing physical activity, avoiding caffeine and alcohol in the evening, maintaining daily rhythms, using artificial lighting when needed during the day, and avoiding bright light exposures during the night to help maintain normal wake-sleep cycles

For vascular dementia, the focus of treatment is managing blood pressure and cholesterol 

To manage safety issues, because people with dementia often fall and hurt themselves

• Wear sturdy, comfortable shoes
• Secure loose rugs or use non-skid backing on rugs
• Hide loose wires or electrical cords
• Maintain well-lit walkways

The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, breaks down an overview of 7 stages of cognitive function in patients with dementia. 

• Stages 1-3 are pre-dementia stages
• Stages 4-7 are dementia stages
• Beginning in stage 5, an individual can no longer survive without assistance

Stage 1: No Cognitive Decline

Patients still function normally and do not exhibit any memory problems or other symptoms of dementia 

Stage 2: Very mild cognitive decline (age associated memory impairment)

• Minor memory problems such as losing things around the house or forgetting names may occur
• Memory loss may be normal age-related memory loss
• Patients still do well on memory tests and dementia may not be detected by doctors at this stage

Stage 3: Mild cognitive decline (mild cognitive impairment)

• Cognitive problems become apparent at this stage
• Performance on memory tests are affected and impaired cognitive function can be detected
• People in stage 3 will have difficulty in many areas including:
  • Getting lost easily
  • Decline in performance at work
  • Finding the right word during conversations
  • Organizing and planning
  • Forgetting names of friends and family
  • Frequently losing personal possessions and important objects
  • Problems remembering information read in a book 
  • Difficulty concentrating
  • Mild to moderate anxiety may occur as symptoms interfere with day to day activities

Stage 4: Moderate cognitive decline (mild dementia)

Symptoms of the dementia are apparent, such as:

• Difficulty with simple math/unable to manage finances and pay bills
• Poor short-term memory 
• Difficulty remembering details about their personal histories
• Decreased knowledge of current events
• Disorientation

Patients may start to become socially withdrawn and show changes in personality and mood

• Denial of symptoms as a defense mechanism is common
• In this stage, patients can still recognize familiar faces and travel to familiar locations, but they will often avoid challenging situations to hide symptoms or to prevent stress and anxiety

Stage 5: Moderately severe cognitive decline (moderate dementia)

Patients begin to need assistance with day-to-day activities and may have symptoms such as: 

• The main sign of this stage is inability to remember simple details about themselves such as their own phone number or their home address
• Disorientation regarding time and place
• Difficulty dressing appropriately
• Significant confusion
• Difficulty making decisions

However, people in this stage usually still have some basic functionality such as:

• Can bathe and toilet independently
• Can eat on their own
• Usually still know their own name, close family member’s names, and some details about personal history, especially childhood 

Stage 6: Severe cognitive decline (moderately severe dementia)

Patients in this stage need constant supervision and often require professional care. Symptoms include:

• Needing assistance with daily activities such as toileting and bathing
• Confusion or lack of awareness of surroundings
• Inability to recognize faces other than close friends and relatives
• Inability to remember most details of personal history
• Significant personality changes 
• Potential behavior problems
• Loss of bladder and bowel control
• Wandering
• Delusions/hallucinations 
• Obsessive behavior 
• Anxiety, aggression, and agitation
• Loss of willpower
• Difficulty sleeping

Stages 7: Very severe cognitive decline (severe dementia)

Alzheimer’s is a terminal illness and patients in this stage are nearing death. Symptoms include:

• Loss of the ability to speak or respond to the environment
• Patients may still be able to utter words and phrases, but they have no insight into their condition
• Assistance is needed with all activities of daily living including walking, eating, and using the bathroom
• People may lose their ability to swallow in the final stages