Does My Mother Have Dementia or
Alzheimer’s Disease?
The 7 Stages of Dementia
By: Sonja Kobrin, M.P.S.
Geriatric Care Manager, V.I.P. Care Management
What is the difference between Dementia and Alzheimer ’s
Disease? Dementia is a general term and there are many types of dementias.
Alzheimer’s Disease is just one disease that can cause a person to lose memory
and thought processes. This loss is called cognitive decline or deterioration.
The following is a lay person’s description of the stages of cognitive loss
based up the Global Deterioration Scale published by Reisberg, Leon and Crook
in the American Journal of Psychiatry in 1982. Regardless of the disease
causing a person’s decline in cognitive ability, the stages of cognitive loss
are the same:
(NO COGNITIVE DECLINE)
Stage 1 - No Cognitive Decline or memory problems noted.
(FORGETFUL)
Stage 2 – Mild Forgetfulness - Person is aware that they are
forgetful and may misplace objects. They may forget names of people they know
well but can maintain work and social
relationships.
Despite some forgetfulness, cognitive decline will not show up on a test.
(MILD)
Stage 3 – Early Stage Confusion – person may become lost
when traveling to a once
familiar location. Co-workers take notice of memory deficits
and work performance is affected. They may lose the ability to make quick
decisions and have difficulty recalling names of objects. They may forget a
word in mid-sentence, have poor reading comprehension, or cannot remember names
of new people or places. Treasured objects may have been lost. Memory loss is
most evident after a long interview but not apparent at first. The ability to
pay bills may be impaired. The person is unable to drive safely as reaction
time is slowed. They may begin to write things down to assist with memory. Clinical testing will reveal a deficit.
Person is aware of cognitive decline & feels anxious about it and tries to
deny it.
(MODERATE COGNITIVE DECLINE)
Stage 4 – Late Confusion/ Early Dementia – Person may become
unaware of current and recent events. There decreased ability to navigate and
travel to familiar locations. They may wander and get lost and/or pace the
floor. They are unable to learn new tasks or perform complex tasks. The tone of
voice may become flat or monotone, they may seem disinterested in the world
around them and withdraw from challenging situations. Person uses denial as a
defense mechanism. One looses ability to perform serial subtraction exercises
and clinical testing reveals marked deficit.
(MODERATELY SEVERE COGNITIVE DECLINE)
Stage 5 – Early Dementia – Person can no longer manage their
life without some assistance. Personal information such as address and
telephone number cannot be recalled. Person may not remember names of
grandchildren, their high school, etc. Person may show disorientation as to
date, time or place. They may have difficulty counting back from 40 by fours,
even though they once could. Persons at this stage remember major life events.
They know their own name and the names of their children. They may need some
assistance with choosing clothing but can toilet and eat independently.
(SEVERE COGNITIVE DECLINE)
Stage 6 – Middle Dementia - Person may occasionally forget
spouse’s name but generally know people they see every day. They may lose the
ability to write. They may hallucinate, see imaginary figures or think their
spouse is an imposter. They may not recognize their own reflection in the
mirror. Personality and mood may show changes. They may become depressed and/or
engage in repetitive behaviors or activities such as cleaning and become
obsessed with ideas. They may rummage through belongings. They may eat
continuously as they do not ever feel satisfied. Abnormal behaviors are worse
in early evening (Sundown Syndrome). Repetitive speech and questions may occur
frequently as well as agitation and even violence. They are unaware of recent
events although they have some memory of the past. Person may be unable to
count to ten backwards or forwards or maintain a thought long enough to act on
it. They may need assistance with toileting, bathing, dressing and sleep
patterns may be disrupted. The person may confuse day and night.
(VERY SEVERE, ENDSTAGE DEMENTIA)
Stage 7 - Late Dementia - All verbal abilities are lost and
may resort to grunting or screaming. Person cannot control bladder or bowel
functions and requires total help with toileting and feeding. Person may lose
ability to walk and may fall frequently as communication is lost between the
brain and the body. The person may experience seizures. They may have
difficulty swallowing food and drink and lose appetite to the point of anorexia
and serious weight loss.
