Dementia, in general, is commonly taken to have 7 stages. Dementia is a chronic, progressive condition, which means that 1) it is not curable, and 2) persons with dementia only progress forward through the stages. They do not regress, or return, to previous stages.
Persons with dementia may also skip stages, meaning that not all the stages may be present or obvious in the course of their condition. Someone may appear to jump from Stage 3 to Stage 5, for example, which can be shocking and challenging for you as a caregiver.
It is also impossible to say how long each stage will last, as individuals progress at different rates, from very slow to very rapid and everything in between.
3 phases and 7 stages of dementia
PRE-DEMENTIA OR EARLY-STAGE DEMENTIA
Stage 1: No cognitive impairment. While someone may not have any symptoms during this stage, changes in the brain are occurring.
Stage 2: Very mild cognitive decline. This appears simply as age-related forgetfulness and may go unnoticed. While about 40% of those aged 65 and older have age-associated memory impairment, annually only about 1% of them progress to dementia. During this stage, you may notice your loved one losing track of familiar items in their home and forgetting names and important dates (like birthdays or anniversaries).
Stage 3: Mild cognitive decline (also known as mild cognitive impairment or MCI). Cognitive and memory problems happen more regularly and are now noticeable, though they don’t disrupt daily functioning to any great extent. This used to be referred to as “senile,” a term that dismissed the problem and is now outdated. 10-20% of those aged 65 and older with MCI will develop dementia within a year, making this stage important to recognize and discuss with a provider. During this stage, you may notice your loved one repeating themselves or experiencing difficulty finding the right words, losing things, forgetting appointments and events, having trouble getting organized, and having problems with driving or getting lost while driving/traveling.
MODERATE OR MIDDLE-STAGE DEMENTIA
Stage 4: Moderate cognitive decline. Clear and visible signs of cognitive impairment are present, and personality changes may begin. This is usually the stage when dementia is diagnosed. Language and problem-solving significantly decline and your loved one may experience trouble with daily living and routine tasks, mood changes and withdrawal from others, and inability to recall recent events.
Stage 5: Moderately severe cognitive decline. Commonly considered as mid-stage dementia among professionals, your loved one may not be able to complete activities of daily living (ADLs) or instrumental activities of daily living (IADLs) without assistance. They typically remember essential facts about themselves (name, birth date, where they grew up) but forget important people, places, and events in their history. It’s at this point when “sundowning” and wandering start.
SEVERE OR LATE-STAGE DEMENTIA
Stage 6: Severe cognitive decline. Assistance performing all ADLs is required. Incontinence is common, as are anxiety and aggression, and further personality changes. Your loved one may also have difficulty sleeping, delusions and paranoia, and will not recognize family. By this stage, you may be exploring full-time care options.
Stage 7: Very severe cognitive decline. At this point, total care is required. Generally, all verbal skills are gone, and movement becomes very limited if not absent. Chewing, swallowing, and breathing are impacted. Complications from Stage 7 dementia are fatal (causing death).
Alzheimer’s disease stages
According to the Alzheimer’s Association, the average person with an Alzheimer’s diagnosis has a remaining life expectancy between 4 to 8 years, though some live up to 20 years after diagnosis. Again, just as with other dementias, there is no way to determine exactly how long each Alzheimer’s stage will last.
Mild (early-stage). Symptoms may not be widely apparent to anyone except family and close friends, or a provider using certain diagnostic tools, and a person may still function independently.
Moderate (middle-stage). Symptoms vary from person to person but are certainly more pronounced, and behavioral changes start to occur. A person can still perform ADLs with assistance, though the need for care continually increases. This stage may be the longest of the three, lasting many years.
Severe (late-stage). A person’s interaction with their environment rapidly decreases and eventually stops. They can no longer carry on a conversation and may become non-verbal altogether. They may also lose their ability to control movement and have significant personality changes. While they may no longer be able to initiate engagement, they can still benefit from interaction (being talked to, listening to music, being gently touched). Extensive care and support services for them and their caregivers are needed, which includes end-of-life care.