I am often asked, “What stage of dementia is my family member in?” I explain the stages here!
The journey through dementia is influenced by the type of dementia (like vascular or Lewy Body) and the person’s personality and physical/mental health, to list just a few items. These stages are rough categories. People with dementia will not always fit “neatly” into a specific stage. There is also movement within each stage.
Mild Cognitive Impairment
Mild cognitive impairment (MCI) is a change in thinking or memory that can be noticed by the patient or another person (sometimes both). A clinician can find evidence of memory or thinking problems during an examination, which usually involves some type of memory testing. The person with the memory problems can live independently and may be able to work, depending on the type of job. Mild cognitive impairment is also known as mild neurocognitive disorder. Having MCI does not automatically mean the person will go on to develop a dementia. Usually, only close friends, family members, or colleagues notice that anything is “off.”
Mild Dementia (2-4 years)
Sometimes this stage is known as “early stage” dementia. Dementia experts do not like to use the term “early stage” because it can be confused with early-onset dementia (dementia before age 60). People in this stage have episodes of forgetfulness and confusion. They may or may not report memory loss. People in the mild stage will frequently misplace familiar objects (like the TV remote or smart phone). Others may notice problems with using the correct noun. For example, instead of saying “cup,” the person in the mild stage may say, “the thing you drink out of.” People in this stage have difficulty remembering new material, like names of new acquaintances or using a new device (like an upgraded smart phone).
Moderate Dementia (2-10 years)
The person living with dementia knows his or her name, where they are currently located (such as the city of the doctor’s office), and the day of the week and date. However, they are starting to need some help in order to safely live in their homes. They have problems with putting together tax paperwork, balancing bank accounts, and remembering appointments. When persons living with dementia enter this stage, they may successfully compensate by using lists, calendars, notes, and alarms. As time goes on, they have more difficulty using these items and strategies. They start having problems dressing appropriately for the season and weather. Many become overwhelmed in new environments because they are unable to filter out unimportant sights and sounds and to pay attention to one conversation. They are unable to remember their data of birth and current address. When asked where they live, they may provide a location from decades ago.
Family caregivers often ask me, “is it safe for people in this stage to be left alone?” It depends. Can the person living with dementia recognize a threat (like a kitchen fire) and safely exit the home? Call 911 if they fall and are hurt?
Severe Dementia (1-3 years)
People with severe dementia cannot live independently. They require partial or full assistance with basic activities like dressing, bathing, toileting, and eating. They may talk much less, or not at all. They usually become bedridden.
Factors That Affect Time in Stages
The duration for each stage is an average and depends on many factors:
- Overall physical and mental health. People in excellent health with few other diseases may remain in MCI or mild for much longer than people with heart disease and past histories of strokes. Diseases that affect blood vessels in the brain (like high cholesterol, which increases risk for strokes) reduce blood flow to brain cells and the cells die.
- Lifestyle changes. Any positive lifestyle change, like more exercise and better eating, reduces risks for other diseases that cause brain cell death. Weight loss, for example, can improve blood pressure and blood sugar, and result in better brain health.
- Quality of care. Persons living in environments where they are stimulated mentally, emotionally, physically, and socially do better than those who may be isolated, or who live with caregivers who are unable (or unwilling) to provide healthy environments. Just like everyone can sing but not everyone is a singer, not everyone has the ability to be a caregiver.
Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.