Written by Josh Horsman
Dementia is a progressive neurological condition, which means that over time the condition worsens and the symptoms increase in severity. Symptoms of Dementia affect the brain and progression of the condition may be seen in the decline of, or change in, a patient’s memory, thinking skills, judgement and behaviour. Over time, the patient’s needs also change, with someone in the early stages of Dementia requiring vastly different care to someone in the more advanced stages. The three main stages, as defined by the widely used ‘Clinical Dementia Rating’, are: ‘Mild Dementia’, ‘Moderate Dementia’ and ‘Severe Dementia’.
The Clinical Dementia Rating (CDR) is a five-stage system used to assess the progression of Dementia based on the severity of a patient’s symptoms. It uses six main areas of evaluation: Memory, judgement, problem-solving abilities, home and hobbies, personal care and community affairs.
Mild Dementia [2-4 years]
A person in the early stages of Dementia is determined by the CDR to have ‘mild Dementia’. This stage is characterised by the patient’s ability to maintain their independence, including leading an active social life. Symptoms of Dementia at this stage are likely to be subtle and may even be mistaken for normal signs of ageing. This may include sporadic incidents of memory-loss, misplacing familiar items and infrequent difficulty remembering common words. The affected individual may also find they begin to sometimes experience difficulties completing their daily tasks as a result of these mild symptoms. For example, if they are employed, work tasks may become more difficult, and they may find they are more error-prone. Problems may also be encountered when it comes to planning or organising their time.
In this early stage of Dementia, individuals should not require round-the-clock supervision or intensive care programmes, as they are likely still capable of functioning independently in daily life. However, they may require frequent reminders about important events or appointments and should be supervised if a task is significant or high-risk, for example when at work. This stage also presents the ideal opportunity for the individual to discuss their future care with their loved-ones and make necessary logistical and financial arrangements for their continuing care as their condition progresses.
Moderate Dementia [2-10 years]
The second most advanced stage of Dementia is referred to as ‘moderate Dementia’. This can last anywhere between 2 and 10 years on average, being the longest of the three stages by far.
This stage sees the damage to the brain become severe enough that outward symptoms are noticeable and begin to significantly affect an individual’s daily life.
Someone in this stage is likely to have trouble both in performing simple daily tasks and in maintaining relationships. They are likely to have trouble following their train of thought which means that they will often be incapable of expressing themselves clearly and holding conversation with them may become a challenge. They are also likely to demonstrate more severe memory problems, including regularly forgetting familiar words, having difficulty recalling short and long-term memories and even occasionally struggling to recognise loved-ones.
These symptoms may also be accompanied by changes in behavior, mood and disrupted sleep. Often, individuals in this stage of Dementia are increasingly frustrated with their symptoms or they may even maintain denial of their condition.
In this stage, individuals are less independent, and they require help with many everyday activities such as bathing, dressing, cooking and leaning. Initially, this assistance may only be needed in the form of frequent reminders and prompts, but as the stage progresses, this is likely to extend to hands-on care for many essential daily tasks. As communication with the person becomes more difficult, caregivers must be sure to exercise patience and understanding, being sure to speak slowly, clearly and with empathy.
Severe Dementia [1 to 3 years]
In the last stage of Dementia, the individual loses their independence almost entirely.
Someone in the stage of Dementia is likely to have lost much of their abilities to communicate and will probably rely on a few words and gestures. They are unlikely to display significant capacity for short or long-term memory and may forget events or activities from only hours or minutes before. In some extreme cases, they may not be aware of time at all or they might think they are in a different period of their life altogether. Recognising even the closest of family members and loved-ones usually proves a challenge for those with severe Dementia.
In this stage, the person will almost certainly require 24-hour care and hands-on help with even the most basic of daily tasks such as dressing, eating and washing. Their independence may be further hindered by a decline in their ability to walk and as this stage progresses, many people with severe dementia are ultimately bedridden as a result of their immobility. Eventually, even swallowing food can become a challenge for those with severe Dementia.
However, if you are a caregiver or loved-one of someone with severe Dementia, you should not fear for the future. There are a range of options, such as nursing homes, to ensure that the burden of care does not fall solely on family members.