Physicians and other health professionals usually describe dementia symptoms as “stages” that progressively worsen over time. Identifying where a person falls along the continuum helps both the health professional and caregiver know how to address current needs and what to expect in the future.
While there are several medical rating scales that physicians use to identify where a person’s symptoms fall, it is easiest to think of them in three basic stages – early, middle, and late or final. Medical testing and evaluations will help to identify where a person fits along the progression scales.
It is important to remember that each person’s progression is different and like any developmental assessment these are approximations.
Learn more about Dementia treatment and care
During the early stages of dementia, your loved one will still be able to do most things for themselves and maintain their social life.
You may begin to notice issues with carrying out a task, forgetfulness, or losing things. You may notice repetition in conversations or losing a train of thought more frequently.
Difficulties at this stage are usually mild enough that it is hard to identify. Forgetfulness or changes in behavior may be attributed to normal aging or other medical conditions, so it is important to notice if symptoms continue to worsen.
This stage lasts, on average, two to four years. This is a good time to plan what to do when more extensive care is needed.
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The middle stages of dementia require more adaptations and flexibility on the part of dementia sufferers and their caregivers.
Behaviors such as irritability, repetition, and depression may become more pronounced and require more patience. Communication becomes more difficult as those with dementia struggle to find the right words, follow conversations, and process information.
Taking care of daily living requirements such as eating, hygiene and grooming often become more of a challenge during these stages and more noticeable. Adaptations such as creating large, visible daily schedules, lining up clothing to wear the night before, and meal preparation can help.
Challenges in information processing and directionality affect the ability to drive during this stage and while it may be difficult to manage; alternative transportation means should be sought.
This stage is the longest and can last between two and ten years.
During these last stages of dementia, more and more care will be needed to manage daily living needs, including eating, bathing, and communicating.
Memory will decline and the person may not be able to remember things that happened just a few hours ago or think that they are in an earlier period of their life. As this stage progresses, the person will become bedridden and may not remember family members.
There is often difficulty with swallowing and incontinence. Round-the-clock care will be needed. Plans for palliative care should be made.
This stage can last one to two years.
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Perhaps the most difficult decision to make regarding dementia is when it is time for memory care. While we may want to, understandably, care for a loved one at home, the reality is that as care needs increase, being able to manage what’s needed becomes more and more difficult.
Planning for memory care should begin at the time of diagnosis. The more time you can allow for your loved one to understand the options and get used to new surroundings, the better.
Caregiving for a loved one with dementia can be tremendously stressful. Without paying attention to the need for respite care, even those who are most determined to give care to their loved ones by themselves can find themselves in need of care as well. Being ready to ask for help to shoulder the burden can actually allow everyone better care.
Read our guide to caring for elderly and aging parents
Noticing a decline in overall health is an indication that it is time for memory care. This is especially true if a person’s dementia is leading to unsafe conditions such as not being able to manage medications, use life-alert devices, or drive a car. Physical decline can include, unexplained weight loss, hunching or stooping, lack of food in the refrigerator, confusion around bill paying and appointments, confusion around the time of day, and sundowning.
Perhaps the most important sign is when your instincts are telling you that something is wrong and that more care is needed. Listen to your gut and use this time to explore what the best options are for your loved one’s care.
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