Dementia is a complex, challenging illness. It has a profound impact on individuals and their families, affecting everything from memory to mood, and even posing stark changes to personality, from loss of inhibition to extreme agitation.
But it affects everyone differently, with symptoms varying based on everything from genetics to the type of dementia a person has.
As such, it’s often difficult to predict exactly how dementia will affect an individual.
That said, years of research has shown that dementia is a progressive disease, moving through several distinct stages: early, middle, and late. (These stages are sometimes also referred to as mild, moderate, and severe.)
Each of the major stages of dementia presents differently, with symptoms worsening over time as the illness progresses. This is particularly true of symptoms such as memory loss, difficulty with speech and language, and issues with perception (i.e. delusions, hallucinations, and paranoia.)
However, it’s not unusual for symptoms to develop at an early stage and lessen in severity, or even vanish entirely, at a later stage, so it’s important to understand how dementia progresses, and which symptoms typically occur and which stage.
With that in mind, we’ve put together a guide to the stages of dementia, packed with insights and observations on this complex condition.
Let’s dive in.
How Many Stages of Dementia Are There?
Dementia is a progressive disease, typically cycling through three major stages: early, middle, and late. Each stage presents with distinct symptoms, typically worsening in severity as the illness progresses.
That said, dementia symptoms will differ from person-to-person, with some people experiencing, for example, hallucinations, while others may not.
To some extent, the word ‘stages’ can be a little tricky when applied to dementia as while the illness does feature distinct stages, each baring unique symptoms, it’s possible for symptoms to appear in a different order, and the stages may overlap.
This is because dementia affects each area of the brain differently, and as the underlying disease progresses, more damage is done to other parts of the brain, while the already damaged parts deteriorate further, causing symptoms to worsen.
You see, dementia is often thought of as a singular illness, with one fixed set of symptoms that everyone will experience. But that’s not entirely accurate.
Dementia is technically an umbrella term referring to several diseases in the brain, such as Alzheimer’s Disease, Vascular Dementia, Frontotemporal Dementia (FTB), and Dementia with Lewy Bodies (DLB). As such, each type of dementia will feature unique symptoms.
But all types of dementia are progressive. And as the structure and chemistry of the brain becomes more damaged, symptoms worsen in severity, creating the three stages of dementia.
But what are the common symptoms of dementia? And at what stage do they (typically) occur?
Note: The symptoms of dementia vary from person to person and are linked to the type of dementia a person has. For the purpose of this article, we’ll be providing a general overview of notable symptoms found across the several types of dementia.
Early Stages of Dementia
Before we begin, let’s clarify some terms. The early stage of dementia is often referred to as the ‘mild’ stage, but this term is used relatively.
In recent years, dementia awareness campaigners have pushed for the term ‘mild dementia’ to be scrapped, arguing that the phrase is both inaccurate and potentially stigmatising.
So, what symptoms are typical of the early stages of dementia?
Memory Loss
Perhaps the most obvious — and, as such, overlooked — is memory loss. It may be as simple as a person forgetting why they entered a room, where they put their car keys, or the details of specific events.
Oftentimes, memory loss is chalked up to the natural process of ageing. And while it’s true that our memory declines as we age, it’s important to understand what’s normal for a given individual. If their recall has typically been sharp and they suddenly begin to experience notable memory loss, they may be in the early stages of dementia.
Loss of Orientation
Orientation (i.e. sense of place and direction) is often affected in the early stages of dementia. A person may find themselves getting lost more frequently, or struggling to remember directions, even to places that they’ve been countless times.
Much like memory loss, difficulties with orientation are often dismissed as simple forgetfulness, and while this can be true, it’s important to be aware of the frequency and severity of the disorientation.
For example, it’s not unusual to lose your way in a busy city that you don’t visit often, but if someone struggles to recall their route home from work on several occasions, it might be worth speaking with their GP, who’ll ask questions to determine what other symptoms of dementia they might be experiencing.
Language and Communication Issues
Perhaps the most noticeable symptom in the early stages of dementia is problems with language and communication, which are typically affected in the earliest stages of the disease.
It might be that a person struggles to find the right words or even follow and understand what’s being said. It might even be that they repeat specific words or phrases, or misuse words (i.e. using one word to mean another.)
As with memory loss and orientation issues, problems with language and communication are often dismissed as a natural part of ageing, but if you find a loved one struggling to understand conversations or grasping for words that usually come naturally, it may be a sign that something is wrong.
Changes to Mood
In the early stages, dementia can greatly impact a person’s mood, often presenting as mood swings, sudden emotional outbursts, or general anxiety. They may also find themselves more irritable than usual, perhaps snapping at the smallest of things, or having less patience with friends and family.
It’s also common for people to become more withdrawn in the early stages of dementia or even lose interest in previously cherished people or hobbies.
Some people with dementia even report a pervasive sense of fear, without a known cause, which can be extremely upsetting.
Whether its unexplained anxiety, persistent low mood, or abrupt angry outbursts, changes to mood are, perhaps, the most obvious symptom of the early stages of dementia and shouldn’t be ignored.
Middle Stages of Dementia
By the middle stages of dementia, symptoms will become more pronounced and pose a significant impact on a person’s everyday life. It’s often at this point that people contemplate dementia live-in care to help with daily tasks such as laundry, cooking, cleaning, and shopping.
In many cases, the middle stages of dementia are the longest, with existing symptoms increasing in severity and new symptoms taking root.
But what symptoms are common in the middle stages of dementia?
Increased Memory and Cognition Issues
As the brain becomes more damaged by the underlying illness, memory and cognition problems are intensified. People may have trouble recognising friends and family— or even confuse them with strangers.
The middle stages of dementia also pose significant challenges to a person’s ability to retain new information. For example, they may find themselves asking the same question repeatedly, often forgetting that they asked in the first place.
More Difficulty with Speech and Language
It’s during the middle stages of dementia that issues with speech and language worsen, becoming more noticeable as the disease progresses.
A person with dementia may find themselves grasping for the right words more often, or even forgetting what they’re saying as they’re saying it. It may also become more difficult for them to understand what people around them are saying, which can be highly distressing and impact their ability to carry out everyday tasks.
Heightened Orientation Issues
As dementia progresses into its middle stages, people often find that problems with orientation worsen, and they struggle to remember locations, directions, and even landmarks. It’s not uncommon for people in the middle stages of dementia to become confused about where they are, even at home.
They may also experience confusion regarding the time of day. This is because dementia affects our natural circadian rhythm (i.e. our internal body clock). As such, people with dementia may find themselves struggling to know what time of day it is, and in some cases, what season it is.
Delusions
It’s during the middle stages of dementia that people may begin to experience delusions, broadly defined as strongly believing things that aren’t true.
For example, they might believe that they’re in danger, or that those around them mean them harm, which can be extremely distressing. Other delusions typical of mid-stage dementia include suspicions of theft, infidelity, and dishonesty.
It’s worth noting that delusions are far stronger that everyday suspicion. In the context of dementia, delusions become strongly held beliefs, which, depending on the nature of the delusion, can be upsetting and result in social withdrawal.
It’s at this stage that support from family, friends, or paid carers becomes vital to prevent people from acting on their delusions, potentially putting themselves in harm’s way.
Hallucinations
As dementia progresses, many people begin to experience hallucinations. Like delusions, hallucinations come in many forms, including visual, auditory, olfactory, and tactile.
For example, a person experiencing a visual hallucination might be able to see someone who isn’t there, such as a friend or family member. The same is true of auditory hallucinations, where a person may hear voices, or other noises.
Some people may even experience tactile hallucinations, in which they may feel physical sensations such as insects crawling on the skin. Tactile hallucinations occur when your brain processes signals for stimuli that aren’t present, such as itching or burning, often leading to uncontrollable skin-picking.
Similarly, olfactory hallucinations (i.e. pertaining to smell) are common in the middle stages of dementia, with people smelling and tasting things that aren’t there, such as petrol, perfume, or cigarette smoke.
It’s worth noting that hallucinations are caused by the brain processing signals for stimuli that aren’t present, and, as such, they’ll feel/smell real to the person experiencing them, which can be upsetting and confusing.
Physical and Behavioural Changes
As dementia reaches its middle stages, people often experience physical and behavioural changes. These vary from person to person, but often include:
- Restlessness and fidgeting
- Repetitive behaviour (such as repeating questions)
- Trailing (following people around)
- Sleep disturbances (such as insomnia or disrupted sleep patterns)
- Loss of inhibition (saying or doing inappropriate things)
- Agitation
- Mood swings (often without an apparent cause)
As with other dementia symptoms, physical and behavioural changes may ebb and flow; being present on some days, but not others. They may also seemingly vanish, only to return later.
Another major behavioural change in dementia is known as ‘sundowning’, which is when a person becomes restless, agitated, or confused towards the end of the day. It’s often during the sundowning period (usually late afternoon – evening) that people experience hallucinations and delusions.
For more information, read our blog on sundowner’s syndrome in dementia.
Later Stages of Dementia
The late stages of dementia are often the most challenging as the damage to the brain caused by the underlying disease is at its peak, causing an intensification in the severity of existing symptoms, as well as newer, more severe symptoms.
Indeed, by the later stages of dementia, the impact on a person’s life will be severe, often requiring full-time support with personal care.
Unlike the early stages of dementia, where symptoms are typically linked to the type of dementia a person has, the symptoms of late-stage dementia are similar regardless of type, with an emphasis on perception issues and physical problems, such as toileting and mobility.
New symptoms in the late stages of dementia can include:
Time Shifting
In dementia’s later stage, which is typically the shortest, people will have significant difficulty remembering even recent events and may experience a symptom known as ‘time-shifting’.
In layperson’s terms, time shifting can be defined as a person thinking they’re literally at an earlier stage of their life. As such, they may request to see people who are no longer alive or even attempt to carry out routines from their younger days, such as getting ready for work or preparing to collect children from school.
Time shifting may also impact a person’s ability to recognise new technology, such as computers and smartphones, even if they’ve been proficient with these devices in recent years.
In some cases, time shifting can also impact a person’s ability to recognise themselves or relatives, as their memory will default to an earlier time. This, of course, can be highly distressing, impacting mood and overall well-being.
Typically associated with Alzheimer’s Disease, time shifting can occur in any type of dementia as the disease enters the late stages.
Mobility and Physical Issues
More so than in any other stage of dementia, a person in the later stages of dementia will experience more significant physical issues, from difficulties with mobility to increased risk of falls, and even problems chewing and swallowing.
It’s at this point that people may need support with personal care such as dressing, bathing, and toileting. Incontinence (i.e. loss of control to bladder and bowels) may also occur at this stage, which can be upsetting and embarrassing.
As you can imagine, a reduction in mobility may also lead to pressure ulcers, sometimes known as bedsores, which can be extremely painful, and even lead to infection if left unchecked.
Dementia is a multifaceted illness, with symptoms often varying in severity and presentation from person to person and based on the type of dementia a person has.
For more information on dementia, please consult our dementia FAQS, where you’ll find information on everything from how to care for someone with dementia to advice on personal care.
If you think your loved one may benefit from personalised care, check out our dementia care services to see how we can help.
