Dementia Stages

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Dementia is a word that strikes terror into the hearts of people and families. Not all dementia is Alzheimer’s dementia, however. There are multiple medical diseases and conditions that may cause dementia, and although in most cases once dementia appears, it is irreversible and incurable, there are some exceptions. While most cases of dementia are incurable, the progression of the disease may be slowed down by medications and other forms of treatment. There are a number of standardized tests to evaluate and diagnose individuals suspected of having some form of dementia. These tests evaluate a person’s orientation to time, place, and person as well as their recent and distant memory.

There are seven stages of dementia. Stages 1-3 are considered “predementia.” Stage 1 actually has no symptoms. If dementia were an infectious disease, Stage 1 would be called the incubation period. Since there are no symptoms, Stage 1 cannot be tested for or diagnosed. Stage 1 can only be diagnosed once Stage 2 appears. No one knows how long Stage 1 may last. Stage 2 involves memory lapses, for example forgetting names that are very familiar or forgetting where an object was placed. Now, we all have memory lapses and the appearance of Stage 2 symptoms may be nothing at all or may be related to normal age-related cognitive decline, not dementia. Stage 2 is undetectable by clinical testing. In Stage 3, clear cognitive problems begin to emerge. Problems like getting lost easily, poor job performance, forgetting names of family members and close friends, difficulty retaining information read in a book or pamphlet, losing or misplacing important objects, and difficulty concentrating. In Stage 3, the symptoms begin to interfere with day to day life and may cause anxiety. Stage 3 may be detectable by testing but in most cases, it is still undetectable.

Stage 4 is mild dementia. The patient may be socially withdrawn and changes in mood and personality may be seen. Denial of symptoms as a defense mechanism is common. Symptoms include decreased knowledge of current or recent events, difficulty remembering one’s own personal history, decreased ability to handle finances or arrange travel plans, disorientation, and difficulty recognizing people or faces, although there is usually no difficulty in recognizing close family, close friends, and familiar places. Avoidance of challenging situations to hide symptoms or prevent stress or anxiety is common. Stage 5 is moderate dementia. There is an inability to remember major details like names of family members or addresses, disorientation to time and/or place, inability to make decisions, forgetting basic information like phone numbers. Stage 5 interferes with basic functioning but assistance with functions like toileting and eating is not necessary. Remembering a spouse’s name and/or childrens’ names is usually still possible.

Stage 6 is moderately severe dementia. Full time care is usually necessary as recalling names of family, recent events, and current surroundings is not possible. Delusional or aggressive behavior may appear as may anxiety, aggression, agitation, and loss of willpower. Wandering and sleep disturbances are common as are hallucinations. Lastly, in Stage 7 the brain seems to lose its connection to the body. Motor skills, speech and verbal abilities are lost. Full time help with eating, walking, and toileting is required.

Next week I will discuss the causes of and treatments for dementia.

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By Peter Galvin, MD

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