Signs, Symptoms and Stages of Dementia

Dementia is a collective term for conditions causing a decline in cognitive function. Although Alzheimer’s is the most common form of dementia, there are many different types of dementia, and each type has its own pattern of progression, with symptoms and signs. Understanding the early signs of dementia is important for managing the condition.

Of the 850,000+ people currently living with dementia in the UK, each individual will experience unique dementia symptoms. While the type and progression of dementia vary, a general guide to its stages can help you understand what to expect and plan for the future.

There are two main ways to measure the progression of dementia: the three-stage and seven-stage models, which we will explore today.

The 7-Stage Progression of Alzheimer’s

The seven-stage model is most appropriate for identifying the stages of Alzheimer’s.

Stage 1: No cognitive decline

In this stage, the person functions normally, with normal cognitive function, no memory loss and generally good mental health. People with stage 1 have no dementia.

Stage 2: Very mild cognitive decline

General forgetfulness, as part of ageing, is associated with stage 2. Forgetfulness is mild and unnoticed by loved ones and medical professionals.

Stage 3: Mild cognitive decline

At this stage, loved ones may notice signs of cognitive decline, such as forgetfulness and slight difficulty concentrating, that begin to impact daily life. A person at stage 3 may also become disorientated, lost, and have difficulty in finding the right words. On average, a person is at stage 3 approximately 7 years before the onset of dementia.

Stage 4: Moderate cognitive decline

At stage 4, symptoms become increasingly significant, affecting daily life. Stage 4 dementia can be identified by symptoms including significant difficulty concentrating, memory loss, disorientation and inability to travel alone to new locations. 

As communication problems develop, someone living with stage 4 dementia may start withdrawing from loved ones and avoiding interaction. The average duration of stage 4 dementia is 2 years.

Stage 5: Moderately severe cognitive decline

Those living with stage 5 dementia will need assistance with daily activities (dressing, bathing, preparing meals). Memory loss will become more severe and may affect the ability to recall major relevant aspects of life, such as address or phone number. Someone living with stage 5 dementia may not know the time or day or where they are. 

The average duration of stage 5 is 1.5 years.

Stage 6: Severe cognitive decline

Someone living with stage 6 dementia will require extensive support with daily life, including continence care as control over the bladder and bowel declines. The names of close family members and the memories of both recent events and early-life details will fade. 

Stage 6 can also be identified by personality changes (such as delusions, compulsive behaviour, anxiety and agitation), difficulty in speaking, counting down from 10 and finishing basic tasks. The average duration of stage 6 is 2.5 years.

Stage 7: Very severe cognitive decline

Stage 7 dementia has the greatest impact on a person’s life. People in this stage typically demonstrate minimal ability to speak or communicate and will require extensive support with all aspects of daily life, including continence and personal care, due to the loss of psychomotor skills (the ability to control movement). 

The average duration of stage 7 is 2.5 years.

The 3-Stage Progression of Other Types of Dementia

The three-stage model can be used for most other types of dementia, including vascular dementia, Lewy body dementia, and frontotemporal dementia.

Vascular Dementia Stages

The symptoms of vascular dementia can occur suddenly, following one large stroke or they can develop over time, after a series of smaller strokes. The progression of stroke-related or vascular dementia symptoms usually follows a ‘stepped’ pattern, with a combination of longer periods of time when symptoms are stable and periods when symptoms change rapidly.

Mild stages

Early-stage vascular dementia can often share symptoms with Alzheimer’s, with the key difference being that mild vascular dementia symptoms are usually associated with difficulties in planning, decision-making, and following instructions rather than memory loss.

Other early symptoms include:

• A reduction in the speed of thought
• Difficulty in concentrating
• Loss of bladder control is common with early subcortical vascular dementia
• Symptoms attributed to the stroke

Moderate stages

As vascular dementia progresses, the earlier symptoms will become increasingly evident. Since vascular dementia affects various aspects of thought processes such as problem-solving, concentrating, reasoning and communication, someone living with moderate vascular dementia may experience:

• Periods of sustained confusion
• Memory loss
• The development of unusual behaviours

Severe stages

In the later stages of vascular dementia, the individual may:

• Becoming less aware of what is happening around them
• Experience delusions and hallucinations

Someone living with vascular dementia will become increasingly dependent on the support of medical professionals and care providers to assist them with most aspects of everyday life such as eating, bathing and dressing

Frontotemporal Dementia Stages

The rate at which FTD progresses varies greatly and research has found that the differences between different types of FTD become less obvious as dementia progresses. Those who originally exhibited symptoms of behavioural variants may eventually experience language difficulties and a person originally diagnosed with a language variant of FTD will typically develop behavioural problems. 

The symptoms and signs of behavioural variant frontotemporal dementia are that individuals are generally unaware of their behaviour and will rely on their loved ones to identify new and unusual characteristics.

Mild stages

Unlike Alzheimer’s, the early stage of frontotemporal dementia doesn’t usually affect memory or cognitive functioning. Someone with FTD may go walking without an obvious purpose, but, unlike someone with Alzheimer’s, will return home without getting lost.

During the early stages of behavioural FTD, changes to personality and behaviour become noticeable.

Typical behavioural changes include:

• Becoming uncharacteristically selfish or apathetic
• Acting impulsively
• Developing obsessive or compulsive behaviours

In language variants of frontotemporal dementia, language difficulties become apparent slowly:

• Semantic dementia primarily affects the ability to understand language
• Aphasia affects the ability to produce fluent speech

Moderate stages

The earlier symptoms of frontotemporal dementia will become increasingly evident.

With behavioural variants: Inappropriate behaviours will become more frequent and more intense.

With language variants: Aphasia will continue to affect speech production and signs of moderate aphasia may include:

• Stuttering
• Mispronunciation
• Grammatical errors
• Impaired understanding

Semantic dementia causes:

• Vocabulary to decline
• Confusion regarding the meaning of familiar words
• Difficulty in finding the right word
• Difficulty with recognising familiar objects

Severe stages

In the later stages of all types of FTD, more brain structures become damaged. Someone living with later stages of FTD usually experiences symptoms that are similar to the later stages of Alzheimer’s disease, such as:

• A disinterest in their surroundings
• Difficulties in communication
• Inability to recognise loved ones
• Behavioural changes may cause increased aggression or agitation

At this late stage, full-time care will be needed to meet the individual’s needs and maximise their ability to access an enriched life wherever possible.

Dementia with Lewy Bodies Stages

Each person living with dementia with Lewy bodies will have a different experience but like all types of dementia, DLB is progressive and the abnormal proteins responsible for causing damage to brain cells (Lewy bodies) will continue to build up in structures of the brain. 

The spread and density of Lewy bodies will vary from individual to individual. This means that the symptoms each individual experiences are unique because Lewy bodies affect different parts of the brain, each with distinct functions.

Mild stages

Dementia with Lewy bodies also shares symptoms with Alzheimer’s in the early stage.

These include:

• Problems with attention and awareness, which can fluctuate significantly daily and even from moment to moment
• Difficulty in judging distances
• Disorientation can lead to falls and fainting
• Sleep becomes disrupted
• The ability to plan and organise is affected
• Recurrent visual and auditory hallucinations can lead to distorted perceptions and delusions of persecution

Moderate stages

The earlier symptoms of dementia with Lewy bodies will become increasingly noticeable.

Signs that someone living with dementia with Lewy bodies has reached a moderate stage include:

• Noticeable decline in motor skills, which causes difficulties with movement.
• Twitching
• Stiffness
• Slow movements
• Loss of balance or coordination

Severe stages

As dementia with Lewy bodies progresses into the ‘severe’ stage, symptoms include:

• Frequent and sustained confusion about days, times and places
• Significant memory decline, which may include forgetting events, names and faces
• Communication problems become increasingly evident and speech can become challenging
• Behavioural changes such as compulsive rituals, repetition and agitation
• Slow movements
• Difficulties in swallowing and eating, often causing weight loss

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