The 7 Stages of Dementia and Symptoms

The most common types of dementia, including Alzheimer’s, are progressive, meaning cognitive decline worsens over time. Dementia is categorized as mild, moderate, or severe as well as early stage, middle stage, and late stage dementia.

Health care providers often use a more comprehensive tool to assess the seven stages of dementia in elderly patients. It’s called the Global Deterioration Scale (GDS), or the Reisberg Scale, and was developed by Dr. Barry Reisberg, a geriatric psychiatrist and professor, in 1982.

The GDS enables caregivers and health professionals to determine how quickly dementia progresses in elderly patients, and which symptoms to expect during each of the seven stages of dementia.

Dementia stages 1-3: no official diagnosis

Someone in the first three dementia stages doesn’t usually exhibit enough symptoms to be diagnosed – while cognitive impairment may be present, phases 1-3 on the GDS aren’t even recognized as the early stages of dementia.

Dementia stage 1: no cognitive impairment

Though it may seem odd, the lowest stage is normal mental functioning, or no cognitive impairment.

Dementia stage 2: very mild cognitive decline

Where did I put my keys? What was that person’s name?

At least half of the population 65 and older reports some minor age-related forgetfulness, according to the Fisher Center for Alzheimer’s Research. Caregivers or medical providers may not even notice such mild impairment, and it’s not a sign of the early stages of dementia.

Dementia stage 3: mild cognitive decline (also called mild cognitive impairment)

When memory and cognitive problems become more regular, as well as noticeable to caregivers and family members, a person is said to be suffering from mild cognitive impairment (MCI). It doesn’t generally have a major impact on day-to-day functioning.

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How quickly does this dementia progress in the elderly? Eight in 10 people with MCI will go on to develop Alzheimer’s disease within seven years, according to the National Institute on Aging. Since MCI can precede more severe dementia stages, it’s important to recognize the signs of this stage and seek medical advice.

Stage 3 dementia symptoms

• Forgetting to go to appointments or events
• Losing things and minor memory loss
• Getting lost while traveling
• Decreased work performance
• Difficulty finding the right words
• Verbal repetition
• Challenges with organization and concentration
• Trouble with complex tasks and problem-solving
• Problems with driving

The early stages of dementia: noticeable cognitive decline

A person is not typically diagnosed with dementia until they’re at stage 4 or beyond. This is when medical professionals and caregivers notice personality changes, as well as cognitive impairment.

Dementia stage 4: moderate cognitive decline

At this point, a person has clear, visible signs of mental impairment. While it’s considered mild or early stage dementia, the medical terminology for the fourth of the seven stages of dementia is “moderate cognitive decline.”

Doctors and caregivers will likely notice a worsening of stage 3 dementia symptoms, such as difficulties with language, problem-solving, and travel.

Stage 4 dementia symptoms

• Social withdrawal
• Emotional moodiness
• Lack of responsiveness
• Reduced intellectual sharpness
• Trouble with routine tasks
• Forgetting recent events
• Denial of symptoms

Middle stage, or moderate dementia

As they progress through the seven stages of dementia, elderly people require more intense care and supervision. Someone with middle stage dementia often needs some caregiver assistance with regular day-to-day activities, such as dressing, eating, or bathing.

Dementia stage 5: moderately severe cognitive decline

This stage marks the onset of what many professionals refer to as “mid-stage” in the seven stages of dementia.

At this point, a person may no longer be able to carry out normal activities of daily living (ADLs), such as dressing or bathing, without some caregiver assistance. They know major facts about themselves — such as their name and their children’s names — but they may not remember grandchildren’s names, their longtime address, or where they went to high school.

Stage 5 dementia symptoms

• Pronounced memory loss, including personal details and current events
• Wandering, especially at night
• Confusion and forgetfulness
• Disorientation and sundown syndrome
• Further reduced mental acuity and problem-solving ability

What are the final stages of dementia?

As seniors progress to late stage dementia, full-time care may become necessary, whether you choose memory care or professional dementia care at home. The symptoms of the final stages of Alzheimer’s include behavioral and personality changes, inability to perform ADLs, and severe cognitive decline.

Dementia stage 6: severe cognitive decline

Stage 6 marks a need for caregiver help to perform basic daily activities such as dressing, eating, using the toilet, and other self-care. Seniors with late stage dementia may have difficulty regulating sleep, interacting with others, or behaving appropriately in public settings.

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Stage 6 dementia symptoms

• Sleep difficulties
• Urinary or fecal incontinence
• Aggression
• Personality changes including paranoia or delusions
• Anxiety
• Pronounced memory loss
• Inability to recognize primary caregiver and loved ones

Dementia stage 7: very severe cognitive decline

In severe Alzheimer’s or late stage dementia, people essentially can’t care for themselves. Generally, all verbal ability is lost, and ambulation and movement become severely impaired. By the end of the seven stages of dementia, bodily functions like the ability to chew, swallow, and breathe may also become compromised.

What are the symptoms of the final stage of Alzheimer’s?

• Inability to speak
• Inability to move without help
• Lack of physical coordination
• Impaired bodily function

Memory care is specialized care for seniors with dementia. It includes 24-hour supervision to prevent wandering, help with ADLs, meal services, and, often, health care as needed.

Memory care can be beneficial from the early stages of dementia through the end of life. Specially designed memory care activities, dining plans, and exercise programs cater to all seven stages of dementia in elderly loved ones.

When to seek memory care will vary depending on a senior’s dementia symptoms, health status, living situation, and more. Reach out to our free, local Senior Living Advisors to discuss memory care and dementia home care options for your family.

Sources: 

Reisberg, B., Ferris, S.H., de Leon, M.J., and Crook, T. The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 1982: 
https://www.fhca.org/members/qi/clinadmin/global.pdf

National Institute on Aging, “What is Mild Cognitive Impairment?”: https://www.nia.nih.gov/health/what-mild-cognitive-impairment