The 7 Stages of Dementia and Symptoms

Dementia is a general term for a decline in cognitive function that affects memory, problem-solving skills, language, and functions that affect daily living. Specific types of dementias — including Alzheimer’s disease and vascular, Lewy body, and frontotemporal dementia — advance at unique rates and differ from person to person.

The seven stages are separated into three progressive phases of dementia:

• Pre-dementia or early-stage dementia. In this initial phase, a person can still live independently and may not exhibit obvious memory loss or have any difficulty completing regular tasks. Mild dementia symptoms mimic episodes of age-related forgetfulness.
• Moderate or middle-stage dementia. Moderate dementia symptoms significantly affect a person’s personality and behavior. Someone with middle-stage dementia will generally need full- or part-time caregiver assistance with regular day-to-day activities. Other moderate-stage dementia symptoms include significant cognitive impairment and mood swings.
• Severe or late-stage dementia. The final phase is associated with severe cognitive impairment along with a loss of physical abilities. Late-onset dementia symptoms are pronounced memory loss, incontinence, and an inability to move without help.

Health care providers use a comprehensive tool to assess the seven stages of dementia in elderly patients: the Global Deterioration Scale.^[01] Also known as the GDS, this trusted method 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. A dementia stages chart can help caregivers track and monitor their loved one’s health status against stage-related symptoms.

The seven stages of dementia are:

• Stage 1: No cognitive impairment
• Stage 2: Very mild cognitive decline
• Stage 3: Mild cognitive decline
• Stage 4: Moderate cognitive decline
• Stage 5: Moderately severe cognitive decline
• Stage 6: Severe cognitive decline
• Stage 7: Very severe cognitive decline

Dementia stage 1: No cognitive impairment

Though it may sound odd, stage 1 dementia often looks like normal mental functioning without any cognitive decline. Someone in the first three dementia stages doesn’t usually exhibit enough symptoms to be diagnosed. However, it’s important to note that changes in the brain are still taking place. While some cognitive impairment may be present, stages 1, 2, and 3 on the GDS are recognized as pre-dementia stages.

Dementia stage 2: Very mild cognitive decline

Stage 2 dementia includes simple memory mistakes like a loved one wondering “Where did I put my keys?” or, “What was that person’s name?”

A significant amount of the senior population experiences age-related forgetfulness, and caregivers or medical providers may not even notice such mild impairment. This explains why stage 2 is also known as “age-associated memory impairment” on the GDS.

“About 40% of people aged 65 or older have age-associated memory impairment — in the United States, about 16 million people,” said Professor Gary W. Small ^[02] in research published by the British Medical Association. “Only about 1% of them will progress to dementia each year.”

Stage 2 dementia symptoms:

• Losing track of familiar objects
• Inability to recall names of friends, family members, and former acquaintances

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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 decline, which is also known as mild cognitive impairment (MCI). Stage 3 dementia doesn’t generally have a major impact on day-to-day functioning.

How quickly does this dementia stage progress in the elderly? An estimated 10 to 20 percent of people age 65 or older with MCI will develop recognizable or diagnosable dementia within a year, according to the National Institute on Aging.^[03] Since MCI often precedes 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

Dementia stage 4: Moderate cognitive decline

Stage 4 dementia is when a person has clear, visible signs of cognitive impairment and exhibits personality changes — both of which are significant dementia symptoms. A person is not typically diagnosed with dementia until they’re at stage 4 or beyond. While the medical terminology for stage 4 dementia is moderate cognitive decline, this stage is officially diagnosed by the GDS as mild dementia.

At this stage, doctors and caregivers will likely observe hallmark signs that dementia is getting worse, including difficulties with language and reduced problem-solving skills.

Stage 4 dementia symptoms:

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

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, or Instrumental activities of daily living (IADLs) without some caregiver assistance. Middle-stage dementia often lasts between two and four years,^[04] though every dementia patient will progress at a unique rate.

In stage 5 dementia, your loved one will likely require more intense support and supervision. 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
• Confusion and forgetfulness
• Disorientation and sundown syndrome
• Further reduced mental acuity and problem-solving ability

Dementia stage 6: Severe cognitive decline

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

At stage 6 of dementia, you may find yourself wondering if full-time care is necessary as symptoms become more complex. You can stay prepared by tracking symptoms, monitoring your loved one’s ability to perform ADLs and IADLs, and exploring care options like memory care or home care.

Stage 6 dementia symptoms:

• Sleep difficulties
• Urinary or fecal incontinence
• Aggression and anxiety
• Personality changes including paranoia or delusions
• Inability to perform ADLs
• Pronounced memory loss
• Inability to recognize loved ones and caregivers

Dementia stage 7: Very severe cognitive decline

In stage 7, which is considered late-stage dementia, people can no longer care for themselves. Generally, for patients with severe dementia, all verbal ability is lost and movement becomes severely impaired. Symptoms of late-onset dementia disrupt bodily functions like the ability to chew, swallow, and breathe.

Stage 7 dementia symptoms:

• Inability to speak
• Lack of physical coordination and the inability to move without help
• Impaired bodily functions

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There’s no real way to know how long it will take for a loved one to progress through all the stages of dementia. Dementia gets worse with time, but some people stay in the early stages of dementia longer and can remain independent for years. However, others experience rapid dementia symptoms and will require more immediate support. End-stage dementia, which is the most aggressive stage of dementia, typically lasts between one and two years.

How long do people live with dementia?

The average person with a dementia diagnosis will live between four to eight years.^[05] Some people, however, live up to 20 years after their diagnosis. Different types of dementias, like Alzheimer’s disease and vascular dementia, follow a similar seven-step progression.

Life expectancies vary slightly for different dementias, according to the Alzheimer’s Society^[06]:

• Alzheimer’s disease. The life expectancy range is between eight and 10 years.
• Vascular dementia. People with vascular dementia face external risk factors like stroke or heart attack, and the average lifespan is five years.
• Lewy body dementia. A greater threat of injuries and infections place the life expectancy for dementia with Lewy bodies at around six years.
• Frontotemporal dementia. The expected lifespan ranges from six to eight years.

Coming to accept a loved one’s dementia diagnosis and understanding what to expect can help you feel empowered and provide opportunities to make the most of this time together. Remember that caregivers have a variety of ways to provide support to a loved one through the progression of dementia.

• Try to have positive and meaningful conversations using effective dementia communication strategies.
• Consider explore unique dementia treatment options and therapies.
• Create a dementia care plan.
• Consider joining a support group for caregivers.

If the idea of navigating a dementia diagnosis alone seems overwhelming, A Place for Mom is here for you. Explore our library of caregiver resources, which contains hundreds of articles covering dementia therapies and memory care communities.

Memory care is specialized support for seniors with dementia. It includes 24-hour supervision to prevent wandering, assist with ADLs, provide meal services, and administer 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 address all types of dementia symptoms in elderly loved ones.

Understanding when to seek memory care will vary depending on a senior’s dementia symptoms, health status, living situation, and more. Our Senior Living Advisors offer free guidance and are ready to discuss local memory care and dementia home care options with your family.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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