The 7 Stages of Dementia and Symptoms

Understanding the dementia timeline is key to making thoughtful medical and personal decisions regarding memory care. Learning the signs of early, moderate, and late stage dementia can help you know what you’re facing, prepare for the future, and determine when it’s time to reassess your family member’s care needs.

Dementia is a term for brain disorders that cause a loss of remembering, thinking, and reasoning skills. Alzheimer’s disease accounts for 60% to 80% of cases. The most common types of dementia, including Alzheimer’s, is progressive, meaning it worsens over time. Dementia is categorized as mild, moderate, or severe as well as early stage, middle stage, and late stage.

Health-care providers often use a more comprehensive seven-stage tool to assess dementia. It’s called the Global Deterioration Scale (GDS), or the Reisberg Scale, developed by Dr. Barry Reisberg, a geriatric psychiatrist and NYU Langone Health professor. It enables caregivers and health professionals to have a rough idea where someone is in the disease’s progression by observing and comparing their symptoms.

Stages 1-3: no dementia diagnosis

Someone in the first three stages of dementia does not usually exhibit enough symptoms to be diagnosed.

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Stage 1 dementia: no cognitive impairment 

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

Stage 2 dementia: very mild cognitive decline 

Where the heck 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 considered to be dementia.

Stage 3 dementia: 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.

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 stages of dementia, 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 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

Stage 4: early stage or mild dementia

A person is not typically diagnosed with dementia until they are at stage 4 or beyond.

Stage 4 dementia: moderate cognitive decline 

At this point, a person has clear visible signs of mental impairment. While it’s considered early stage or mild dementia, the medical terminology 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

Stages 5-6: middle stage or moderate dementia

People require more intense care and supervision at this point. Someone with middle stage dementia often needs some caregiver assistance with regular day-to-day activities, such as dressing, eating, or bathing.

Stage 5: moderately severe cognitive decline 

This stage marks the onset of what many professionals refer to as mid-stage dementia.

At this point, a person may no longer be able to carry out normal day-to-day activities, 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
• Confusion and forgetfulness 
• Disorientation to time or sundown
• Further reduced mental sharpness and problem-solving ability 

Stage 6 dementia: 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.

Stage 6 dementia symptoms

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

Stage 7: last stage or severe dementia

In severe Alzheimer’s or late stage dementia, people essentially can’t care for themselves.

Stage 7 dementia: very severe cognitive decline 

All verbal ability is lost over the course of this final stage. Motor impairment occurs as well.

Stage 7 dementia symptoms

• Inability to speak
• Inability to walk without help

When is memory care needed?

Memory care is specialized care for seniors who have Alzheimer’s disease, another type of dementia, and other forms of memory loss. It includes 24-hour supervision to prevent wandering, help with activities of daily living (ADLs), meal services, and health care as needed. Some carefully designed memory care facilities have layouts and therapies to reduce confusion and promote familiarity.

When to seek memory care will vary depending on a senior’s dementia symptoms, health status, living situation, and more. One of our Senior Living Advisors can discuss memory care thoroughly and share information on communities in your area.

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