People diagnosed with dementia can often live for years after the diagnosis, creating special end-of-life challenges due to the unpredictable progression of the disease. Furthermore, patients in the later stages of dementia have a challenging time communicating pain, feelings, wants and needs. This puts the caregiver in a tough position to meet the needs of their loved one.
If you’re caring for someone with dementia, there are signs to know how your loved one is progressing through the disease and when they are nearing the end of their life.
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What Are the 7 Stages of Dementia?
Dementia advances at unique rates that differ from person to person, making it important to understand the signs and symptoms at each stage.
Stage 1
During stage 1, patients can function normally and don’t show signs of memory loss, confusion or cognitive impairment. However, In the early stages of dementia, their brain function and structure start to deteriorate as the neurons in the brain start to lose connection with other brain cells and die.
Stage 2
In stage 2, the person will start to experience occasional lapses in memory, such as forgetting where everyday objects are placed or names they once knew very well. At this stage, symptoms are unlikely to affect the person’s work or social interactions and may be too mild to detect in a clinical interview with a healthcare provider.
Stage 3
Cognitive impairment becomes more noticeable to the patient and their friends and family in stage 3. Various symptoms may include:
- Getting lost while walking or driving.
- Retaining very little of something read.
- Forgetting words and names of loved ones.
- Losing important items.
- Poor performance at work.
- Verbal repetition.
- Trouble with complex tasks and problem-solving
Stage 4
In a clinical interview, the person in stage 4 will show a decline in cognitive ability and avoid challenging situations to prevent anxiety and hide distress from others. Symptoms in stage 4 may include:
- Social withdrawal
- Emotional moodiness
- No knowledge of recent or current events.
- Forgetting their own personal history.
- Trouble with routine tasks.
- Denial of symptoms
Stage 5
Most patients aren’t diagnosed with dementia until they have reached stage 5. Stage 5 can last from 2- 4 years and from stage 5 onward, the patient can no longer function without at least some assistance.
Other symptoms include:
- Pronounced memory loss including important details such as addresses or phone numbers.
- They may remember their own name and the names of their children and spouse but struggle to remember the names of their grandchildren.
- Wandering
- Confusing the time of day, day of the week, date or season.
- Reduced mental acuity and difficulty with problem-solving.
Stage 6
Patients start to show an additional cognitive decline in stage 6 and require assistance to perform daily activities. Stage 6 is the longest stage lasting from 4-8 years. In addition to all the previous symptoms identified, the patient will progress to the following symptoms:
- Require assistance with bathing, dressing, eating, toileting and other self-care activities.
- Inability to recognize family and friends.
- Urinary and fecal incontinence.
- Sleeping difficulty.
- Unsettled behaviors like aggression and anxiety.
Personality changes may include:
- Paranoia, hallucinations, and delusions, such as talking to themselves or thinking their caregivers want to hurt them.
- Irritability and striking out.
- Obsessive tendencies, such as cleaning or performing a task over and over.
Stage 7
Stage 7 is considered the end-stage of dementia. At this stage the patient has met all previous stages and is no longer able to provide self-care.
Patients will progressively:
- Lose the ability to talk and make their needs known.
- Their functional status will decline based on the cognitive changes.
- The patient will no longer be able to walk because they can’t remember how.
- The patient will eventually require total care for all activities of daily living: bathing, dressing, eating, toileting and other self-care activities.
Depending on certain factors, such as age and health, the final stage can last around 1-2 years.
What Are the Three Phases in the Global Deterioration Scale (GDS)?
The Global Deterioration Scale is used by professionals and caregivers to provide an overview of the stages of cognitive function for patients diagnosed with dementia. The GDS is broken down into seven stages as mentioned above, and the seven stages are divided into three phases of dementia:
Pre or Early Phase
This phase includes stages 1 through 3. A person can still live independently and may not exhibit obvious memory loss. By Stage 3 they are starting to demonstrate mild cognitive impairment.
Moderate or Middle Phase
In stages 4 and 5, the patients’ personalities and behaviors begin to change and they have significant difficult with memory. At stage 5 the patient is considered to have moderate dementia and can no longer survive without assistance for regular day-to-day activities.
Final or End Phase
Stages 6 and 7 of are known as end-stage or severe dementia due to cognitive impairment and the loss of physical abilities. At the end stages the patient will eventually require total care for all daily activities. The patient will have no verbal abilities, will be unable to eat, bathe or dress independently. They will be incontinent of bowel and bladder and will no longer be able to walk independently.
What Causes the Stages of Dementia to Progress?
How quickly someone progresses through the stages of dementia depends on various factors, such as how old the patient was at the diagnosis and what type of dementia they have. In addition to the progression of dementia, other symptoms may occur.
Delirium
Delirium is defined as a state of confusion with reduced awareness of surroundings. Delirium appears suddenly and can fluctuate with inattention, disorganized thinking and altered level of consciousness. It may be due to underlying physical causes such as:
- Infection: Infections are a common cause of delirium and with dementia, patients are especially vulnerable to urinary tract infections (UTIs).
- Medication: 39% of delirium cases are caused by medication side effects.
There are three types of delirium:
- Hypoactive - when the patient seems sleepy, tired, or depressed.
- Hyperactive - when the patient is restless or agitated.
- Mixed - when the patient changes back and forth between being hypoactive and hyperactive.
In advanced stages of dementia, patients may also develop delirium in response to more minor conditions such as constipation, dehydration or lack of sleep.
Stroke or brain injury
Brain injuries often exhibit symptoms that are similar to dementia and patients can develop new or worsened dementia symptoms after a stroke. Signs of a stroke or brain injury to look out for include:
- Sudden confusion.
- Difficulty speaking or understanding speech.
- Weakness, numbness, or inability to move one side of the face or body.
- Sudden change in balance or coordination.
- Sudden loss of vision.
- Severe headaches.
Change in routine
Dementia patients rely heavily on routines as a sense of comfort. Sudden disruptions in routine can cause the patient to have unsettled behaviors. Changes that may trigger unsettled behaviors include:
- Moving to an assisted living facility or nursing home.
- Moving in with family or out of the family home.
- Transition in caregivers.
Hospice for Dementia Patients
Hospice may be the answer for patients with advanced dementia. To qualify for this service, an individual must have a terminal diagnosis and a life expectancy of six months or less as certified by a physician. According to Medicare the patient diagnosed with dementia may be eligible for hospice if:
- The physician determines the patient has a life expectancy of six months or less if the disease takes its normal course.
- Patient scores 7a or greater on the FAST scale that includes:
- Unable to ambulate without assistance
- Unable to dress without assistance
- Unable to bathe without assistance
- Incontinence of bowel and bladder
- No consistent meaningful communication
- The patient must have an additional diagnosis/condition that affects their life expectancy.
If you are caring for someone who is diagnosed with dementia, choose a hospice provider who specializes in dementia to ensure the highest level of care is received. Some questions you can ask include:
- Is your program certified by Medicare?
- Is your staff experienced in providing care for patients with dementia-related illnesses?
- Do you offer specialized services to improve a comfort for a patient diagnosed with dementia?
- Do you offer services to the family and caregivers of the patient?
If you or a loved one think it may be time for hospice, take our hospice eligibility quiz for a unique report on whether hospice might be right for your situation.
