How dementia progresses
Dementia is a neurodegenerative disease which means it worsens over time. But the rate at which the condition progresses varies from person to person.
Brain changes associated with types of dementia such as Alzheimer’s usually occur years before any symptoms become noticeable. The stages of dementia can generally be grouped into three phases: early-stage, moderate and severe. But it can sometimes be difficult to place someone with dementia in a specific stage. Knowing a little about what to expect can make the journey easier.
The stages of dementia can generally be grouped into three phases: early-stage, moderate and severe.
While symptoms will start to affect day-to-day life in the early stages of dementia, the person with the condition will still be fairly independent. Dementia can develop slowly so the initial signs may not be obvious.
Some symptoms may appear before a diagnosis of dementia is confirmed. These include:
- Memory loss – problems with short-term memory such as forgetting recent events or people.
- Poor concentration
- Being confused about time and place
- Mood changes
- Struggling to follow a conversation or forgetting simple words
These symptoms are not only associated with dementia – many other conditions such as depression, the menopause and mild cognitive impairment (a condition where memory loss is not severe enough to be defined as dementia) can cause similar problems.
If you suspect that you or a loved one may have dementia, it’s important to get a proper diagnosis. Find out about diagnosing dementia.
Once dementia has been confirmed and it reaches its middle stages, symptoms may become more obvious as cognitive decline increases. Mid-stage or moderate dementia can last a long time and the person will generally need more support to help them cope with daily life during this stage of the disease. You may want to consider extra support for your loved one, such as sheltered housing, home care or residential care.
In the middle stages of dementia, people tend to be less aware of their memory problems even though the decline is more severe than in the early stages. Moderate dementia also starts to affect the long term memory, as well as the short term.
As dementia progresses, behaviour changes become more noticeable. These may include repetitive behaviour, lack of inhibition, night-time waking and paranoia.
People with dementia experience more communication problems as the disease progresses. In the middle stages, they may have trouble finding the right word, losing their train of thought and start relying on non-verbal communication.
Eating, dressing and grooming become more challenging as the disease progresses and they may need help with these daily tasks.
As the condition progresses to the later stages, memory loss and difficulties with communication often become very severe. In the later stages, more care and support from a range of people will be required.
In the later stages of dementia, people may not recognise family and friends; may forget where they live; and may not know where they are. They might find it difficult to understand simple pieces of information, carry out basic tasks or follow instructions.
People with dementia often have difficulty speaking and they may eventually lose the ability to speak altogether. It’s important to keep communicating with someone who has dementia, and to recognise and use other, non-verbal, means of communication such as expression, touch and gestures.
Many people with dementia can become less mobile and need help to move around. They might appear increasingly clumsy when carrying out everyday tasks, and be more susceptible to accidents or falls. In the later stages of dementia, they may be unable to walk and need help with moving.
Bladder incontinence is increasingly likely in the later stages of dementia. If you’re caring for someone at home, you’ll need a continence assessment and advice from the community nursing team about management and care. Your GP can arrange this for you.
Eating, appetite and weight loss
Loss of appetite and weight loss are common in the later stages of dementia as people’s interest in food changes, and their tastes and likes can change. It’s important that people with dementia get help at mealtimes to ensure that they eat enough. Offering food that is appetising and appealing is a key part of the day and offering smaller amounts more frequently might be more successful. Seek advice from a dietician or the nursing team in the community or care facility. Being creative and adaptable is key.
Some people have trouble eating or swallowing, causing risk of choking, chest infections and other problems. If you have any concerns, speak to the clinical professionals in charge of your family member’s care.
When to consider arranging care
Caring for someone with moderate dementia can be challenging – it requires a lot of patience and flexibility. It’s important to take care of yourself and seek support when your caregiving responsibilities get more demanding.
In the later stages of dementia, it’s likely that your loved one will become increasingly frail and dependent on others, meaning that they need 24/7 care. Their behaviour might mean that they need constant supervision to make sure that they don’t hurt themselves or get lost. You may be able to get NHS support or help from your local council.
The Alzheimer‘s Society provides a simple leaflet called ‘This is me’ for anyone with dementia who is receiving professional care. It can be used to record details about a person who can’t easily share information about themselves such as their cultural and family background, important events, people and places from their life their preferences and routines. It can be used in any setting – at home, in hospital, in respite care or in a care home. ‘This is me’ helps care professionals better understand the person and tailor the care to their needs.
Read more about the different care options to consider for someone with dementia.
When your loved one might need a hospice
In some cases, a person nearing the end of their life will require specialist palliative care. Palliative care focuses on reducing physical and psychological distress and providing support to the family.
They may be cared for in a hospice or be supported at home by a community palliative care team or by support staff from a local hospice. The palliative care team can help in managing symptoms and provide expert advice, generally provided by district nurses.
We explain how to spot the signs of dementia and the difference between this condition and mild cognitive impairment.
Getting a professional dementia diagnosis will help you to get access to appropriate support and treatment.
We look at the different options to explore when planning dementia care.