3 stages of dementia

Dementia Aware: What you need to know about the three stages of dementia

By Tracey Maxfield

Dementia will affect each person differently.

Its impact can depend on the type of dementia the person has and what the person was like before the diagnosis:  personality, lifestyle, relationships, physical health, mental health and health history.

The changes a person with dementia will usually experience are best understood in three stages:

• Stage 1 - the Early Stage
• Stage 2 - the Middle Stage
• Stage 3 - the Late Stage.

Remember, that not all people with dementia will display all the symptoms listed below.

These are merely guidelines to help caregivers to be aware of potential problems and to allow them to think about the person with dementia’s future care needs. 

Stage 1 - Early Stage

In the early stage of dementia, the changes a person may experience can be gradual and subtle, and it is not uncommon for some to be dismissed as a senior moment or old age.

The person may experience:

• Memory loss – particularly for things that have just happened
• Difficulty making decisions, handling money, paying bills
• Not knowing the time of day or day of the week
• Become lost in familiar places
• Have unusual reactions – anger, aggression
• Loss of interest in hobbies, social activities
• Problems talking properly – repetition, mixing up words or forgetting words, stammering or stuttering

Stage 2 - Middle Stage 

As the dementia progresses, the person will have trouble with day to day living and:

• Is unable to cook, clean or shop
• Needs help with personal hygiene – washing, dressing, using toilet
• May start falling
• Easily misplace items (purse in microwave) or hide items (soiled incontinence pads)
• Has increased difficulty with speech
• May become lost in the home and outside the home
• Has difficulty driving
• May see or hear things which aren’t there (hallucinations)
• May become very forgetful of recent events, people names
• Show problems such as repeated questioning and calling out, clinging, repeated telephone calls to family, disturbed sleep, inappropriate behaviour, anxiety, paranoia
• May start wandering and/or sundowning (late day confusion)
• May become very dependent on caregiver or family/friends
• Can no longer manage to live alone safely

Stage 3 - Late Stage

At this stage, the person with dementia is almost totally dependent, memory problems are very serious and the physical side of dementia becomes more obvious.

The person may:

• Have difficulty eating
• Be unable to recognise family, friends and even familiar objects e.g. chair, table
• Have great difficulty understanding what is going on around them
• Have difficulty walking or be confined to a wheelchair or bed
• Have bowel and bladder incontinence
• Be unable to communicate or make self understood
• May display inappropriate behaviour at home and in public.

Tracey Maxfield is a dementia consultant and advocate with over 35 years experience working with dementia populations in the U.K. and Canada. She is is lobbying the federal and provincial governments and local municipalities to respond to the dementia crisis in B.C., especially in the Okanagan. She can be reached at [email protected].

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.