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These are the 7 Stages of Dementia, Say Experts

Neurologists explain the stages of dementia and what to expect in each one. 

Almost 6 million Americans are living with dementia, according to the Centers for Disease Control and Prevention. "Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person's daily life and activities," says Raymond Dacillo, director of operations for C-Care Health Services. "One in six people over the age of 80 have dementia, in which most have Alzheimer's. Women are also more likely to be affected than men." Although dementia can be a challenge to diagnose, particularly early on, the condition tends to have seven main stages. ETNT Health spoke with specialists who detailed those stages and what to expect from each. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


The Difference Between Alzheimer's and Dementia

woman having serious chat with her doctor

"The difference between Alzheimer's and dementia is that dementia is an umbrella term," says clinical neuropsychologist Kendal Maxwell, Ph.D. "There are many types of dementia, such as vascular, frontotemporal, and Lewy bodies. Alzheimer's is a type of dementia that largely includes changes to learning and memory, semantic knowledge, and word-finding issues at the earlier stages. It involves changes to the brain (such as neuronal loss, neurofibrillary tangles, and amyloid plaques) that can be tested by way of PET scan, brain MRI, and lumbar puncture." 


Before Symptoms

Middle aged barefoot woman sitting at the floor embracing her knees, near sofa at home, her head down

In this stage, "No early symptoms of dementia are noticeable outwardly," says Santoshi Billakota, MD, an adult neurologist epileptologist and clinical assistant professor at NYU Grossman School of Medicine. "Usually things are normal at the start, and only a brain scan (like a PET scan) can pick up any abnormalities."


Forgetfulness (Very Mild)

Middle-aged businesswoman standing holding the frame of her glasses to her mouth as she stares pensively into the distance.

At this stage, a person may display forgetfulness, including word-finding difficulty or misplacing objects like keys. Symptoms are very mild and generally don't interfere with work or life, says Billakota.

Changes in personality can happen, says Dalia Lorenzo, MD, a neurologist at Baptist Health's Miami Neuroscience Institute. "This is of particular concern to neurologists for two reasons," she says. "First, patients can start to show problems in one cognitive realm (planning and strategizing) while still appearing to be completely normal in terms of their day-to-day functioning. This can lead to terrible problems socially, at work, at home, and with potential legal repercussions. The second reason neurologists are concerned about personality changes preceding memory changes is the possibility of frontotemporal dementia, a more aggressive neurodegeneration. These patients will have a shorter lifespan than patients with Alzheimer-type dementia."


Noticeable Memory Issues (Mild)

Woman comforting anxious husband

These symptoms are more noticeable. An affected person might forget what they just read or ask the same question repeatedly. "There might be more notable deficits in making plans, managing tasks, or organizing finances," says Billakota. "More complex tasks are difficult, like driving. They might get lost driving in familiar neighborhoods and grocery shopping."

"A few of the most common signs of memory-loss issues are trouble with day-to-day memory, difficulty completing familiar tasks, confusion with time or place, constantly misplacing things, and problems with words, either when speaking or writing," says Jim Dan, MD, a geriatric clinical advisor and member of the Senior Helpers board of directors. The person may increasingly rely on memory aids, such as reminder notes or family members.


Worsening Memory Loss (Moderate)

Grey haired senior male seats on couch in living room.

People in this stage can forget important details about loved ones or themselves, says Billakota. They may have trouble using the phone or other electronics. Simple household chores may become difficult.

"In the earlier stages of cognitive changes, people begin to rely on their habits, routines, and rituals to support their daily functioning," says Kelly O'Connor, a certified dementia practitioner. "This reliance on patterning may show up as forgetting to change clothing and wearing the same clothes day after day. People who are losing the executive functioning of the brain which controls decision-making may also dress in the wrong season."


Decreased Independence (Moderate)

Senior Hispanic Man Suffering With Dementia Trying To Dress

This stage can bring a quick decline in mental functioning and independence, says Billakota. An affected person may not remember who or where they are.

"Confusion, even in well-known places, is another [stage] of dementia or Alzheimer's," says Dan. This may include becoming disoriented in familiar places or losing track of dates, seasons, or the passage of time. "A loss of enthusiasm for previously enjoyed activities can be an indicator as well. You may experience changes in the ability to hold or follow a conversation. Significant mood swings may cause you to withdraw from hobbies, social activities, and other engagements that you previously enjoyed."


Increased Severity of Symptoms [Severe]

senior woman with adult daughter at home.

In this stage, an affected person might have trouble recognizing faces and people, says Billakota. Delusions and behavioral changes can set in. A person may have trouble going to the bathroom, eating, sleeping, and even walking.


Very Severe Decline

Elderly woman wearing oxygen mask sleeping in hospital bed

"At this point, basic abilities are compromised," says Billakota. "The person is usually bed-bound and unable to do much for themselves. They can't tell whether they are hungry or thirsty. They are more prone to developing infections and bedsores. Hospice is a good idea around this stage." 


How Lack of Sleep is Connected to Dementia

woman sleeps peacefully in plush gray bedding

One easy way to reduce your risk of dementia: Get enough quality sleep. "Although most people think of sleep as seven hours of downtime and their 24-hour day, the truth is that sleep has a very important function in refreshing and recharging the brain," says Lorenzo. "Purposeful curtailment of sleep hours is seen as a good way to squeeze a few more hours of work and play in the day. But studies say otherwise. We know that people who get less than six hours of sleep nightly have a higher risk of developing dementia later in life." 


Eating a Healthy Diet Helps Prevent Dementia

mediterranean diet

"Eating an inflammatory diet that is high in refined sugars and processed grains may contribute to brain aging and cognitive decline," says Heather Hanks, MS, CAM, a nutritionist and medical advisor with Medical Solutions BCN. "Focus on eating healthy fats that have been shown to possess neuroprotective benefits, such as omega-3 fatty acids from fish, flax, walnuts, and chia seeds, as well as monounsaturated fatty acids from avocados, nuts, and olive oil.  It's also important to eat lots of low-carb vegetables that can reverse disease-causing inflammation, such as spinach, cruciferous vegetables, asparagus, onions, and root vegetables like sweet potatoes and carrots." And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Heather Newgen
Heather Newgen has two decades of experience reporting and writing about health, fitness, entertainment and travel. Heather currently freelances for several publications. Read more about Heather