Dementia — Stages and Types
What does “having dementia” really mean?
Having a “diagnosis” of dementia does NOT mean that the individual can no longer be productive. A person “diagnosed” with dementia develops challenges with comprehension, participation, coping and behaviors. Understanding that dementia is a progressive illness and that there is a decline, not an immediate termination in capabilities, is important to know. So the question becomes, how many stages of dementia are there and how is dementia evinced in each of the stages?
The Seven Stages of Dementia
Medical professionals identify seven stages of dementia based on cognition loss:
Although medical professionals use the seven-stage scale for noting cognition loss, the non-medical world groups people with dementia more generally in three stages—early, middle and late.
Important to Understand the Three Stages of Dementia?
For family members, home caregivers and workers in Activity departments that provide recreational opportunities for seniors, recognizing cognition levels in people with dementia is very important. Dementia is not a nice term and undermines self-esteem and personal valuation. As such, “dementia” should not be used as a word to label but only as a means to identify and provide appropriate stimulation.
For people in the early stages of dementia, they may still be able to participate in the majority of activities, but the activities may need to be simplified a bit. Accommodating people for their decline in movement, ability to comprehend or stay focused helps them to keep participating and massages their emotional well-being.
Two key points on accommodating people to participate are:
(1) Supporting their ability to achieve!
People who still can achieve the task in front of them—crafts, a simplified puzzle, a recipe—have reduced frustration, a huge symptom of dementia. A boost in self-esteem is from achieving and/or completing a task, even a simplified one!
(2) Maintaining their social engagement!
People who participate are better socialized as they still feel part of a group. Being socially-included helps deflect depression and reduces dementia-associated behaviors, like agitation and aggression. The more people participate, the longer they maintain mood-appropriate social skills.
Sad to say, people who are not achieving or given the opportunity to achieve tasks or who aren’t socially engaging with groups tend to decline faster. In short, busy seniors are engaged seniors with heightened quality of life and potentially inner well-being!
Two big drawbacks of OVER-accommodating people are:
(1) Dependency is created!
While it is good to be attentive to people’s needs and fulfill their wishes, every person needs to have the satisfaction of accomplishing something. Give some small task and give effusive praise when it is accomplished, e.g. setting the table. Too hard? Wiping the table, or sorting silverware.
For people who can achieve but prefer to be assisted, logically reason then gently direct that person to do what he/she can because when skills are lost, they aren’t easy to regain.
(2) Perceptions of being patronized … resulting in perceived loss of dignity!
Accommodations are to help people with or without dementia participate as fully as possible. However, over-simplified tasks can be perceived as childish and patronizing. People with dementia might not be able to express their feelings well but they have a keen sense of dignity and self-respect. Being undervalued or disrespected with “childish” activities can negatively impact their willingness to participate or even trust in the activity organizer.
To prevent over-dependency, encourage the person to participate in small ways to reach the goals of the situation. People should be empowered to help themselves, and when it becomes apparent that abilities are declining, the tasks requested can be simplified and fewer. Giving people the sense of small accomplishments and participation gives them dignity and respect. Giving them age-appropriate tasks does too!
Is Dementia a Diagnosis?
No, dementia is not a diagnosis—dementia is in fact an umbrella category for symptoms of cognitive loss that is related to underlying issues. Dementia is therefore a comorbidity of illness and is not a diagnosis in itself.
What Is the Comorbidity of Dementia?
8 types of dementia specific to disease comorbidities
1. Alzheimer’s disease – by far the most common comorbidity of dementia affecting 60-80% of people with Alzheimer’s. Alzheimer’s is the disease of memory loss, and over time dates and time are confused, conversation becomes difficult and eventually lost, friends and families forgotten, and eventually even movement and the ability to eat on their own is forgotten.
2. Vascular dementia – the second most common type of dementia—this one affecting blood flow to parts of the brain, depriving oxygen and killing cells. Strokes and TIAs result affecting people by severity of damage location. Early symptoms may be language difficulties, poor planning and judgment, emotional outbursts and poor attention span. Later symptoms may be loss of memory, confusion, loss of motor skills and bladder control, depression and even hallucinations.
3. Lewy body dementia (LBD) – a dementia affecting people over age 50 and which is caused by protein build-up. The protein alpha-synuclein clumps called Lewie bodies accumulate on brain nerve cells responsible for memory, motor control and cognitive processes, which often makes it appear like Parkinson’s at first. Movement is first affected and later memory and cognition. Hallucinations are often a hallmark. Rigid muscles, tremors, and radical moodiness day to day can be expected.
4. Frontotemporal dementia (FTD) – a less common dementia but one which affects people under age 60, starts in the frontal lobe, which is responsible for mood and behavior. Behaviors can therefore be aggressive or apathetic, devoid of empathy, language sexually inappropriate, and which often affect a misdiagnosed of a psychiatric disorder like depression or bipolar behavior. Cravings, unusual eating patterns or compulsions like binge-watching the same movie over and over can also evince. Depending on location affected in the brain, other problems with speaking, writing, comprehension, muscle weakness and atrophy can result. Memory loss is not a major symptom.
5. Normal pressure hydrocephalus (NPH) – a dementia with successful treatment. Buildup of excessive cerebrospinal fluid in the brain from head injury, trauma, meningitis or unknown other can impact drainage and flow, but which can be released with a surgically inserted shunt. Underdiagnosed symptoms are often attributed to Alzheimer’s, Parkinson’s or “normal aging”. The three main symptoms are urinary incontinence, balance and walking difficulty, and cognitive problems—short-term memory loss, mood changes, difficulty with decision making and task performance.
6. Huntington’s disease – an inherited progressive brain disorder affecting movement, behavior and mood, with symptoms typically appearing between ages 30-50. Early symptoms affect planning, recall, staying on task as well as physical difficulties like inability to hold a cup without dropping it. Progressive symptoms affect involuntary movements—e.g. slurred speech, abnormal twisting of arm, knee or foot—and later stages may include significant memory loss.
7. Creutzfeldt-Jacob disease (CJD) – an extremely rare but fast-moving brain disorder caused by an infectious, misfolded prion protein in the brain. Symptoms quickly progress from depression, mood swings, agitation, confusion, and memory and judgment difficulties to difficulty walking, twitches, involuntary movement, blindness and hallucinations.
8. Wernicke-Korsakoff syndrome (WK) – a degenerative brain disease caused by vitamin B1 (thiamine) deficiency. Thiamine deficiency is related to alcoholism, anorexia and other illnesses and in the early disease state, it’s referred to as Wernicke. Untreated it leads to chronic, irreversible Korsakoff syndrome, which unfortunately occurs in 80-90% of cases. Memory loss, vision problems, lack of concentration, disorientation can result, along with ataxia or inability to coordinate voluntary movement. To note, though having memory loss and inability to retain information, they can still socially converse but with confabulation, aka inventive gap fills.
The original questions here was, “How many stages of dementia are there and how do they evince?” To completely answer that loaded question is to understand which type of comorbidity attached to the dementia is affecting the person concerned. Once the underlying diagnosis is known—and remember, dementia is not a diagnosis but an umbrella term—then more informed guesses can be made on how “dementia” will affect that person, and how care-givers can approach that person with appropriate cognitive and supportive activities.
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Cohen, M. (2021, August 30). 8 types of dementia and how to recognize their symptoms, according to experts. Prevention. https://tinyurl.com/398xvhj4
Hallstrom, L. (2024, May 28). The 7 Stages of Dementia: What they are and What to expect. https://www.aplaceformom.com/caregiver-resources/articles/dementia-stages