The 7 Stages of Dementia is not as widely spoken about as the 3 stages of Dementia. Most people recognize Dementia as a three-stage process, Mild Dementia, Moderate Dementia, and Severe Dementia. It may also be referred to as, Early Dementia, Middle Dementia, and Late stage Dementia.
There are actually seven stages of dementia. Over the years, measuring tools, referred to as scales, has been developed that helps to accurately determine where an individual’s illness has progressed to. These stages are usually based on the individual’s symptoms. The three widely used scales are as follows:
The Global Deterioration Scale (GDS) is the most commonly used in staging Dementia. It divides the disease process into seven stages, based on the individual amount of cognitive decline. The GDS scale works best in individuals with Dementia but is not the first choice in each type of Dementia. It is most useful in cases where memory loss is an issue but memory loss is not always the first issue to deal with in each type of Dementia. For example, Frontotemporal Dementia causes a deterioration in behavior and significant changes in personality. It also causes language disturbances and an alteration in muscle or motor function. In frontotemporal Dementia, memory loss is less prominent in the early stages.
With the GDS scale, individuals in stages 1-3 does not exhibit enough symptoms for a Dementia diagnosis. Using the GDS scale, an individual could progress to stage 4 before being diagnosed.
The functional assessment Staging Test (FAST) also uses a seven-stage system which looks at the individual level of functioning and his or her ability to perform the activities of daily living versus the cognitive decline, look at by the GDS scale.
The third scale is the Clinical Dementia Rating Scale (CDR) which uses a five-point system. This five-point system is based on cognitive ability and the individual ability to function. This scale is more commonly used among researchers than by everyday medical professionals.
Listed below are 7 stages of Dementia, some signs and symptoms, and the average duration of each stage.
Stage 1: No Cognitive Decline
Stage 2: Very Mild Cognitive Decline
Stage 3: Mild Cognitive Decline
Stage 4: Moderate Cognitive Decline
Stage 5: Moderately Severe Cognitive Decline
Stage 6: Severe Cognitive Decline
Stage 7: Very Severe Cognitive Decline
Using the GDS scale, an Individual with stage 1 dementia functions normally without any memory loss and, is mentally stable. The average duration of this stage is unknown. The same goes when using the FAST scale, there is no sign of dementia and therefore the duration in this stage is unknown.
The CDR scale is a bit different, it does not begin with stage1. As mention above, this scale uses a five-point system. These stages are CDR-0, CDR-0.5, CDR-1, CDR-2, and CDR-3.
In this stage, using the GDS scale, symptoms do not clearly suggest Dementia. The individual may experience normal forgetfulness that can be associated with the aging process. He or she may notice minor memory problems or even begin to lose things around the house. Duration of this stage is unknown.
Using the FAST scale, there may be personal awareness of some functional decline. Again in this stage, the duration is unknown
At this stage, the CDR scale is still registering a zero.
Using the GDS scale, stage 1 and 2, could virtually go undetected. Stage 3 brings with it an increase in forgetfulness, slight difficulty concentrating, and a decrease in work performance. In this stage, an individual may start searching for his or her words. Individuals with stage 3 dementia may sometimes get themselves lost. The cognitive decline will be noticeable to love ones or to anyone with frequent contact. The average duration of this stage is 2-7 years.
Using the FAST scale, a decline in functioning is more noticeable, especially in demanding job situations. The average duration of this stage is 7 years.
Somewhere around this point, the CDR scale starts to recognize a very mild Dementia, CDR-0.5. The average duration of this stage can range from 2-7 years.
Stage 4, on the GDS scale, Moderate Cognitive Decline, becomes easier to identify. An individual in this stage can have decrease memory of recent events, difficulty concentrating, difficulty managing finances. This individual will get lost more frequently especially when traveling alone to new locations. He or she may start withdrawing from family and friends because socialization becomes difficult. An individual in this stage may have difficulty recalling portions of his or her own personal history. In an interview, a physician can easily detect cognitive problems at this stage. The average duration of this stage is 2 years.
Using the FAST scale, stage 4 is quite similar, in terms of symptoms, and average duration.
On the CDR scale, the impairments listed above falls somewhere between CDR-1 and -2, with an average duration of 2-4 years.
In stage 5 on the GDS scale, memory problems are more pronounced. An individual may not remember his or her phone number or address. Individuals in this stage may require assistance with activities of daily living, such as personal hygiene, dressing, and preparing own meals. The average duration in this stage is 1.5 years.
At this stage, with the FAST scale, the level of functioning has declined to where individuals may require assistance choosing proper clothing,(for example, clothing appropriate for the season). The average duration for this stage is 1.5 years.
Moderate Dementia on the CDR scale is CDR-2. It has an average duration of 2-4 years.
In stage 6, with severe cognitive decline, the individual’s short term memory has declined significantly. The ability to speak declines. He or she may start forgetting the names of family members and have little memory of recent events. For example, an individual may forget eating breakfast and request to have breakfast again an hour later. Some individuals may suffer from delusions, others may repeat a single task over and over.
In this stage, an individual may have difficulty controlling bladder and bowel functions. Those that may still have control over these functions may have difficulty finding the bathroom. Individuals at this stage require extensive assistance with activities of daily living. The average duration of this stage is 2.5 years.
Using the FAST scale, the levels of decline is quite similar to the level of decline with the GDS scale. The average duration of this stage is 3.5 months to 9.5 months.
Individuals in this stage require extensive assistance or total care with most activities. They usually lose their ability to feed themselves, to toilet themselves, some may even lose the ability to walk and speak. The average duration of this stage is 1.5 to 2.5 years.
Using the FAST scale, stage 7 brings almost identical impairments as with the GDS scale. The average duration of this stage is 1 year to 1.5 years.
Severe Dementia falls in CDR-3, characterized by severe memory loss, disorientation, poor judgment, the inability to problem solve. The average duration of this stage is 1 year to 2.5 years.
Sauer, A., Sauer, A., & Sauer, A. (2018). The 7 Stages of Dementia. Retirement Resources | Leisure Care. Retrieved 2 December 2018, from https://www.leisurecare.com/resources/7-stages-dementia/
Seven Stages of Dementia | Symptoms, Progression & Durations . (2018). Dementiacarecentral.com. Retrieved 3 December 2018, from https://www.dementiacarecentral.com/