Dementia Stages

Stage 1

No cognitive decline. no memory deficit on clinical interview, no subjective complaints of memory deficits

Stage 2

Very mild cognitive decline, subjective complaints of memory deficits, no deficits on clinical interview, no deficits with ADL’s, social or employment

Stage 3

Mild cognitive decline, deficit with concentration during interview, memory deficit only noted during intensive questioning, denial begins, mild anxiety, lost traveling to unfamiliar locations, functional deficits only with demanding work or social situations, co-workers or family notices problem, word retrieval deficits,

Stage 3 Caregiver approach

simplify complex tasks or provide cueing for executive functions, education patient and caregivers, monitor and limit or restrict hazards

Stage 4

moderate cognitive decline, clear cut memory deficits during interview, decreased knowledge of current/recent events, difficulty recalling personal history, concentration deficits/poor attention/ distractible, decreased ability to travel, handle finances, perform ADLs, denial, flat affect, very focused want to prove they can complete the task, anxious angry, wants autonomy and control, able to make wants/needs known but has word-finding deficits, communication is self-centered, limited reading comprehension and retention

Stage 4 Caregiver

external cues for orientatioin, participated best is high value tasks, able to follow a calendar or schedule, aviod reasoning, begin assess for safety issues, establish ASL routines, set up ADL supplies to minimize mistakes, cues for word finding, memory book, spaced retrival

Stage 5

moderately severe, cannot survive without 24 hour care, unable to recall aspects of current lives, still know spouse and children’s names, frequent disorientation to time or place, difficulty counting backwards, can follow directions, lives in immediate situation, delusion, escape risk, afraid to be alone, tunnel vision, physically cold, difficulty being understood, complex language is hard to understand, not able to answer detailed questions, able to name familiar objects, may be able to read

stage 5 caregiver

environmental assessment for safety, give extra time to complete tasks, expect mistakes and inattention to ADLs, avoid correcting, simplify cues and language, provide structured hydration and meals, use lots of repetition to assist patients

stage 6

forgets name of spouse, largely unaware of current events, diffuclty counting, know their name, able to distinguish familiar person, personality and emotional changes, delusions and hallucinations, wander, no boundaries, connect with others through touching, shadowing, verbalizations, body language and tone, aphsic language, able to respond to yes/no about self

stage 6 caregiver

anticipate needs, consistent caregiver diminish behaviors, find strategies to redirect, focus on safety and fall prevention, closely monitor weight, determine best method of communication, break down ADL into smaller tasks, demonstrate what you want the to do

stage 7

automatic reaction, little to no ability to verbalize, dependent on others for survival, may respond to facial changes or repetitive words, may express self with grunting or yelling,

stage 7 caregiver

total care: comfort, dignity, quality of life, provide sensory stimulation, develop turning and repositionaing program, monitor swallowing function and weight