The progression of dementia can span anywhere from a couple of years to more than a decade, and no two people experience the different stages of dementia in the exact same way. That unpredictability challenges family caregivers to meet their loved one’s changing needs—and to plan for the future.
Understanding the different stages of dementia will help you prepare for, recognize, and accommodate changes that are taking place in your loved one. And amid these changes, it’s important to help your loved one maintain his or her individuality. Surrounding him or her with familiar people, routines, and things will keep him or her connected and engaged—and that will help you enjoy your time with him or her during the different stages of dementia.
Understanding the Early Stages of Dementia
The early signs of dementia can be subtle and often go undetected. Your loved one might hide his or her symptoms out of fear or embarrassment, and family members often mistake early symptoms for normal signs of aging. In fact, about half of dementia cases are undiagnosed in the U.S. at any given time.
The early stages of dementia might begin with slight declines in memory and concentration. Trouble with short-term memory recall, delays in recognizing familiar names and faces, and difficulty with problem-solving could all be early indicators. But these symptoms can be subtle, which is why about two-thirds of people are diagnosed when they begin experiencing mild cognitive impairment toward the end of the early stages.
For the most part, people in the early stages of dementia safely remain in their own homes and carry on with their daily routines. But deviations from the normal routine can be difficult for a person with dementia to adjust or react to, so it’s important for family caregivers to visit on a daily basis to check in on a few basic points:
- Finances: Balancing checkbooks, depositing checks, and paying bills might become a challenge for a loved one in the early stages of dementia; your loved one might need help staying on track.
- Nutrition: People with dementia might stop preparing balanced meals for themselves and instead graze on whatever food they find in the refrigerator or cupboard; stocking shelves with healthy foods and prepared meals will help.
- Medications: Keeping up daily medication regimens and filling prescriptions can be a challenge for people with dementia; sorting pills to make daily routines easier to manage, counting pills to ensure your loved one is taking the correct amount, and picking up prescriptions will help.
- Hygiene: Staying on top of personal hygiene is a big part of a loved one with dementia being able to live independently; make sure your loved one is bathing, washing his or her hair, brushing his or her teeth, and wearing clean clothes.
Finally, how to handle driving is usually a big question for family caregivers in the early stages of dementia. Decisions about driving should be made with the help of your loved one’s medical providers, but some people with dementia are able to safely drive to familiar places like a local market or library. They could, however, have trouble adjusting to any deviation with their normal route, like a detour.
Understanding the Middle Stages of Dementia
Of the different stages of dementia, the middle stages usually last the longest, spanning years. Cognitive decline becomes more significant, and people in the middle stages of dementia require more care and supervision that eventually makes remaining alone in their home unsafe.
People in the middle stages of dementia move beyond short-term memory loss and struggle to recall details about their own personal histories. They might forget important dates, milestones, and people they’ve known along the way—which can lead to anger, frustration, and depression. Emotional outbursts and paranoia are common in the middle stages of dementia. Your loved one’s feelings of anxiety and confusion might grow worse in the evenings, which is known as “sundowning.”
And the middle stages of dementia often require more assistance with activities of daily living, and as a family caregiver, you need to ensure that your basic needs are being met, too. The Alzheimer’s Association makes these recommendations:
- Take a breather: Take regular breaks from caregiving, even if they’re just a few minutes long.
- Stay engaged: Caregivers of loved ones with dementia often become isolated from the outside world, so find ways to keep up with your social circles, professional groups, and other family members.
- Respite services: Look into what respite services are available in your community and allow family and friends to help with caregiving when they offer.
- Future plans: Research and prepare for long-term care for your loved one, visit memory care communities in your area, and explore financing options so that you’re prepared when the time comes to make the transition.
People in the middle stages of dementia are often able to do familiar household chores and routines—and it’s important to enable people in the middle stages of dementia to keep performing these tasks as a form of physical therapy. It’s great for people in different stages of dementia to perform these tasks to the best of their ability.
Understanding the Later Stages of Dementia
People in the later stages of dementia, often the last two to three years of the disease, need around-the-clock care and supervision from family caregivers or professionals in a memory care community.
As memory loss becomes more dramatic, people in the later stages of dementia might not recognize spouses, children, grandchildren, or their own reflections in the mirror. Even a longtime home can feel unfamiliar, and they might restlessly search for someone or something from an earlier period of their life.
Keeping your loved one comfortable and limiting his or her anxiety and restlessness should be your primary goals in the later stages of dementia. The Alzheimer’s Association offers these tips:
- Daily checks: Make sure glasses are clean, hearing aids have batteries, medication is appropriate, and any pain is being managed on a daily basis.
- Controlled environment: Make sure your loved one isn’t being agitated by too many visitors, lighting, loud sounds, and abrupt movements in his or her home.
- Relaxation: Playing familiar music might soothe your loved one, as well as a hand massage or sensory stimulation like stroking a piece of fabric.
- Comfort is key: Making sure your loved one isn’t in pain, hungry or thirsty, or in need of using the restroom on a regular basis will help keep him or her comfortable.
As the disease progresses, most people with dementia gradually lose the ability to communicate and eventually their ability to walk. People in the later stages of dementia often lose interest in food, or they become unable to chew or swallow, which often leads to malnourishment and compromised immune systems.
For most people with dementia, secondary illnesses and infections are listed as the cause of death. Pneumonia is listed as the cause of death for as many as two-thirds of the people who are diagnosed with dementia.
Understanding the Different Stages of Dementia: A Recap
Seeing the progression of dementia in a loved one can be one of life’s most difficult challenges. But understanding the different stages of dementia allows you to provide care and support that your loved one needs now—and to make plans for the future. In the early stages, find ways to make daily routines and tasks more manageable. In the middle stages, find ways to balance meeting your loved one’s care needs with meeting your own needs to avoid caregiver role strain. In the later stages, find ways to limit your loved one’s discomfort and sources of anxiety and frustration. Ultimately, your goal during the different stages of dementia should be to help retain your loved one’s sense of individuality.