Contrary to popular belief, dementia is not a specific disease. It’s an overall term that describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.
Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected. The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally. Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. In Alzheimer’s disease, for example, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s.
Symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood. Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. If you or a loved one is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. See a doctor soon to determine the cause.
Stages of Dementia
Rather than simply using “mild stage”, “middle stage”, and “late stage” dementia as descriptors, there are scales that exist that are slightly more comprehensive in description. These scales allow one to better understand the different stages of Alzheimer’s disease via cognitive decline and functionally. These scales are the Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS) also known as the Reisberg Scale, the Functional Assessment Staging Test, and the Clinical Dementia Rating. The GDS is the most commonly used scale and divides the disease process into seven stages based on the amount of cognitive decline in the inflicted senior.
Stage 1: No Cognitive Decline
In this stage, the person functions normally, has no memory loss, and is mentally healthy. People with NO dementia would be considered to be in Stage 1.
Stage 2: Very Mild Cognitive Decline
This stage is used to describe normal forgetfulness associated with aging. For example, forgetting names and where familiar objects were left. Symptoms of dementia are not evident to the individual’s loved ones or their physician.
Stage 3: Mild Cognitive Decline
This stage includes increased forgetfulness, slight difficulty concentrating, and decreased work performance. People may get lost more frequently or have difficulty finding the right words. At this stage, a person’s loved ones will begin to notice a cognitive decline.
Stage 4: Moderate Cognitive Decline
This stage includes difficulty concentrating, decreased memory of recent events, and difficulties managing finances or traveling alone to new locations. People have trouble completing complex tasks efficiently or accurately and may be in denial about their symptoms. They may also start withdrawing from family or friends because socialization becomes difficult. At this stage, a physician can detect clear cognitive problems during a patient interview and exam.
Stage 5: Moderately Severe Cognitive Decline
People in this stage have major memory deficiencies and need some assistance to complete their daily living activities (dressing, bathing, preparing meals, etc.). Memory loss is more prominent and may include major relevant aspects of current lives. For example, people may not remember their address or phone number and may not know the time or day or where they are.
Stage 6: Severe Cognitive Decline
People in Stage 6 require extensive assistance to carry out their Activities of Daily Living (ADLs). They start to forget names of close family members and have little memory of recent events. Many people can remember only some details of earlier life. Individuals also have difficulty counting down from 10 and finishing tasks. Incontinence (loss of bladder or bowel control) is a problem in this stage. Ability to speak declines. Personality / emotional changes, such as delusions (believing something to be true that is not), compulsions (repeating a simple behavior, such as cleaning), or anxiety and agitation may occur.
Stage 7: Very Severe Cognitive Decline
People in this stage have essentially no ability to speak or communicate. They require assistance with most activities (e.g., using the toilet, eating). They often lose psychomotor skills. For example, the ability to walk.