The way people experience dementia depends on many factors, including physical make-up, emotional resilience, the environment they live in and the support available to them. Viewing dementia as a series of stages can be a useful way to understand the illness, but it is important to realise that this only provides a rough guide to the progress of the condition and not all people will display all of these symptoms. Some of these symptoms may appear in any of the stages, for example a behaviour listed in the late stage may occur in the middle stage. Also, care partners should be aware that in all stages, short, lucid periods can occur. The following outlines the characteristics of early, middle, late and end stage Alzheimer’s disease:

 

Early stage

 

The early stage is often overlooked and incorrectly labelled by professionals, relatives and friends as ‘old age’ or a normal part of the process of ageing. Because the onset of the disease is gradual, it is difficult to identify the exact time it begins. The person may:

 

• Have difficulty following conversation with more than one person at a time

• May forget specific words for objects

• Experience short-term memory loss such as not remembering having lunch yesterday with a friend

• Have trouble with appointments and schedules

• Have difficulty with numbers and money

• Become lost in familiar places

• Display difficulty in making decisions

• Lack initiative and motivation

• Show signs of depression and anger

• Show a loss of interest in hobbies and activities

 

Middle stage

 

As the disease progresses, problems become more evident and restricting. The person with dementia has difficulty with day-to-day living, and:

 

• May become very forgetful – especially of recent events and people’s names

• Has difficulty living alone

• Is unable to cook, clean or shop without support

• May need assistance with personal hygiene, i.e. toilet, washing, and dressing

• Needs cueing on how and when to eat

• Has increased difficulty understanding language

• May wander or show other challenging behaviours

• Can become lost at home and in the community

• May experience hallucinations

 

Late stage

 

This stage is one where constant support and supervision are needed. Memory disturbances are very serious and the physical side of the disease becomes more obvious. The person may:

 

• Need assistance to eat

• Not recognise relatives, friends, and familiar objects

• Have difficulty understanding and interpreting events

• Be unable to find their way around in the home

• Have difficulty walking

• Have bladder and bowel incontinence

• Display inappropriate behaviour such as yelling which may express an unmet need or physical pain

 

End Stage

 

In the end stage of dementia, the person is in the active dying process. Very often a person with dementia will die of other diseases and conditions prior to dementia being the actual cause of death. The symptoms include:

 

• Very little, if any, speech

• Very little movement and be confined to a bed

• Sleeps most of the time

• Needs total assistance with personal care

• Has swallowing problems

 

 

Starting in the late stage into the end stage, people with dementia should have access to any comforting measures to maintain the best quality of life possible. It is best to know ahead of time the wishes of the person with dementia in regards to dying peacefully or using life sustaining measures such as artificial hydration and nutrition when the individual is no longer able to eat or swallow his or her food properly. Using life-sustaining measures is a personal decision. Comfort can be provided either in addition to life-sustaining measures or in place of them to ensure the person with dementia maintains dignity and is pain free.

 

Although these stages and symptoms are listed for Alzheimer’s disease, other types of dementia  follow a similar progression, especially after the early stage.

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Sources: Alzheimer’s Disease International