An overview of the different Stages of Dementia – Dementia is a degenerative process affecting the brain. It occurs worldwide, although the majority of cases, over 60 percent, arise in developed countries. Around 35.6 million people suffer from dementia, over 800,000 in the UK and over 5 million in the USA. Projections estimate that 115 million will have dementia by the year 2050. The global cost of care for dementia sufferers in 2013 is £388 billion ($589 billion).
Dementia is a decline in the functioning of the brain. This is usually a gradual decline, but it is a progressive condition that will worsen as one progresses through the various stages of dementia over time. The brain functions which are most affected by dementia include language skills, information processing, memory and mental agility. A person with dementia often suffers from mental health problems such as depression and anxiety, and it also triggers personality changes and loss of emotional control. The condition usually occurs in people over the age of 65, although some cases do develop earlier. One in three people will develop dementia at some point. There is currently no cure for the condition, although some treatments, such as drugs, can slow the progression of dementia in certain cases.
There are over 100 different types of dementia. The most common form is Alzheimer’s disease, making up 62 percent of dementia cases. Vascular dementia is the second most common, while other variations are dementia with Lewy bodies, front-temporal dementia, Korsakoff’s syndrome and Creutzfeldt-Jakob disease. There are some rare causes of dementia, including Neimann-Pick’s disease, which mainly affects young children. There are also illnesses which increase the risk of dementia, including multiple sclerosis, Huntingdon’s disease and motor neurone disease. Patients with AIDS, HIV or Parkinson’s disease can also exhibit symptoms of dementia. The exact signs of the development of dementia vary with each type. There are several clinical scales to assess its progression, including the seven-stage Functional Assessment Staging (FAST), and the five-stage Clinical Dementia Rating (CDR), but dementia can be roughly divided into three stages: early, middle and late.
Dementia is often hard to diagnose in the early stages, as the minor changes in behaviour and the memory lapses it causes are often attributed to normal ageing signs, or as a result of events such as bereavement or stress. Finding recent events hard to remember is one of the first signs of dementia, along with forgetfulness and mislaying items. A person with dementia will struggle to remember names or words, and lose track in the middle of conversations as they forget what has been said, often repeating themselves. They can become easily confused, and find it hard to make decisions. A resistance to change will often manifest itself, and new ideas will not be welcomed or remembered. Distress can occur as difficulties arise, with signs of anxiety and agitation.
This is the stage when the symptoms of dementia become more noticeable and cannot be dismissed as normal ageing signs. A person may start to forget everyday actions such as eating, washing and using the toilet, and will need frequent reminders to help them with their day-to-day life. Forgetfulness will lead to repetition, and phrases or questions will be repeated many times, while acquaintances will not be recognised, or will be mistaken for someone else. Confusion about what time of day it is leads to dementia sufferers getting up in the middle of the night, or going outside in their pyjamas. Everyday tasks such as cooking will become dangerous without supervision, as they may forget to turn off cookers and appliances, and a tendency to wander off and get lost may develop. The emotions become hard to control, with mood swings from aggression and anger to sadness and withdrawal. Personality changes often appear, with a tidy person becoming very messy, or a sociable person no longer wanting to see anyone.
In the later stages of dementia, it becomes clear that the condition has severely impaired the brain’s functioning. The ability to speak declines, and this, together with memory loss, makes it hard to communicate. In the late stages sufferers often cannot recognise even close family members. A test used to determine if this stage has been reached is to ask a person with dementia to count back from 10 to 1, as they will be unable to carry out this simple task. Some details of early life may be remembered, but all recent events are forgotten. Hallucinations and delusions may become common, loss of bladder and bowel control usually begins and increased agitation and anxiety occurs. As the condition inexorably progresses, all ability to speak or communicate is lost, they need assistance to eat or use the toilet, and loss of psycho-motor skills leaves them unable to walk. This will progress to an inability to sit up, to smile, or to raise the head unaided.
Research is continuing, but no one is sure exactly what causes the brain cell damage which leads to dementia. Scientists believe it is triggered by a complex mix of genetic, lifestyle and environmental factors, but it is impossible for them to target any one particular cause in order to cure it. One variation, vascular dementia, is caused by blocked arteries cutting off the supply of oxygen to the brain and causing tiny strokes which leave the brain damaged. Other variations, including Alzheimer’s and Dementia with Lewy Bodies, have protein developing inside the brain and nerve cells. Scientists are still not sure if the protein is a cause of dementia, or just a sign of damage.
Having seen the unpleasant progression of dementia, and knowing that there is no cure, one question arising is whether dementia can be prevented. One thing scientists have discovered is that some people have a higher risk factor of developing dementia than others. Smoking, heavy drinking, lack of exercise and poor diet make an older person more likely to suffer from the condition.