Once dementia is diagnosed - or at least strongly suspected - the stage the illness has reached is determined by the Dementia Rating Scale. Most often expressed as a five-stage progression scenario, some of the stages are occasionally sub-divided to encompass other behaviours and symptoms which may be the precursor to the next step of the illness, or may indicate that dementia is likely to develop in an individual.
Diagnosing someone in the early stages of dementia can be very difficult. Dementia symptoms such as memory loss or decreased reasoning ability can also indicate other illnesses such as depression or some cancers. A firm diagnosis, particularly in the early stages of dementia, can be very difficult.
The Dementia Rating Scale is usually defined as having the following stages:
No symptoms whatsoever - the patient does not have dementia, and is not at any apparent imminent dementia risk. This stage can often have further sub-divisions encompassing natural age-related cognitive decline, such as increasing forgetfulness, occasionally getting lost, and mild difficulty finding the right words. These symptoms may or may not be noticeable to friends or family, and it's unlikely that a medical professional would do more than note them for further investigation down the line, as they could indicate a raised level of dementia risk a few years in the future. There may be indication of some very mild pre-dementia symptoms, or a potential increased risk, and advice may be to increase "brain activity", such as crossword puzzles, quizzes, Sudoku, or concentration intensive hobbies requiring calculation or planning.
The very mild symptoms that a suspected dementia sufferer might suffer at this second stage don't appear to differ wildly from stage zero. However, they may now be more pronounced and consistent, instead of the intermittent issues detailed above.
This relatively mild stage in the progression of the disease can often be the most difficult for carers, family, and friends to deal with. The sufferer can be in denial, and there's often dogged determination to continue with day to day tasks even though these may be difficult. At this stage, reminder notes and routine can be enormously helpful, especially as cognitive issues will now be very apparent to a GP.
With moderate difficulties in independent living now being likely, the dementia patient will now be exhibiting issues with bathing, dressing, normal conversation, and ability to stay "in the present". Getting lost on even the most familiar short journeys - such as a walk to the corner shop - will become more common, and some supervised care beyond family assistance may become necessary. In the later stages of this level, forgetting the names of familiar people is likely, as is increased difficulty with conversation and speech.
A stage three dementia patient will deteriorate to the point where they appear "locked in". They are unlikely to communicate any longer, but it is likely they can still be reached by familiar sounds, such as favourite music.
Although it's useful to have a rough guide to the progression of the illness, dementia sufferers remain individuals, with each case progressing at a slightly different rate from person to person.