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Different Phases of Adult Dementia

 

According to the WHO, around 50 million people worldwide have dementia. Of these, 60% live in low- to middle-income countries. Approximately 10 million new cases of dementia are diagnosed every year around the globe.

The Alzheimer's Association reports an estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia in 2021. In other words, one in nine people in this age group has Alzheimer's. The number of people ages 65 and older with Alzheimer's dementia is projected to jump to 12.7 million by 2050.

Dementia is not a condition that appears out of the blue. Instead, these neurodegenerative disorders develop gradually through different stages. Scroll down to learn more about phases of adult dementia.

Dementia vs Alzheimer's disease

Before we discuss phases of dementia, it's important to address a common misconception implying Alzheimer's disease and dementia are the same things. Many people use these terms interchangeably, but they're not synonyms. In order to truly understand how dementia works, we need to clarify this important subject first.

Dementia is an umbrella term that refers to symptoms caused by disorders affecting the brain. These symptoms refer to memory loss, decreased performance of daily activities, and other cognitive, communication, and behavioral changes.

In other words, dementia is not a single disease but a term that refers to multiple conditions affecting your brain and cognitive abilities. On the other hand, Alzheimer's disease is the most common type of dementia.

Besides Alzheimer's disease, other forms of dementia include:

         Vascular dementia - the second most common type of dementia, caused by the lack of blood flow to the brain

         Lewy body dementia - caused by protein deposits in nerve cells that interrupt chemical messages in the brain and lead to memory loss and disorientation

         Parkinson's disease - many people with advanced Parkinson's disease also develop dementia

         Frontotemporal dementia - a term that describes different types of dementia with one thing in common - they affect primarily front and side parts of the brain. These areas control language and behavior

         Creutzfeldt-Jakob disease - one of the rarest forms of dementia affecting one in 1 million people

         Wernicke-Korsakoff syndrome - caused by lack of vitamin B1, which leads to bleeding in the lower sections of the brain

         Mixed dementia - refers to cases when a person has more than one type of dementia

         Normal-pressure hydrocephalus - a condition that causes a person to accumulate excess fluid in the ventricles of the brain

         Huntington's disease - a genetic condition that causes dementia. Two types of this disease include juvenile and adult-onset

Stages of dementia

As mentioned above, dementia does not occur suddenly. A person doesn't simply wake up one day with dementia. These conditions develop gradually. For that reason, many people and their loved ones often fail to notice the early stages. Or they don't know what to expect when someone is diagnosed with some form of dementia. The more you know about these phases, the more prepared you'll be.

Yet another reason to learn more about the stages of dementia is that health professionals often discuss the condition in different phases. Each phase refers to how far a person's condition has gone or what to expect moving forward. Moreover, defining the phase helps healthcare professionals determine the most suitable treatment option and provide the best advice to caregivers of persons with dementia.

Generally speaking, dementia is often considered as a condition that occurs in three phases: mild, moderate, and severe. But, a more specific stage is assigned based on symptoms, and you may find classifications that describe seven phases of these conditions. Of course, all these additional phases fall into the three main stages mentioned already (mild, moderate, and severe).

To make it easier to track symptoms and learn as much as you can about the progression of dementia, we will discuss the expanded list of seven phases. Scroll down to see them all.

1.    No impairment

In this phase, dementia disorders such as Alzheimer's disease are not detectable. A person does not experience any symptoms that would be a source of concern. However, tests may reveal a problem.

2.    Very mild cognitive decline

The term cognitive decline, or cognitive impairment, refers to trouble remembering, concentrating, learning new things, or making decisions that affect a person's everyday life. Cognitive decline can range from mild to severe.

In this phase, a patient with dementia may experience slight changes in behavior. These behaviors could be losing things such as keys around the house. At the same time, they are still independent and can function on their own. The loss of memory loss here is not serious to the point where it can be distinguished from age-related memory loss, which is normal. In fact, a patient may do well on memory tests. That's why the disease may go undiagnosed in this stage too.

3.    Mild cognitive decline

During this phase, you may notice changes in your loved one's thinking and reasoning. For example, they may experience difficulty making plans or sticking to them. A person with dementia may repeat oneself a lot. The trouble remembering recent events or names of new acquaintances is also a common manifestation of this phase of dementia.

An affected person may struggle to find the right word during a conversation. Additionally, your loved one could be more prone to losing personal possessions, including valuable items.

Since memory is more impaired than in the previous stage, performance on memory tests is also affected. At this point, a healthcare provider can detect impaired cognitive function.

4.    Moderate cognitive decline

Moderate cognitive decline is characterized by more pronounced symptoms of dementia. For instance, a person experiences more problems with making plans or remembering recent events. In other words, their short-term memory is significantly affected at this point, e.g., they may not be able to remember what they had for breakfast.

Additionally, they may experience difficulties with handling money and traveling.

In other words, the clear-cut symptoms of dementia are apparent in this stage. Your loved one may also have difficulty with simple arithmetic and may forget details about their life events and histories.

5.    Moderately severe cognitive decline

The progressive nature of dementia in this stage manifests itself through even bigger memory problems. An affected person may not be able to remember their phone number or names of their grandchildren. Moreover, they may be confused about what day of the week it is or time of day.

The moderate, severe decline is difficult for a patient. Generally, people in this stage are unable to function on their own entirely. They may need assistance with basic daily functions such as choosing clothes to wear. Assistance with this seemingly basic function is necessary because a person may experience difficulty dressing appropriately in the fifth stage of dementia.

Even though your loved one will need assistance with some things, they can still retain a great deal of independence. For instance, a patient with dementia may still be able to bathe oneself. They generally recognize their family members and may know some life histories, especially about young age and childhood.

6.    Severe cognitive decline

Memory impairment becomes more serious at this point. A person with dementia may forget the name of their spouse, for example. The changes in their emotions and personality are also more pronounced and noticeable.

Your loved one needs constant supervision in this phase or requires professional care. They may experience confusion or unawareness of their surroundings and environment. Except for close relatives or friends, persons with dementia may have difficulty recognizing people and faces. Remembering details about personal history becomes more difficult at this point, as well.

Severe cognitive decline is also characterized by loss of bladder and bowel control. In this stage, a patient loses independence and may wander around or get lost. They will also need help with activities such as bathing or toileting.

7.    Very severe cognitive decline

In the most severe stage, a person with dementia can no longer speak their thoughts or communicate with their environment. Keep in mind they may utter a few words or phrases. In most cases, this person loses the ability to swallow, can't walk, and spends most of their time in bed.

Since this is the final stage and the disease is a terminal illness, a person with very severe cognitive decline is nearing their death.

How is dementia treated?

Alzheimer's disease and other forms of dementia are incurable conditions. No medication or surgery would eliminate them entirely. Treatment options aim to manage behavioral changes and reduce the severity of symptoms.

Since dementia is a progressive condition, treatment options vary. For this reason, doctors track and determine stages of dementia. Based on the progression of dementia, the doctor prescribes the most suitable medications.

Medications work by adjusting chemicals that carry messages to the cells in the brain. These specific drugs are called cholinesterase inhibitors. They are generally prescribed to patients with mild to moderate symptoms. Cholinesterase inhibitors may address problems with memory, communication, and confusion.

Treatment of moderate to severe dementia involves memantine, a drug that helps improve thinking, memory, and language. Memantine's mechanism of action revolves around regulating glutamate, a brain chemical involved in learning and memory. The drug could delay the progression of symptoms in some patients.

A healthcare provider may also prescribe medications that decrease psychological and behavioral changes, e.g., sleep problems and anxiety. In later stages, a patient may need to take drugs that treat restlessness, fear, and hallucinations.

The progression of dementia changes the approach to the treatment. As the final stages approach, the treatment focuses on improving a patient's quality of life. Occupational therapy could be useful here. The therapy helps patients use adaptive equipment that improves their motor skills.

Caring for someone with dementia

Dementia is difficult for affected patient and their caregivers alike. The progressive nature of the disease may be overwhelming to the point when you don't know what to do or how to help a loved one.

The most important thing to do is to consult the healthcare professional. The doctor who monitors the patient and their treatment will also provide useful advice you, as a caregiver, should know. Below are some useful things you need to keep in mind at this point.

Set a positive note

While this may seem difficult or unnecessary even, you should still set a positive note. The affected person should feel loved and accepted. They need to feel support and encouragement. A person with dementia is very sensitive, so it's important not to choose words that make them feel guilty for their behavior and other symptoms.

Plan for gaps in care

A caregiver may need to take on more responsibilities if family members or maybe in-home health aids can't come by as often as you need them to. For that reason, it's a good idea to be ready for the unexpected gaps in care. One way to do that is to create a list of essential supplies like food, hygiene products, and medications. Make sure to stock up on essential, nonperishable supplies.

Help with everyday tasks

As seen throughout this post, patients may retain dependent life until the late stages of the disease. It's important to support them and their independence. While it's useful to help loved ones with everyday tasks, you should still support their independence, encourage them to socialize, or take part in different activities. This will help them feel better about themselves. For example, you may want to let them help with activities such as laying the table, shopping, gardening, or taking the dog for a walk. You can place memory aids around your home to help the person remember where things are. For instance, you could put labels and signs on drawers, cupboards, and doors. Removable multi-use labels that stick to different surfaces can be helpful in this case.

Create a routine

When caring for a person with dementia, it is crucial to create a daily routine. For example, you should make sure their bedtime is the same every night, and they wake up every morning at the same time as well. The routine should also include a schedule for baths, getting dressed, cooking and eating, nap time, socializing, gentle physical activity, relaxing activities, among other things.

Make sure to stick to that routine as closely as possible. A person with dementia, especially a person whose memory is severely impaired, may function better when they have a specific routine.

Help with eating and drinking

A person with dementia, especially in later stages, may not be able to swallow food properly. Consult a doctor about using liquid thickeners that make liquids easy to swallow. For example, the powered liquid thickener is easy to add to beverages and makes them easy to swallow without too much pain and discomfort.

Even if your loved one is not in the advanced stages of dementia, they may not drink enough fluids. That happens because they don't realize they're thirsty. Lack of hydration puts them at a higher risk of constipation, headache, and urinary tract infections. These problems can only worsen their confusion. As a caregiver, you need to understand they don't do it on purpose.

To help them, you need to set aside enough time for meals and offer foods and beverages in smaller quantities. If they struggle with cutlery, you may want to prepare finger foods.

Fluids should be offered in a clear cup that is easy to hold.

Help with bathroom

The consequences of dementia go beyond cognitive abilities but extend to physical health and functioning. A patient with dementia may not be able to control their bladder, particularly in advanced stages. Protective underwear could be a useful option in these cases. This type of underwear is worn just like regular underwear and enhances the sense of freedom, dignity, and confidence. Additionally, special needs undergarments may help secure incontinence products and prevent disrobing.

When caring for a person with dementia, it may be useful to put a sign on the toilet door and keep it open. You may also want to leave the light on during the night or consider installing sensor lights. Although it may take a while to get things in "order," you could put toilet-related needs on the routine list.

Observe the person's behavior to see whether they may need a toilet. For example, they may fidget or stand up, sit down.

Help with bathing, washing, and dressing

A man or woman with dementia can become anxious about personal hygiene and may need help with these activities. To help them bathe, you may want to use a bath seat. To make bathing a pleasant experience, it's practical to use products you know they used to like. After washing and bathing, you will need to help them get dressed.

Dementia patients may be prone to undressing. One way to prevent that is to go for jumpsuits designed specifically for persons with this problem. You can get a jumpsuit with short sleeves and legs or a long-sleeved jumpsuit with long legs.

Conclusion

Dementia disorders are progressive diseases that develop through several stages. A person may retain independence for a while, but in later stages, they may need someone's health. There are many things you can do to improve their quality of life.

References

https://www.who.int/news-room/fact-sheets/detail/dementia

https://www.alz.org/alzheimers-dementia/facts-figures

https://www.healthline.com/health/types-dementia

https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf