Stages of Dementia: Stages 1, 2, 3

The next three blog posts will be discussing the seven stages of dementia as influenced by the Global Deterioration Scale and the Functional Assessment Staging Test or Tool. There is a three stage model, which is Early, Middle, Late, which is definitely helpful when talking about some forms of dementia. However, for right now, we're going to cover the seven stages. This particular blog post will be covering stages one through three.

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Before I get started on breaking down the different stages, I want to kind of clarify some things. Now, I know a lot of people really want to know... "What stage is my partner at?" But, what I want you to know is that a lot of times these staging tools are created with Alzheimer's disease in mind. That means if your partner has some other type of dementia, that their symptoms may look a little bit different. How they progress may look a little bit different, especially in those early stages. So, stages 1 through 4 will look a little bit different for your partner. Then, as the dementia progresses, it might start looking very similar to the stages that we're talking about in these next couple of blog posts.  

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I also want you to keep in mind that with dementia, dementia affects everyone differently. So, when you hear that phrase, "When you've met one person with dementia, you've only met one person with dementia." — you've really only met one person with dementia. Not only are we as humans just unique in our own right, but you have to remember dementia is affecting the brain. Therefore, depending on how the brain is being affected, different things can present.  

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When you hear these stages, I don't want you to think of them as these concrete, rigid stages. I more so want you to think of them as a basic framework to kind of inform you of what to look out for. I want you to think of it as dementia being progressive and worsening over time. But, I don't want you to think that your partner has to fall into this specific number because sometimes people get really caught up on figuring out "what stage their partner is at," and in some cases, it like impairs their ability to care for their partner. I want you to keep in mind that we're caring for a person, not a stage. I'm going to say that again, we're caring for a person, not a stage. Okay? So I really don't want you guys to get too caught up on "what stage is my partner."

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Now, some people don't like staging at all, because they say, "Oh, well, you know, people are not numbers and you can't reduce them to that." Or sometimes they think of stages as focusing on the losses and what the person's lacking instead of focusing on the strengths. I personally like the staging system just to kind of inform you of what to expect so that there's no shock factor. I really like the stages because it kind of highlights the fact that dementia is terminal, it's progressive, it worsens over time. A lot of people don't realize that and so as the dementia progresses, they get really shocked and surprised by some of the things and behaviors and symptoms that they start seeing because they didn't realize it could get that "ugly," right? But, the stages kind of help you be aware of what may be to come.

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When we think of the first three stages, we can think of them as the "pre dementia stages." So, stage 1, 2, and 3 are the stages before actually being diagnosed with dementia.

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Stage 1

Stage one is by far the easiest to remember. Stage one is no cognitive impairment, no cognitive decline, no decline in memory, the brain is healthy and it's functioning normally. So there's no issue, okay? And an easy way to remember that is one equals none.  

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Stage 2

Stage two is very mild cognitive decline. So, at this stage, those changes in your memory and cognition are only really noticeable to you. But, your friends, your coworkers, your family members, they're not able to recognize anything out of the ordinary. If you were to take some kind of clinical cognition type test. It's not going to be able to be picked up on that. It's only noticeable to you. So, maybe you:

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• Take a little bit longer to process things
• You misplace things
• You forget a familiar word here and there

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...but you're able to function well. You're able to compensate, play it off, and nobody around you really notices anything out of the ordinary or special. Okay?  

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An easy way to remember stage two is stage two equals you, meaning that those changes in your memory and cognition are only noticeable by you.

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Another thing that I want to add about stage two is that these changes can be considered like normal age related decline. So, even though you can notice them, it's nothing to be like concerned about, okay?

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Stage 3

Stage three is mild cognitive impairment. The defining factor of stage three is that now these changes in your memory and your concentration and your cognition are noticeable by your family, your friends, your coworkers, and is now detectable through clinical testing. It's actually a diagnosable condition, mild cognitive impairment.  

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So, some of the things you may notice is:

• Trouble remembering new names
• Sometimes repeating things
• Frequently misplacing important objects
• Reading something, and then forgetting what you just read
• A breakdown in your job performance
• It's getting harder to plan and organize things
• It's harder to travel to new places

So, during stage three, the person can develop a little bit of anxiety, because they don't understand why they're having these issues. It's becoming more noticeable not only to them, but to those around them. They may also be in denial. So, because it's noticeable by other people, other people might bring something up and then they kind of deny, "Oh, no, you know, I don't have a problem with that, I'm fine."  

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Now, an easy way to remember stage three, is that stage three equals me, meaning it's no longer just noticeable by you, but it's now noticeable by me, your friend, your family, your coworker.  

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I hope I broke that down in a way that's easy to understand. Again, stages one through three are the pre dementia stages before it's actually considered dementia. Now, one thing I want you to know is that with mild cognitive impairment, not every person who has mild cognitive impairment progresses to dementia. Some people just stay at mild cognitive impairment, and depending on what might be causing the mild cognitive impairment, it could even be reversible. So, if there's some kind of vitamin deficiency, dehydration, malnutrition, or infection that may be going on, that impairment in cognition and concentration and memory could improve.

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Image Credit: freepik