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Dementia isn’t a singular noun. Part 3: Stages of dementia

Of the nine forms of dementia I described in the previous post, at least eight are irreversible. (The one, partial, exception is Normal Pressure Hydrocephalus, which can be treated and, to at least some extent, reversed by surgically draining built-up cerebrospinal fluid from the brain.)

Dementia’s cognitive damage doesn’t happen all at once, but in seven stages. The earlier you can recognize these stages, the sooner that diagnosis and proper care can manage its symptoms and slow down its progression:

· Stage 1: Apparent Normality – To all outward appearances, there’s no sign of dementia. People talk, listen, and understand normally. They function normally. They don’t seem to have memory problems or other forms of cognitive impairment. But brain and neural degeneration has started, too subtly for even the most modern medical technology to detect.

· Stage 2: Seemingly Normal Old-Age Memory Decline – As I wrote earlier, as most people move into their 50s, they start gradually losing memory and attention span. That’s normal. But when people don’t remember when and where they’ve forgotten things, and what it was they forgot, that could very well be dementia.

· Stage 3: Mild Cognitive Impairment – Patients start getting lost easily, losing or misplacing important objects, forgetting family members’ and close friends’ names, having a hard time concentrating and retaining what they’ve read – and feeling anxiety about it. At this stage, a clinical interview can lead to a proper diagnosis (which, in turn, can lead to treatment that could help).

· Stage 4: Mild Dementia – While Stage 4 individuals have no trouble recognizing familiar faces or traveling to familiar locations, they do have difficulty recognizing acquaintances and their faces, remembering things about their own personal history, handling finances or travel plans, and keeping up with recent events. They often adopt defense mechanisms; including denial, stress, and anxiety, and social withdrawal to conceal their symptoms while avoiding challenging situations.

· Stage 5: Moderate Dementia – Stage 5 patients can still remember their own and, generally, their spouses’ and children’s names. They can eat, use the bathroom, and carry out other basic functions on their own. But they can no longer remember major specifics, such as an extended-family member’s name or their own address. They may have trouble making decisions and become disoriented about where they are and what time it is. As a result, they need some assistance to carry out their daily lives.

· Stage 6: Moderately Severe Dementia – At this stage, patients start to need full-time care. They start forgetting their spouses’, their children’s, and their primary caregivers’ names. They’re generally unaware of their surroundings, can’t recall recent events, and have distorted memories of their personal past. Their behavior can become obsessive and delusional. They show anxiety, aggression, and agitation. They lose willpower. They may even begin to wander and start having hallucinations.

· Stage 7: Severe Dementia – In this final stage, the brain seems to lose its connection with the body. Patients lose not only all verbal and speaking abilities, but motor skills as well. So they need help with walking, dressing, eating, using the bathroom – all the activities of daily life.

Though dementia’s progression is inexorable, it’s not uniform. It progresses at different speeds with different people. That’s why it’s so important to identify its starting signs as early as possible. The earlier the diagnosis, the more possible it is to prolong the early, mild, stages and postpone the severe, later ones. (It could even turn out that treatable underlying deficiencies or illnesses may be what’s causing dementia-like symptoms – not dementia itself.)

That’s why the last things that senior care should be are routine and superficial. It’s why we get to know our clients and their families with a thorough three-part needs assessment covering everything from physical, psychological and mental status to mobility issues, nutritional needs, and legal wishes. Why we custom-design a holistic, coordinated care plan based on each client’s individual needs. And why our monthly nursing assessments involve not just checking vital signs, but carefully tracking not only physical, but also cognitive changes– and updating the caregiving plan accordingly.

Whether for dementia or regular aging, please contact us to see the difference that kind of individual approach can make.

Next: Part 4 – Treatments

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