Progression of dementia

When people hear dementia is a progressive disease, they like to know what to expect and when to expect it.

Some questions may include:

  • What changes are likely to happen?
  • What sort of behaviour will be encountered in the future?
  • Might a person with dementia become incontinent/need feeding/not recognise people?

It is important to realise people with dementia have differing symptoms and different rates at which their symptoms change. This is not only because there are different types of dementia, but also because it affects people differently.

There is a great deal of variability in the progression of dementia, and no definite answers can be given as to what the future holds. A person's abilities may fluctuate to some extent from day to day, or even within the same day. A massive decline may be seen in a few months - in other cases this may happen over a number of years. This is because people with dementia may have fewer resources in reserve to withstand influences like tiredness, anxiety, or physical ill-health – which previously they may have taken in their stride.

Some people with dementia retain a similar personality to their earlier life, although sometimes a little exaggerated - the person who was always irritable, stubborn and difficult to get on with may remain so. The person who was friendly and affectionate may remain sweet and loving.

However, some people can show a complete change and do things completely out of character. For example, a quiet, calm husband may become aggressive and abusive.

Stages of dementia

It is important to remember not all of these features will be present in every person, nor will every person go through every stage. However, the links below will help you get an idea of what to expect throughout the progression of the disease.

Stage one: Early/mild dementia

The start of dementia is very gradual and often this stage of dementia is only apparent when looking back. At the time it may be missed or put down to "old age" or work pressure.

Symptoms include:

  • an unwillingness to try new things/unable to adapt to change
  • taking longer to do routine jobs
  • losing interest in hobbies and activities
  • being irritable and easily upset
  • showing poor judgment and making poor decisions
  • repeating oneself

Stage two: Moderate dementia

When the dementia is moderate independent living can be risky and some supervision is usually required.

Symptoms include:

  • forgetting to eat and/or neglecting personal hygiene
  • seeing or hearing things which are not there
  • becoming easily lost if away from familiar environments
  • forgetting about recent events or the names of family and friends
  • becoming very easily upset and distressed through frustration

Stage three: Severe dementia

By the time a person reaches the severe stage of dementia they need continual supervision, and will often need the specialist care of a dementia unit. The person will need help to shower and get to the toilet and their speech may deteriorate to the point where they can no longer be understood.

Symptoms include:

  • an inability to recognise family and friends or even everyday objects
  • an inability to locate their own room and bed
  • forgetting about what happened in the last few minutes
  • incontinence of urine, and later faeces
  • disturbance at night and restlessness at sundown




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