The Progression of Dementia: Looking down the road to prepare for the future

When you hear the word “dementia” the first thing that you may associate it with is memory problems, but it is important to understand that these changes in memory are symptoms of changes within the brain. Not just memory, but physical functions and coordination, emotion regulation, speech and comprehension are all impacted by brain disease. Currently dementia is the only top 10 cause of death in the United States that cannot be cured or even slowed. Given the inevitability of this decline, it is important to know the different stages of dementia as it evolves. Each person may be different based on the type of dementia they have such as Alzheimer’s or Parkinson’s disease. Environment, emotions, other chronic illnesses, and physical triggers can also shape each day differently. This is a general overview of the stages of dementia and what to expect in each stage. For the dementia caregiver invested in the day-to-day care of a loved one, it is crucial to remain open to the differences from one day to the next. What may work at one time may not work at another time. What your loved one may be capable of doing one day may be beyond them another day. The variability can be both frightening and frustrating, which is why patience, reprieve, good training, and support are key components to successfully accompanying a loved one with dementia.

Mild Cognitive

In the mild cognitive stages of dementia symptoms can be subtle and may be easily passed off as the result of “old age”, fatigue, or busyness, particularly with those diagnosed with early-onset Alzheimer’s. Symptoms can include decreased job functioning at work or at home, short-term memory loss, trouble traveling to new locations, or a decreased organizational capacity. Before we all think we have the beginning stages of dementia, remember to look for patterns and departures from normal behavior. If someone has always been disorganized or had trouble traveling to new locations, it probably isn’t a symptom of a change in cognitive function.

Mild Dementia

Individuals with a mild stage of dementia will have a difficult time forming and retaining new memories while their long-term past memories remain intact. They will also show difficulty finding words and often will ask questions repeatedly. Even when going to a familiar place, they may lose their way and have trouble making sense of their environmental surroundings. Complex multi-step tasks that we take for granted everyday like planning and making dinner, managing finances, or doing the laundry may become too difficult. You may also see signs of depression at this stage, in part because of the decline in functionality.

Moderate Dementia

In the moderate stages of dementia the above symptoms become much more pronounced such as confusion about their location, the date, day, or season. They may have trouble recognizing familiar faces such as close friends and family. You may also see significant personality changes at this stage in the disease. Agitation, suspiciousness, delusions, hallucinations, and anxiety can compound on one another. We tend to understand behaviors as expressions of a person, but it is important to remember that these seeming changes in personality are symptoms of the brain disease. As caregivers, grieving along the way is an important aspect of your own processing and mental health. These changes in the person you love can be small and big losses throughout the process. Support groups where you can journey with others who are seeing the same changes and meeting the same challenges can really help in coping with the isolation and challenges you are facing and anticipating in the future.

Moderate to Severe Dementia

The moderate to severe stages of dementia will often manifest itself in the need for more assistance with everyday activities of living. This might include choosing seasonally appropriate clothing and dressing, assistance using the shower, toileting, taking care of personal hygiene, etc. The difficult behaviors may also change and increase in intensity and frequency. They may include wandering, sleep problems, unfiltered comments/ swearing, or outbursts.    

Severe Dementia

A person in the final stages of dementia often requires 24/hour care to meet their needs for living. They will no longer recognize close family and will require assistance to walk and eat. They may lose control of bowels and bladder and may exhibit sounds such as groaning, mumbling, screaming, crying out, or speaking gibberish. This stage can be very frightening for a family caregiver and the most physically and emotionally demanding. Often families will look to in-home care agencies or facilities that have trained staff who specialize in providing customized and complex memory care.


Each person is unique and there are a myriad of factors that influence how and when the brain is impacted by these brain diseases. At this time, there are tests to determine if you have one of the types of dementia, but currently no way to treat it. This presents a complicated dilemma for family who notice changes in their loved one early in adulthood or as they age. Do we want to know if nothing can be done to cure the disease? Ultimately the difficult decision is up to each person and their family. Living with the knowledge of a terminal diagnosis may not be the right choice for everyone. However, given the progression of the disease, the more notice you have, the more time you have to shape your remaining life in such a way as to prepare relationally, financially, organizationally, legally, spiritually, etc. for what is to come. 

Since 1989, Sound Options has been accompanying families in the Puget Sound region with dementia from diagnosis to last days. Families gather round our table with Registered Nurses and Masters of Social Work for guidance, support, expert information, disease education, and care planning for the future. They also find the day-to-day memory care that allows their loved ones safety and quality of life in the comfort, stability, and surroundings of their own home. You have memory care options with Sound Options. Give us a call today and begin a 1-hour consultation. We’ll help you figure out your next steps and take them together. 800.628.7649


Published on November 17, 2014.