Though every type of dementia is different and every person who has dementia is different, understanding the basic stages can make a tremendous difference in the life of the senior, says Kim Warchol, president of Dementia Care Specialists, a specialized offering of the Crisis Prevention Institute. “Alzheimer’s disease and the related dementias tend to progress through predictable stages,” she explains. “When you know the characteristics of each stage and the abilities that remain, you can capitalize on those.”
That’s where Warchol chooses to focus in her work – finding the highest level of independence at each stage of dementia, rather than concentrating on what’s been lost.
Here, the occupational therapist and memory care consultant walks us through the five stages of dementia, and what to expect for each stage.
1. High-Early Stage of Dementia
This early stage of dementia is characterized by challenges with instrumental activities of daily living (IADLs), which include driving, managing medications, managing finances, and cooking. The reason for this, explains Warchol, is cellular death in the area of the brain responsible for executive cognitive function, which is the area that is the last to develop and the first to decline.
At this stage, she says, seniors need “distance supervision.”For example, if seniors are home alone, someone should check in every day to help them solve problems or adjust to any changes in routine. Doctors and other health care professionals can help the family start the conversation about dementia so the task doesn’t fall solely on the shoulders of the adult child, she adds.
2. Low-Early Stage of Dementia
A hallmark of the progression of dementia is that basic ADLs, such as dressing and showering, are now impacted. At this stage, says Warchol, seniors need 24-hour supervision because their judgment and safety awareness are compromised, so they are prone to accident and injury and are susceptible to predatory behavior.
However, she emphasizes that some critical abilities remain. Seniors at this stage of dementia are still goal-directed, so if the activity is familiar and routine, they can sequence themselves through it to the end. For example, says Warchol, if the care partner were to set out a man’s shaving supplies at the appropriate time of day, he would be able to complete the steps on his own. The key is to tap into seniors’ long-term memory to increase their opportunities for success and limit their feelings of anxiety and stress.
3. Middle/Moderate Stage of Dementia
At the middle stage of dementia, says Warchol, seniors have lost goal-directedness and can no longer sequence themselves through multiple steps. They now need one-to-one assistance for everything.
However, she emphasizes that seniors at this stage can still participate in activities that have been simplified to “just-right” challenges. For example, a care partner can learn from family members what kind of razor, shaving cream, and aftershave a man once used, and then have him smell the aftershave lotion first so it processes through the limbic system of the brain, helping him retrieve the steps to shaving himself.
“The person can be participatory in any meaningful activity,” says Warchol. “You just have to simplify it and adjust it to his level.”
4. Late Stage of Dementia
At the late stage of dementia, walking, speech, and fine motor coordination are becoming noticeably compromised, says Warchol. She adds that these are purely functional changes related to cognition, and if a person has additional health issues, he or she will likely have greater functional loss. Seniors at this stage need a one-to-one care experience, but they are still able to communicate through behavior and facial expressions, and they can participate in their care. For example, they can’t button their shirt, but they can push their arm through the sleeve.
At this stage, two ADLs Warchol promotes are self-feeding and toileting. “If we can simplify meals to finger foods and decrease distractions, they can feed themselves,” she says. In addition, though seniors at this stage are typically using adult diapers, they might still have some awareness of voiding if a care partner helps them sit on the toilet from time to time.
5. End Stage of Dementia
At the final stage of dementia, the brain has significantly atrophied, and seniors are mute and bed-bound. But, says Warchol, they still have their five senses intact and can respond and engage with anyone who stimulates them. “We can help them feel loved, safe, warm, and engaged, or they can feel hopeless, frightened, and in pain if we don’t treat them like human beings,” she says.
Because even at this end stage, seniors are still capable of tracking with you as long as you bring activities down to the sensory level.
“Abilities remain at every stage,” says Warchol. “Learning the characteristics of each stage can help the senior stay meaningfully engaged.”