Navigating dementia: The stages of dementia and how to live well

Receiving a diagnosis of dementia can be an unsettling experience, and while it may require some adjustments to your plans for the future, it doesn't mean that life has to stop being fulfilling.

With the right support, people with dementia can and frequently do continue to engage in meaningful activities, and experience a good quality of life.

This article offers you insight into the different stages of dementia. While every dementia patient will progress at a unique rate, the article can provide guidance on what to expect on this journey. You will also find useful tips on how to support the well-being and independence of a person with dementia, as well as information on care support services available to meet your specific needs.

Jump to the following:

• The seven stages of dementia
• Pre-dementia
• Early-stage dementia
• Middle-stage Dementia
• Late-stage dementia
• Practical tips for living well with dementia

The seven stages of dementia

According to the Reisberg Scale, dementia can be categorised into seven stages, which can be further grouped into four levels:

While this scale was originally developed to assess the progression of Alzheimer's disease, it can also be used to assess other types of dementia like vascular dementia, frontotemporal dementia and lewy body dementia.

Pre-dementia

Stage 1: No symptoms

In Stage 1, while individuals display no signs of clinical dementia or memory issues, and are able to function normally, changes in the brain are taking place.

Stage 2: Mild age-related forgetfulness

Individuals in this stage exhibit mild dementia symptoms that can look like normal age-related cognitive decline. Memory lapses such as forgetting familiar words or misplacing objects are typically not obvious enough to raise concerns at this point. Symptoms associated with stage 1 and 2 could also be just normal ageing.

Stage 3: Noticeable cognitive Decline

In the final stage of pre-dementia, individuals exhibit more noticeable cognitive lapses, such as mild difficulty concentrating and finding the right words, decreased work performance, and increased instances of getting lost. Some individuals may also experience mild anxiety as these symptoms begin to impact their daily life.

On average, this stage lasts between two to seven years. During this time, the symptoms may become evident to loved ones and while individuals may still function independently, it is advisable for them to see a family doctor for early intervention.

At this stage, caregivers can start looking into options such as dementia daycare and home care to ensure that their loved ones are well taken care of when they are busy or away at work.

Early-stage dementia

Stage 4: Moderate cognitive decline

This stage marks the onset of early-stage dementia, where individuals experience a range of notable cognitive problems detectable by clinical assessments. Common symptoms include:

• Decreased ability to organise affairs and manage finances
• Having trouble concentrating
• Failure to recognise faces
• Difficulty navigating unfamiliar places on their own
• Forgetting recent events
• Withdrawing socially to hide symptoms and avoid challenging situations

Family members should approach the topic of dementia with sensitivity as denial is a common defence mechanism for individuals at this stage.

This stage is also known as mild dementia. By this stage, life expectancy is greatly reduced. Dementia patients should also start thinking about their Advance Care Plans (ACP).

Middle-stage dementia

Stage 5: Decreased independence

A key indicator of mid-stage dementia is the inability to recall important basic details like a home address or the names of close family members.

Individuals who have progressed to this moderately severe cognitive decline will need some assistance to perform certain activities of daily living (ADLs). These may include basic and routine tasks such as bathing and choosing proper clothing. Additionally, they may also struggle with decision-making and may be losing track of the day and time. They may also require help with walking and sitting as their physical abilities are declining.

Stage 6: Severe cognitive decline

Full-time care is typically required at Stage 6 as individuals become increasingly unaware of their surroundings, and can no longer carry out activities of daily living (ADLs) without assistance.

More severe and pronounced symptoms such as difficulty speaking, behavioural and personality changes can also occur at mid-stage dementia. These can include:

• Forgetting the names of their loved ones
• Difficulty counting down from ten verbally
• Distorting past memories
• Delusional or obsessive behaviour
• Anxiety, agitation, and loss of willpower
• Sleep disturbances
• Wandering and hallucinations

Dementia patients may also start having issues with bladder and bowel control. Caregivers must be mindful of the demanding responsibilities of round-the-clock care and be careful to avoid caregiver burnout. Not all families are equipped to handle this type of care, so it’s important to be aware of available support services.

Options such as dementia daycare, home care, and nursing homes provide both long and short-term arrangements to assist with the care of individuals with dementia. These support services can help alleviate the strain on caregivers, and ensure the well-being of both the caregiver and their loved one.

Late-Stage Dementia

Stage 7: Severe mental and physical impairment

In this advanced stage of dementia, individuals face very severe cognitive decline and are completely dependent on their caregivers, having lost all verbal ability and control of their bodily functions. Dementia patients at this stage will face difficulties with eating and swallowing, increased risk of chest infection and pressure sores due to decreased mobility.

Practical tips for living well with dementia

If the cause of a person’s dementia cannot be reversed, there are many ways to prevent it from progressing and to support the well-being and independence of the dementia patient. This would help to increase their overall satisfaction and quality of life.

Get medical treatment for symptoms

Medication plays a key role in the management of dementia symptoms. Find out more from your family doctor or general practitioner.

Be sociable

Social interactions can help boost one’s mood, reduce stress and loneliness, as well as provide mental stimulation.

Day care programmes like NTUC Health’s Fun with Friends and Inter-generational Programme offer opportunities for individuals with dementia to connect with others in a safe and supervised environment. Participants can look forward to mind-stimulating puzzles and games, light exercise routines, music and art segments, and other interactive activities that are designed to promote a sense of purpose and fulfilment.

Adjust Your Lifestyle

• Regular exercise not only boosts the release of mood-lifting endorphins but also improves mobility, stimulates growth and connectivity of brain cells, and promotes better sleep. Engaging in physical activities like walking, chair-based workouts and even gardening can make a significant difference in one’s sense of well-being.
• Eat a brain-healthy diet that incorporates a variety of fruits, vegetables, adequate water, and lean protein for balanced nutrition and hydration. Be sure to include omega-3 rich foods like salmon and mackerel which are essential for brain health, along with anti-inflammatory foods like berries and walnuts.
• Prioritise stress management: Research shows that prolonged stress shrinks a key memory area of the brain, and negatively impacts cognitive abilities. To reduce tensions and stay calm, try relaxation techniques such as listening to soothing music, deep breathing exercises, and aromatherapy.
• Improve your sleep hygiene: During sleep, the brain clears waste products to maintain its health. To promote good quality sleep, establish a regular sleep schedule and create a comfortable sleep environment. It’s also a good idea to avoid caffeine and alcohol close to bedtime.

Make your home dementia-friendly

Minor modifications to your home can help create a safer environment for a person with dementia to continue living independently.

• Installing a 360° security camera enables loved ones to have monitoring access, and allows for early detection of accidents and prompt response in case of emergencies.
• Remove clutter and obstacles to minimise fall risk. Try to avoid rugs and floor mats as they pose a fall hazard. Wires should be secured and kept away from walk paths.
• Opt for an induction stove instead of a gas stove. They are a safer choice due to their built-in safety features and reduces the risk of accidents, such as burns or fires.
• Install night lights along the hallways and in every room to improve the lighting and make it safe to walk around at night.

If you are unsure of how to proceed, it can be helpful to work with an occupational therapist to assess your unique needs and challenges, and follow their recommendations for appropriate home modifications.

Plan for the future with ACP

Advance Care Planning (ACP) is particularly important for individuals with dementia as it allows them to express their healthcare and lifestyle preferences while they still have the capacity to do so. This ensures that their medical and personal wishes are known and respected as the disease progresses.

Having an ACP in place relieves your loved ones from the burdens of decision-making based on guesswork, and helps prevent family conflicts that may arise from differing opinions on your care. Find out everything you need to know about making your ACP, and other useful care plans here.