What are the Different Stages of Dementia?

What are the different stages of dementia?

There are 3 stages in the progression of dementia.

A person with mild dementia may need assistance in instrumental activities such as managing finances, paying bills, marketing, operating complex appliances. They may lose track of time and events.

In the moderate stage, he/she may need assistance with basic day-to-day activities such as showering, toileting, personal hygiene and grooming. Occasionally, they may experience urine and bowel incontinence. Some behavioural changes may happen, such as becoming withdrawn, irritable, agitated or even losing their way.

In the severe stage, a person with dementia may be totally dependent on their caregiver to provide personal care for activities like showering, using the toilet and eating. He or she may be talking less, eventually leading to the inability to speak.

How is dementia diagnosed?

You may be noticing your loved one becoming more forgetful, misplacing things and getting lost in familiar environments. These may be signs to get him or her evaluated by a medical professional. Accurate diagnosis for dementia is important as other factors like depression, hypothyroidism and vitamin deficiencies also exhibit similar symptoms to dementia.

Diagnosing dementia may include:

• A case history analysis and history-taking verified by a family member. This allows the professional to distinguish the significant changes in your loved one’s functioning levels.
• A basic blood test to rule out any treatable medical conditions such as thyroid problems and vitamin deficiencies.
• Brain imaging such as CT and MRI scans to determine the structural pattern of brain shrinkage and to see if there are signs associated with stroke diseases.
• Cognitive tests such as Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT). These test the memory, attention span and concentration levels. They help to determine the severity of memory and cognitive deficits. Your physician may refer your loved one for neuropsychological assessment which provides details and a standardised assessment across a wide range of cognitive domains in the brain.
• A complete physical examination and psychiatric evaluation to rule out any possible sign of stroke, treatable depression and other mental health disorders.

Early detection and diagnosis enables you to better manage the functional decline due to dementia. A diagnosis also helps you to better understand and react to challenging behavioural changes like agitation and withdrawal. Finally, your family will be able to plan ahead for the future; including your finances, future health choices and medical care for your loved one.

Client Profile: Home Personal Care Client with Dementia

Mr Tan*, age 73, has been an NTUC Health Home Care client for 3+ years. He suffers from late stage dementia and has difficulty talking, standing and swallowing. He lives in a landed property in Kranji with his wife, son, daughter and domestic helper. Our Care Associate, Ruben, visits him twice a week for 3 hours:

• Companionship: Ruben keeps Mr Tan company from 8 to 11AM twice weekly. They play classical music and do colouring exercises
• Cognitive Exercises: Ruben will also stimulate Mr Tan’s memory by sharing stories from the past
• Showering: Ruben helps to shower Mr Tan and change his diapers
• Physical Exercises: Ruben takes Mr Tan for walks in the neighbourhood and practices stretches at home.

Client Profile: Home Physiotherapy Client with Dementia

Mrs Lai*, age 76, suffers from dementia. Like many dementia patients, she struggles with inertia. Physiotherapist Christina explains to her and her family the importance of moving and developing a routine. Mrs Lai sees Christina twice a week for 4 – 5 months. When Christina first saw her, she would only shower once a month. After therapy, she would shower every other day.

• Day Rehabilitation: Mrs Lai was initially referred for rehabilitation at our centres before being referred to Home Therapy.
• Functional Exercises: Dementia clients usually find it challenging to focus on typical strength training exercises like wall push ups and lifting dumbbells, so Christina uses functional exercises like walking down corridors or stairs.
• Exercise via Games: Christina plays card games (e.g. Snap) with Mrs Lai, getting her to stand up and play for as long as she can. This improves balance and standing tolerance.
• Cognitive Therapy: Christina asks Mrs Lai to write down “promises” to herself in her diary (e.g. to shower every other day). Mrs Lai can recognise her own handwriting, which helps her to recollect past thoughts.

*These are case examples of how we support clients with dementia.