Dementia and Staging

The Alzheimer’s Association uses a three stage approach for classifi cation of dementia, including mild, moderate, and severe. Understanding these varying stages can make it easier to provide support, know what to anticipate, and prevent caregiver burnout.

In dementia’s mild or early stage, most people can do things for themselves, are able to drive, and participate in favorite activities. However, they may require assistance with some activities and cues or reminders for keeping appointments or remembering words and names. They may also need help maintaining familiar routines, managing household bills, grocery shopping, or preparing full meals. Fluctuations often start early and happen throughout all stages.

The moderate or middle stage of dementia is usually accompanied by diffi culty with immediate recall, logic, situational memory, language, and organization. New daily care needs may arise when routine isn’t enough. An individual may have more diffi culty starting and completing tasks in order. There may also be more repeated comments or questions about the situation. They may experience confusion, depression, anxiety, agitation, irritability, suspiciousness, and repetitive behaviors. Sleep changes, physical and verbal outbursts, and wandering may occur. Loss of independence and privacy can be diffi cult. Instead of taking over, it may be benefi cial to ask for their help or present steps in order with visual cues and participation praise.

The severe or late stage is characterized by declines in environmental response, conversational skills, and movement control. Because of motor memory damage, most time will be spent resting. The person’s immune system may weaken as the brain can shrink to 1/3 of its original size.

Automatic movements like swallowing and eating can be challenging, and liquid can build in lungs. Infections or skin breakdown may result from poor nutrition. Repositioning, slow muscle movements, singing, playing music, or saying prayers may bring comfort and relaxation. Caregivers must read facial expressions, body language, and sounds to detect pain or discomfort due to a lack of communication.

Dementia progresses diff erently for each individual, and their ability to function varies from week to week and day to day. Staging helps determine how much help and what kind of help loved ones may need. It’s important to observe subtle changes and patterns and remain fl exible as solutions may need to be adapted.

Editor’s Note: This article was submitted by Michelle Pekich, Director of Marketing, for in-home care provider ComForCare Home Care. She may be reached at 724-759-7674 or by email at mpekich@comforcare.com. See ad on page 131.