Stages of Dementia

Hello Everybody! I am so glad you are here with me today. I am the Proactive Caregiver and I specialize in educating others on how to be a proactive caregiver as well by empowering you, the caregiver rather than the care recipient. If you cannot take care of yourself, then you cannot take care of your loved one.

Today I wanted to continue with our previous conversation around deciphering the difference between Dementia, Delirium, Bipolar Manic Depression, and go a bit deeper into the stages of Dementia. Just like the late Maya Angelou said "We do better when we know better" I too was able to do much better by Mom and reduce my own level of stress from the unknown the more I learned. There are two things that made the biggest difference for me - 1) Understanding our Anatomy {the heart and gut in connection to the brain} and 2) Understanding the stages of dementia regardless of the type. Before I get into the details please keep in mind this is strictly based on my personal experience caring for Mom who lives with mixed Dementia and not at all intended to be medical advice or replacement for seeking care for your loved one.

Dementia in itself is not a disease but a loss of mental function in more than two areas. Dementia is far more than simply the loss of memory, but is noticeable because of the loss of memory and other mental abilities that affect daily life. It's rarely the sole cause because it may include a series of symptoms that affect language, judgment, memory, spatial abilities, and visual abilities. The stages represent the outward appearance as the brain continues to degenerate. The behaviors or responses vary based on the area of the brain which has degenerated.

During Mom's early stages there always seemed to be an event with an explainable or excusable reason for her lack of judgment in coping with life or loss of memory with driving for example. Being able to laugh at ourselves is healthy but when the joke is repeated or when they began to be not so silly or act "stupid" then it is time to pause for a closer look. Mom's response often was a laugh followed by her saying "I'm so stupid, I can't believe I did that!" Followed with "Oh well, no big deal." We would all laugh rather than stop to think about why she did something or how it was actually possible. What makes sense in the moment may be what we want to see instead of what the behavior might indicate.

The stages of Dementia can vary and overlap:

Stage 1 - No Impairment - not detectable and no memory problems or other symptoms are evident. Often minor symptoms are dismissed due to lack of vitamins, hormonal imbalances, or infections such as UTIs (urinary tract infections). Need for more sleep but able to maintain a normal routine for most of the time.

Stage 2 - Very Mild Decline - begin to lose things around the house yet not to the point where memory loss is distinguishable. They may become socially awkward with an increased loss of reaction, logic, and judgment yet still have enough awareness to recover from mistakes. They begin to struggle with normal daily tasks.

Stage 3 - Mild Decline - Friends and family are able to notice memory and cognitive problems. Performance on cognitive tests is affected and physicians will be able to detect impaired cognitive function. Your loved one may begin using humor to hide their shortcomings. They may begin struggling to find the right words during conversations, remember names of new acquaintances or family, or struggle with planning and organizing. Carelessness with the appearance and lessening facial emotions are more noticeable. They have minimal brain tissue loss.

Stage 4 - Moderate Decline - Believed to have lost roughly 4 ounces of brain tissue. Behaves like a 12 to 20-year-old. Begin having problems with simple math. They may forget the details of their life history or have obvious poor short-term memory. They struggle or become enabled with managing finances to pay bills. Hygiene is dismissed or forgotten. The conversation is reduced down to yes or no answers and even head nods or shakes. Driving privileges should be provoked but it often becomes a family stress point of how to handle delicately. The desire for sweet foods takes over the desire to eat otherwise healthy or their normal meals.

Stage 5 - Moderately Severe Decline - Often split between an early stage 5 and late stage 5. This stage is typically when the diagnosis is rendered when so many more symptoms and variations of behaviors are apparent consistently. It is believed they have lost roughly 1/2 to 1 pound of brain tissue. They begin to behave like an 8 to 12-year-old. They can appear normal and act as if they do not need any help but the reality is they need help with 2 or more of their active daily living skills (personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating). They need help with managing finances, medications, food preparation, housekeeping, laundry. They begin to be a fall risk. Even though they experience significant confusion, inability to recall simple details like phone numbers, they can still recall personal histories.

Stage 6 - Severe Decline - Believed to have lost roughly 1 1/2 to 2 pounds of brain tissue. Behaves more like a 2 to 4-year-old with serious loss of abilities. Your loved one will need constant supervision and require professional care. They are experiencing confusion, unawareness of the environment, and surroundings. There are major personality changes with potential behavior problems. They need assistance with ADLs for toileting and bathing. They may not be able to recognize the faces of their closest family and friends. They may begin to lose control of the bladder and bowels. If still able to walk on their own they may begin to wander to find "home." Sleep disturbances begin causing their sleep patterns to get out of sync.

Stage 7 - Very Severe Decline - The final stage. With roughly 2 pounds or more of brain tissue loss, the body begins to shut down. With a significant loss of brain, the body struggles to know how to continue functioning through loss of control of bowels, bladder and even swallowing. Your loved one may be able to utter words or phrases but is most likely incoherent with an inability to respond to their environment or have insight into their condition. They are now behaving more like an infant 2 years or less without much energy at all. If hospice services are not already in place then they would be required during this stage.

Every type of dementia is different as we discussed during the podcast just as each individual level of progression is dependent on many factors. Knowing who your loved one is before they began stage 3 is helpful but unless you have a willing participant to actively fight the progression then you may save your body the effects of stress by understanding their type of dementia along with the stages. I do not have all the answers for Mom. The more I understood this painful process the more her behaviors made sense and the less I fought with her. Time is precious no matter what stage they are in so learn more about their particular type of dementia and make the most of your time with them.

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I hope this gave you more food for thought. Until next time, BE PROACTIVE. Take care, everybody.

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Music:

Intro: Vacation Time by Khris Paradise

Outro: Misty by Khris Paradise

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