The 7 Stages of Dementia: What to Expect

Dementia is marked by a severe decline in cognitive functions, such as thinking, reasoning, and remembering, to the extent that it interferes with the person's daily life.

Dementia typically affects older adults, but it is not a normal part of the aging process—while some amount of forgetfulness is normal with age, dementia is a severe disorder that can affect the person’s ability to function on a daily basis.

According to the National Institute on Aging, about one-third of all people above the age of 85 have some form of dementia. Dementia can stem from various causes, the most common being Alzheimer’s disease. Some of the other causes include Parkinson’s disease, Lewy body dementia, and frontotemporal dementia.

Dementia progresses in stages, ranging from mild to severe. In 1982, Dr. Barry Reisberg created the Global Deterioration Scale (GDS), consisting of seven stages, to help clinicians categorize the progression of dementia.

This article explores the seven stages of dementia, so you know what to expect if you or a loved one have been diagnosed with it.

The stages are as follows:

1. No cognitive decline
2. Very mild cognitive decline
3. Mild cognitive decline
4. Moderate cognitive decline
5. Moderately severe cognitive decline
6. Severe cognitive decline
7. Very severe cognitive decline

Stages 1 to 3 are the pre-dementia stages; whereas Stages 4 to 7 are the dementia stages. Clinicians typically compare the person’s symptoms to the criteria listed for each stage and use their judgment to determine which stage the patient is at.

The 7 Stages of Dementia

The seven stages of dementia are outlined below.

Stage 1: No Cognitive Decline

At this stage, the person is able to function normally and doesn’t exhibit any signs of memory loss, confusion, or cognitive impairment.

However, the structure and functioning of their brain may have started to deteriorate, as the neurons (nerve cells) in their brain start to lose connection with other brain cells and die.

Stage 2: Very Mild Cognitive Decline

The person starts to experience occasional lapses of memory, such as:

• Forgetting where they keep familiar everyday objects
• Forgetting names they once knew very well

At this stage, the symptoms are unlikely to affect the person’s work or social interactions. 

In fact, the symptoms may even be too mild to detect in a clinical interview with a healthcare provider, as the person may be able to adequately perform memory tests during the interview. 

Stage 3: Mild Cognitive Decline

This is the stage where cognitive impairment starts to become more noticeable to the patient, as well as their friends, family members, and colleagues.

The person may start to show symptoms such as:

• Getting lost while walking or driving, particularly in unfamiliar places
• Reading something and retaining very little of it
• Forgetting the names of people they’ve just met
• Losing items of importance or value
• Having trouble concentrating and performing complex tasks
• Experiencing increasing difficulty in social settings
• Frequently forgetting words and the names of loved ones
• Performing poorly at work, to the extent that it becomes evident to colleagues

The person may start to feel anxious as their symptoms start to become apparent and interfere with their ability to function. 

Stage 4: Moderate Cognitive Decline

In this stage, the person will exhibit a definitive decline in cognitive ability in a clinical interview.

Some of the symptoms of this stage may include:

• Lack of knowledge of current and recent events
• Difficulty remembering parts of their own personal history
• Trouble with organizing, planning, traveling, and managing finances

At this stage, the person will likely still be able to recognize loved ones’ names and faces, and be able to navigate familiar places. However, they may start to avoid challenging situations in order to prevent anxiety and hide their distress from others.

Stage 5: Moderately Severe Cognitive Decline

From this stage onward, the person may no longer be able to function without some assistance. 

These are some of the symptoms of this stage:

• Difficulty recalling an important detail such as their address, phone number, or high school
• Disorientation in terms of place and time, such as confusion regarding the season, date, day of the week, or time of day
• Difficulty counting backward from 20 by 2s or from 40s by 4s (provided they are educated and were once able to do this calculation)
• Trouble with making decisions

In this stage, the person can likely still remember their own name and the names of their spouse and children, but they may struggle with recalling the names of their grandchildren. They may be able to eat and use the bathroom without assistance, but may need help with tasks such as deciding what to wear.

Stage 6: Severe Cognitive Decline

At this stage, the person may require a high degree of care, as they may have symptoms such as:

• Difficulty remembering the names of their spouse, children, or primary caregivers
• Lack of awareness regarding all the recent events and experiences in their life
• Patchy or skewed recollection of their early life
• Difficulty counting backward or forward to 10
• Lack of awareness regarding their surroundings as well as the time and place
• Inability to travel alone without assistance
• Tendency to wander

The person is also likely to experience emotional and personality changes, such as:

• Paranoia, hallucinations, and delusional behavior, such as talking to themselves or believing their caregivers are trying to harm them
• Obsessive symptoms, such as repeatedly performing cleaning activities
• Agitation, anxiety, and even violent behavior
• Loss of willpower, due to being unable to carry a thought long enough to complete the action

During this stage, the person is likely to still be able to remember their name, as well as distinguish between familiar and unfamiliar people in their environment. They will probably need assistance with daily living activities and may experience incontinence as well as sleep-related difficulties.

Stage 7: Very Severe Cognitive Decline

In the final stage, the brain appears to lose its connection to the body and becomes incapable of telling it what to do. 

The person is likely to progressively lose their motor skills as well as the ability to speak. They may only be able to utter unintelligible sounds or words, if at all. They will need assistance with all personal care tasks such as eating, walking, and using the bathroom.

A Word From Verywell

Dementia is a challenging condition to live with because it increasingly affects the person’s mental faculties and ability to function. Being aware of how the condition progresses can be useful because it can help you take steps to slow it down, in addition to helping you understand what to expect and how to prepare for it.