The cognitive impairment associated with dementia gives different warning signs depending on its evolution.
The concept “senile dementia” is used to refer to degenerative diseases that affect cognitive functioning, particularly memory, and that occur in advanced ages. On the contrary, we speak of precocious or presenile dementia when the symptoms occur earlier than would be expected, generally in middle age.
In this article we will describe the 7 phases of senile and early dementia indistinctly, since the development of cognitive impairment follows the same approximate general lines regardless of the age at which the symptoms begin to manifest.
The 7 phases of dementia
There are a large number of diseases that can cause dementia; some of the most common and known are Alzheimer’s, Lewy, and recurrent strokes. Each disorder of this type initially affects different regions of the brain, although the symptomatic differences are reduced in advanced stages.
Although the symptoms of dementia depend on the specific alteration of each patient, the general progress that these diseases follow has been divided into seven phases depending on the degree of cognitive impairment that the person presents at any given time.
1. Absence of cognitive impairment
The first stage of cognitive impairment corresponds to the absence of it; therefore, most people are in this phase, which can be included together with the next two in the category “pre-dementia”, characterized by normal or practically normal cognitive functioning.
A person is considered to be in phase 1 when they do not present significant cognitive symptoms that could be attributable to a deterioration of the brain, such as memory losses more relevant than those that occur due to lack of energy or attention, among other common factors.
2. Memory deficits associated with age
Aging, and in particular the arrival of senescence, is naturally associated with small memory losses that are manifested mainly in forgetting names or locations of objects. The second phase of cognitive impairment is characterized by the presence of these deficits in a more or less common way.
Although in many cases the appearance of specific forgetfulness is nothing more than a consequence of age, on some occasions memory losses can indicate a future severe deterioration of cognition, especially if the frequency of these is high and if the person he is relatively young to have typical forgetfulness of old age.
3. Mild cognitive impairment
The term “mild cognitive impairment” is used to describe cases in which there are notable signs of memory impairment and in performing everyday tasks. In this phase, cognitive deficits are more marked than would be expected for the age of the person, even taking aging into account.
People with mild cognitive impairment are at higher risk of developing dementia than those without it, although progress of the deficits often stops at this stage. It is common for those who suffer from this type of impairment to have problems retaining information, remembering words, concentrating, or orienting themselves.
4. Mild or early dementia
The fourth phase corresponds to the onset of dementia as such. In this stage, which usually lasts about two years, changes in personality and mood begin to appear. Since social skills also deteriorate, it is very common for the frequency of social interaction to decrease.
Cognitive problems become much more apparent from the onset of dementia. Patients usually have some awareness of their disease when they reach this stage, although dementia affects this recognition as well. They also tend to deny their symptoms as a defense mechanism.
5. Moderate dementia
During the middle stage of dementia, affected people begin to need the help of other people to carry out daily tasks. As the disease progresses, abilities such as using money, telephones or kitchen tools, reading and writing, remembering information about oneself, and even dressing, deteriorate.
6. Moderately severe dementia
In this phase, memory and cognition problems have worsened to the point that they interfere with the performance of a large number of activities; it will continue to increase as the dementia progresses. Most often, at this stage, the person needs constant supervision from one or more caregivers.
As for the most common symptoms and signs, in addition to the worsening of memory problems (which already include the recognition of close people) we find the appearance of feelings of anxiety and agitation, sleep problems, ambulation, obsessive and repetitive behaviors, delusions or aggressiveness.
7. Severe or advanced dementia
The average duration of the final stage of dementia is approximately two and a half years. Advanced dementia is characterized by a general loss of psychomotor skills, including those needed to talk, walk, eat, or use the bathroom.
Although the progress of each case of dementia depends on the disease that causes it, they are all very similar during the final period because the structural deterioration has spread to all regions of the brain.