Progression of dementia

The progression of dementia varies in different people, depending on what type of dementia they have and their general medical and physical health.

Each person will experience their journey through dementia in a different way, depending on their life history and personality. It is important that people who are caring for somebody with dementia know the person's life history, especially if they go into respite or full-term care. This will enable them to communicate better with the person.

People living with dementia differ in the patterns of problems they have, and the speed with which their abilities deteriorate. Their abilities may change from day to day, or even within the same day. What is certain though, is that the person's abilities will deteriorate, sometimes rapidly over a few months, in other cases more slowly over a number of years.

Phases of the condition
Some of the features of dementia are commonly classified into three stages or phases. It is important to remember that not all of these features will be present in every person, nor will every person go through every stage. However, it remains a useful description of the general progression of dementia.

Early dementia
Often this phase is only apparent in hindsight. At the time it may be missed, or put down to old age, or overwork. The onset of dementia is usually very gradual, and it is often impossible to identify the exact time it began.
The person may:-
• Appear more apathetic, with less sparkle
• Lose interest in hobbies and activities
• Be unwilling to try new things
• Be unable to adapt to change
• Show poor judgment and make poor decisions
• Be slower to grasp complex ideas and take longer with routine jobs
• Blame others for 'stealing' lost items
• Become more self-centred and less concerned with others and their feelings
• Become more forgetful of details of recent events
• Be more likely to repeat themselves or lose the thread of their conversation
• Be more irritable or upset if they fail at something
• Have difficulty handling money

Moderate dementia
At this stage the problems are more apparent and disabling.
The person may:-
• Be more forgetful of recent events. Memory of the distant past generally seems better, but some details may be forgotten or confused
• Be confused regarding time and place
• Become lost if away from familiar surroundings
• Forget names of family or friends, or confuse one family member with another
• Forget saucepans and kettles on the stove; may leave gas unlit
• Walk around streets, perhaps at night, sometimes becoming lost
• Behave inappropriately, for example going outdoors in nightwear
• See or hear things that are not there
• Become very repetitive
• Be neglectful of hygiene or eating
• Become angry, upset or distressed through frustration

Advanced dementia
At this third and final stage, the person is severely disabled and needs total care.
The person may:-
• Be unable to remember occurrences for even a few minutes, for instance forgetting that they have just had a meal
• Lose their ability to understand or use speech
• Be incontinent
• Show no recognition of friends and family
• Need help with eating, washing, bathing, using the toilet and dressing
• Fail to recognise everyday objects
• Be disturbed at night
• Be restless, perhaps looking for a long-dead relative
• Be aggressive, especially when feeling threatened or closed in
• Have difficulty walking, eventually perhaps becoming confined to a wheelchair
• Have uncontrolled movements

Immobility will become permanent, and in the final weeks or months the person will be bedridden.

Early-onset dementia usually begins with changes in behaviour rather than memory loss. They might become more aggressive and disinhibited. For example, they might make inappropriate remarks or sexual suggestions: in other words, they lose their social skills. Over time, the other symptoms of dementia will become apparent.

Remember

Some abilities remain, although many are lost as the disease progresses. The person still keeps their sense of touch and hearing, and their ability to respond to emotion.

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Did you know?

More than 60 per cent of all care home residents, aged over 65, have a form of dementia.