The 7 stages of dementia: What they are and what to expect

After a dementia diagnosis, it’s common for seniors, their loved ones and their caregivers to wonder how quickly the dementia might progress and what changes are on the horizon.

“Families often ask how quickly thinking skills will decline and what everyday life might look like as dementia progresses,” says Dr. Daniel Glazer, clinical psychologist and co-founder of US Therapy Rooms. “They want to know if mistakes, such as leaving the milk in the cupboard, are harmless lapses or warning signs that more help is needed.”

Learning about the stages of dementia can help you prepare for the future — financially, emotionally and medically. It can also help ensure you or your loved one stays safe and well cared for as dementia progresses. Here, we’ll take a close look at the stages of dementia, including tips for caregivers on managing these changes. 

What is dementia? 

Dementia is an umbrella term that used to describe a collection of symptoms that are severe enough to interfere with a person’s daily life. Most often, it refers to a change in cognition that occurs as a result of changes in brain neurology. Dementia symptoms vary from one person to another and by what type of dementia they have, but it generally impacts a person’s memory, reasoning skills and personality. As dementia progresses, people may lose the ability to perform the daily activities of living, like dressing, feeding and ambulating.

Dementia tends to occur in people as they get older, but sometimes dementia impacts people under the age of 65, a condition called young-onset dementia. Although it can be normal for people to lose some mental capacity as they age, when memory loss and cognitive changes impact someone’s ability to function in daily life or take care of themselves safely, they may have dementia.

Types of dementia

There are several types of dementia, and it’s possible to have more than one type of dementia at once. The most common types are:

• Alzheimer’s disease: The most common type of dementia, characterized by memory loss, trouble communicating, wandering, repeating questions and impulsive behavior.
• Vascular dementia: Dementia caused by blood flow issues in the brain. Includes symptoms like difficulty learning new information, poor decision-making and delusions.
• Frontotemporal dementia: Symptoms include executive function issues, impulsive behaviors, hallucinations and struggles with balance and walking.
• Lewy body dementia: Characterized by difficulty paying attention, coordination issues, muscle rigidity and visual hallucinations. 

“Naming the stage opens a doorway to honest conversations about driving, household safety and advance care directives.”

— Dr. Daniel Glazer, clinical psychologist

The 7 stages of dementia 

No matter which  type of dementia someone has, dementia can generally be divided up into stages. The 7 stages of dementia are a framework taken from the Global Deterioration Scale and are as follows: 

• Stage 1: No noticeable cognitive impairment.
• Stage 2: Subjective memory loss.
• Stage 3: Mild cognitive impairment.
• Stage 4: Moderate cognitive decline.
• Stage 5: Moderately severe cognitive decline.
• Stage 6: Severe cognitive decline.
• Stage 7: Very severe cognitive decline.

It’s important to understand that these stages are merely guides, says Dr. Aaron R. Ritter, psychiatrist and director of the Memory & Cognitive Disorders Program at Hoag. “Just like with cancer and other diseases, each individual is unique and experiences different rates and progression of symptoms,” he says.

Below, Glazer shares some key facts about the seven stages of dementia and what caregivers need to know.

Stages 1 and 2: No symptoms or early dementia

In these stages, patients may either have no memory issues or mild forgetfulness, which may seem like normal age-related memory issues and only be evident to the person experiencing it. 

Stages one and two may be characterized by word-finding pauses or misplaced keys, yet daily tasks stay intact, Glazer says. “Offering reassurance and periodic cognitive checks at this point prevents unnecessary worry and builds a baseline for future comparison.”

Stage 3: Mild cognitive impairment

In this stage of dementia, memory issues become more obvious to others, though a person still may be mostly functional. It’s common for people in this stage to frequently misplace items and/or get lost when traveling to familiar places.

Additionally, “complex activities such as managing taxes or medication schedules can feel overwhelming, so arranging power of attorney documents and simplifying household billing during this window protects the person’s wishes while cooperation remains high,” Glazer shares. This is also the stage where you may be able to get a dementia diagnosis, he notes. 

“Stages are based on functional ability. In our clinic, we use the different stages to inform the requirement for caregiving.”

— Dr. Aaron R. Ritter, psychiatrist

Stages 4 and 5: Moderate to moderately severe impairment

These stages mark moderate dementia, where the person begins to lose the ability to function normally in their day-to-day life and starts to need extra help. “Abstract reasoning weakens and learning new information becomes difficult, which makes unsupervised medication or budgeting tasks risky,” Gazer says. Symptoms may include:

• Difficulty with complex tasks (e.g., managing finances, traveling independently).
• Some memory loss of personal history.
• Confusion about the date, day of the week or season.
• Confusion about location.
• Reduced ability to concentrate.
• Social withdrawal or moodiness.

It’s vital to seek medical care and diagnosis at this stage, so that you or your loved one can get the care needed. “Naming the stage opens a doorway to honest conversations about driving, household safety and advance care directives,” Glazer notes.

Stage 6: Severe cognitive decline

This is the severe stage of dementia. “Language ability shrinks, everyday movements like buttoning a shirt become confusing and spatial memory slips, so wandering out of familiar rooms or even outdoors can occur,” Glazer describes. Additionally, the person may require substantial assistance with daily activities like dressing, bathing and toileting. They may also experience:

• Personality changes.
• Obsessive symptoms.
• Anxiety.
• Agitation.

It’s essential that people have round-the-clock supervision at this stage. Many families rely on assisted living and memory care.

Read more:

Alzheimer’s and dementia care options to consider

Stage 7: Very severe cognitive decline

During stage seven, more profound motor decline occurs and patients generally require total care for all activities of daily living. The person may lose the ability to walk, sit up, hold their head up. They may experience incontinence and difficulty swallowing. Patients are also at high risk of aspiration pneumonia.

“Anticipating these complications guides families toward comfort-focused feeding plans that respect dignity and reduce hospital trips,” Glazer shares. “Frequent repositioning, soft cushions and regular skin checks protect against pressure injuries, which improves quality of life when curative treatments are no longer possible.” 

Diagnosing and monitoring the stages of dementia 

Your neurologist, geriatric doctor or internist will likely monitor you at various intervals, such as yearly, or more frequently based on symptom progression. Understanding where you or your loved one is in terms of dementia stages helps make sense of the symptoms. It also helps you make practical decisions about care.

“Stages are based on functional ability,” says Ritter. “In our clinic, we use the different stages to inform the requirement for caregiving.” This may include how many hours of care the patient needs, what they need help with and how much supervision they need in order to stay safe.

Clinicians use various testing methods to diagnose the stage of dementia someone is in. The method used will vary based on symptoms and medical needs of the patient. According to Glazer, the following tests are used to diagnose and track dementia:

• Short cognitive tests, like the Mini-Mental State Examination, give a quick snapshot of thinking skills and allow clinicians to compare results over months or years.
• Functional scales, such as the Clinical Dementia Rating, add information and insights about daily activities. These capture changes that shorter tests might miss.
• Brain imaging (MRIs, CT scans, PET scans) reveals patterns of brain changes that hint at the type of dementia the person has.
• Spinal fluid or blood biomarkers (when available) can clarify dementia diagnoses, allowing targeted treatments. 

Tips for caregivers navigating stages of dementia 

Moving through the stages of dementia — whether it is Alzheimer’s, vascular dementia, Lewy Body dementia or frontotemporal dementia — can be extremely challenging. Caregivers will face challenges in how to communicate with their patient or  loved one and how to keep them safe in their environment. They will also face emotional challenges as they see the person struggle and as their relationship with the person changes.

For dementia caregivers, Glazer offers the following advice:

Adjust your communication

How you communicate, support and provide instructions to someone with dementia may need to change as they move through the stages of disease. Glazer offers the following tips to make day-to-day communication easier:

• Use short sentences to cut down on mental load, which helps prevent frustration and decrease arguments.
• Offer two distinct choices rather than asking open-ended questions. For example, “Would you like tea or water?” works better than “What do you want to drink?”
• Visual and tactile cues are helpful. For instance, you can label drawers, add contrasting colors to bathroom fixtures and utilize night lights. 

Make the environment safer

As someone’s physical limitations increase and their mobility becomes more impaired, you may need to make changes to their home or living space. Remove loose rugs and add grab bars to prevent falls, sparing both parties the trauma of emergency room visits, Glazer says. In-home support with home health aides or moving your loved one to a care facility also becomes more necessary as the disease progresses. 

Seek emotional support

Caring for a dementia patient is mentally and emotionally taxing. Caregivers need support too. “Joining caregiver support groups provides practical tips and emotional validation, which lowers burnout and improves care quality,” Glazer recommends. The Alzheimer’s Association sponsors a variety of support groups nationwide. You can also use the Eldercare Locator to find local support groups for caregivers.

Frequently asked questions about the stages of dementia 

It’s common to have ongoing questions about how to manage dementia. Here, Glazer shares some brief insights about some of the most common questions that come up for dementia patients and caregivers. Since each diagnosis is unique, it’s important to consult a doctor for specifics. 

How fast does dementia progress?

The pace of decline is different for everyone. It also depends on the type of dementia you have. For example, people tend to move through Alzheimer’s stages more slowly (eight to 12 years) than Lewy body dementia (five to seven years). 

How long does each stage last?

Again, there is a lot of variability here. Most dementia stages last between one and two years, but the middle stages (stages four and five) typically last longest, between two and four years. 

Can people skip stages of dementia?

Although the pace with which you pass through dementia stages varies, it’s not common to skip a stage entirely. Still, the first phases may pass so quickly and with so few noticeable symptoms that patients and family members often miss them. 

Is progression predictable?

While most people pass through all of the stages of dementia, how quickly they pass through the stages and what symptoms they have depends on several factors, including:

• Overall health.
• Access to mentally stimulating activities.
• Social opportunities.
• Adequate care and supervision.

Whether you’re facing a dementia diagnosis or caring for someone with dementia, it’s vital to stay in touch with a doctor or medical team as you move through each stage of the illness. They can offer advice and resources to help handle affairs, treat symptoms and, most importantly, to improve and sustain a patient’s quality of life.