Dementia: Stages, Symptoms, Causes, and More

_{The content of this article was reviewed by Roger Landry, MD, MPH | Preventive Medicine Specialist and author of Life Long, Die Short}

A 2022 study by the American Medical Association’s JAMA Network estimated that about 10% of U.S. adults ages 65 and older have some form of dementia, while as many as 22% have mild cognitive impairment. This translates to approximately 6.07 million cases of dementia among older adults. Although the rate of dementia (cases/thousand people) is declining, projections show the number of cases will increase significantly in the coming decades due to the aging population.

So, What Exactly is Dementia?

Dementia is often misunderstood. Many assume that any form of cognitive decline or memory loss is attributed to Alzheimer’s disease. The Alzheimer’s Association states that while Alzheimer’s is the most common cause of dementia, dementia isn’t one specific disease but rather a broader term for various conditions that affect memory, thinking, behavior, and the ability to perform everyday activities.

Dementia usually comes on gradually, causing deterioration in memory that worsens over time. Unlike other cognitive conditions like delirium and amnesia, which occur suddenly and can often be successfully treated or reversed, most dementias are irreversible, according to Medical News Today. However, there are new treatments coming available which show promise in slowing the progression of the disease.

Causes of Dementia

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. It can affect people differently. The symptoms depend on the area of the brain that’s damaged, but they generally involve memory loss, one of the most common early signs of dementia.

The Mayo Clinic says common causes of dementia include:

• Alzheimer’s disease. This is the most common type of dementia. While we don’t know all the reasons why people get Alzheimer’s, we do know that, in some cases, it runs in families. One Alamyloid) and tangles (masses of tau protein) in their brains. Over time, the plaques and tangles spread throughout the brain, leading to increased memory loss and trouble thinking.
• Vascular dementia. Caused by damage to the vessels that supply blood to the brain, vascular dementia is caused by the same risk factors that increase the risk for stroke, such as high blood pressure, diabetes, and high cholesterol. The most common symptoms of vascular dementia include problems with problem-solving, slowed thinking, and loss of focus and organization, which tend to be more noticeable than memory loss.
• Lewy body dementia. Lewy bodies are balloon-like clumps of protein that form in nerve cells. One of the most common types of dementia, symptoms include trouble with thinking, behavior, and sleep. Other signs may include slow movement, tremors, and stiffness.
• Frontotemporal dementia. This is a group of disorders that affect the frontal and temporal lobes of the brain. Changes in this brain region would affect memory, the ability to reason, make decisions, prioritize, multitask, act appropriately, and control movement, as well as the ability to understand words, recognize things, and identify and respond to emotions. There are many types of frontotemporal dementia, including primary progressive aphasia and Pick’s disease.
• Mixed dementia.  People often have more than one type of dementia at a time, with vascular dementia and Alzheimer’s disease being the most common.  There are no specific symptoms for mixed dementia, as they depend on the type of dementia that has been diagnosed.

Other causes of dementia include Parkinson’s disease and other neurodegenerative conditions. Less common causes include infections, brain injuries, and certain autoimmune diseases.

Is it Dementia or Normal Aging?

Typical age-related memory loss doesn’t cause a major disruption in your daily life. For example, you might occasionally forget a person’s name but recall it later in the day. You might, oftentimes, misplace your glasses. Or maybe you need to make lists more often than in the past to remember appointments or tasks.  These changes in memory are generally manageable and don’t affect your ability to work, live independently or maintain a social life. For most people, memory loss doesn’t disrupt daily life or their ability to complete normal tasks, nor does it affect one’s ability to learn or remember new things. * People with dementia have memory loss that gets worse over time and often progresses until they are unable to care for themselves.

The Stages and  Symptoms of Dementia

The Alzheimer’s Association classifies dementia into three stages: early, middle, and late (sometimes referred to as mild, moderate, and severe). Since dementia affects people in different ways, each person may experience symptoms—or progress through the stages—differently.  Often, the disease’s early stage is preceded by a condition known as Mild Cognitive Impairment (MCI).

According to the Mayo Clinic, people with MCI may have memory lapses when it comes to information that is usually easily remembered. This may include conversations, recent events or appointments.

People with MCI also may have trouble judging the amount of time needed for a task. They may have trouble judging the number or order of steps needed to complete a task. The ability to make sound decisions can become harder.

Early Stage:

Early signs of dementia are mild and can be easily overlooked. Someone with early-stage dementia may still function independently, drive, work, and be part of social activities. However, families may begin to notice subtle changes, including:

• Forgetting recent events or conversations
• Misplacing items more frequently
• Increasing trouble in finding the right words
• Occasional confusion about time or place
• Complex tasks and decision-making become more of a struggle
• Mood changes or loss of interest in activities

Middle Stage:

As dementia progresses, symptoms become more pronounced, affecting everyday life. Frustration, anger, and confusion become more common. Acting in unexpected ways, like refusing to bathe, may also happen more frequently. In this stage, expressing thoughts and performing routine tasks and daily activities without assistance also becomes more difficult. What to look for:

• Significant memory loss, especially for recent events or personal history
• Confusion about where they are or what day it is
• Feeling moody or withdrawn in socially or mentally challenging situations
• Increased need for help with personal care tasks like dressing or bathing
• Occasionally unable to recognize family and friends
• Personality and behavior changes or mood swings
• Propensity to wander; gets lost easily
• Have difficulty with communication
• Changes in sleep patterns
• Compulsive, repetitive behavior like tissue shredding.

As the need for more care increases, caregivers can become overwhelmed. They may consider respite care allowing a temporary relief from caregiving yet ensuring their loved one continues to receive care in a safe environment. Find respite care here.

Late Stage:

In the late stage, symptoms are severe, and full-time care or hospice care is often required. Symptoms include:

• Little to no awareness of recent experiences and their surroundings
• Severe memory loss – Inability to recognize close family members
• Disorientation – confusion about place and time, inability to recognize familiar environments
• Extensive help with daily activities and personal care is necessary
• Significant changes in physical abilities (walking, sitting, swallowing); weight loss
• Difficulty communicating verbally and understanding what others are saying
• Mood Alterations – Depression, anxiety, and apathy are common, as are delusions and hallucinations, restlessness, agitation, and aggression
• Becoming prone to infections and other health complications

Risk Factors for Dementia

Certain physical and lifestyle factors can increase the chances of getting dementia. According to Stanford Healthcare, common risk factors include:

• Advanced age, especially after age 65
• Family history – certain genetic mutations have been linked to higher risks of specific types of dementia, such as Alzheimer’s disease
• Cardiovascular issues like high blood pressure, high cholesterol, and atherosclerosis
• Diabetes and obesity
• Physical inactivity, smoking, and alcohol use
• Poor dietary habits may contribute to dementia risk while following a diet rich in fruits, vegetables, and whole grains may have protective effects
• Social isolation, depression, severe head trauma or repeated head injuries, and exposure to air pollution may also increase the risk of dementia

While some risk factors, like age and genetics, cannot be changed, many others can be modified by making lifestyle changes and managing health conditions.

Diagnosing Dementia

Diagnosing dementia requires a comprehensive approach involving a variety of assessments and tests, as no single test can definitively diagnose dementia. According to the Mayo Clinic, a diagnosis is based on the collective findings from these evaluations and the doctor’s clinical judgment. Diagnostic tests may include:

• Medical history and physical exam
• Cognitive Assessments that evaluate memory, attention, concentration, language skills, reasoning, judgment, and orientation to time and place
• Laboratory tests are conducted to rule out other conditions that may cause dementia-like symptoms
• Brain imaging (MRI, CT, PET) to identify structural changes in the brain and rule out other conditions like tumors or strokes, detect signs of specific types of dementia
• Neurological examination

Some newer tests, such as cerebrospinal fluid (CSF), look for specific proteins associated with Alzheimer’s disease.

When to Seek Help

Seeking help is a sometimes difficult but necessary decision when persistent memory problems, cognitive difficulties, or behavioral changes begin to interfere with daily life. Signs to watch for include often forgetting recent information, having trouble with familiar tasks, getting confused about time or place, and noticeable changes in mood or personality. While it’s normal to forget things from time to time as we age, it’s important to consult medical professionals if symptoms are persistent, worsen over time, or are disconcerting to family and friends. Early diagnosis can provide access to treatments, support services, and the opportunity to plan.

Dementia Treatment*

While there’s no cure for dementia, certain medications, therapies, and lifestyle changes can help manage symptoms for a time.

Drugs like the recently FDA-approved donanemab (Kisunla), cholinesterase inhibitors (e.g., Aricept), and memantine (Namenda) can support memory and thinking, and some treatments, like monoclonal antibodies, may slow the progression of Alzheimer’s for those with specific brain changes. Doctors may also prescribe medications to ease related issues like depression, anxiety, or aggression.

Non-drug therapies, such as reminiscence therapy or cognitive stimulation, can help engage the mind and improve quality of life.

Lifestyle changes, such as staying active, eating brain-healthy foods, and maintaining a good sleep routine, also play a significant role in managing dementia symptoms and improving mood.

*Sources: National Institute of Health, Mayo Clinic

Supporting a Loved One with Dementia

The Family Caregiver Alliance says caregivers can support loved ones throughout all dementia stages and can enhance care and quality of life by:

• Establishing consistent daily routines
• Adapting communication techniques specifically for dementia
• Exploring new treatments and therapies
• Creating a comprehensive care plan
• Joining support groups to share experiences and gain advice
• Learning specialized dementia care methods
• Researching local memory care options

Memory Care

When treatments become less effective and caring for a loved one at home is no longer possible, memory care communities (also known as dementia care communities) provide safe, secure housing, 24-hour specialized care – and peace of mind for families. Memory care communities create meaningful, positive experiences in safe, engaging environments, allowing residents to live purposeful, enriched lives at every stage of their journey.

Support is provided by a trained staff experienced in dementia care and includes personalized assistance with daily tasks like eating, bathing, and using the bathroom. Many memory care communities also provide research-based programs and therapies designed to reduce confusion, ease agitation, and improve overall quality of life.

How do you know it’s time for memory care? While it’s different for everyone, experts from organizations like the Alzheimer’s Association, Mayo Clinic, and the National Institute on Aging recommend some common signs to watch for.

• Safety red flags
• Difficulty completing tasks
• Wandering and getting lost
• Changes in personality or mood
• Personal care challenges
• Social withdrawal 

Find a memory care community here.
Find answers to common questions about memory care communities here.

Seeking Help: An Important Step

We are learning more and more about dementia, and so seeking help is a major step toward taking advantage of this new knowledge in the diagnosis, treatment, and overall management of this disease.  By accepting the diagnosis, understanding its progression, and partnering with medical and logistical support, family members can more effectively navigate the significant challenges of dementia care while fostering a positive outlook and making the most of their time with their loved ones.

For more information on supporting a loved one living with dementia, see our Dementia Caregivers Toolbox for resources.

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About Our Expert Reviewer

Dr. Roger Landry is a preventive medicine physician and President and Chief Content Officer of Bright Side of Longevity LLC, a group of multi-discipline specialists in healthy longevity who partner with communities to provide holistic content to enrich their wellness offerings and with individuals to support their healthy longevity strategy. Read his full bio here.