When someone develops dementia, it happens gradually and in stages with a progressive downward spiral. There are seven stages of dementia which are similar to those in Alzheimer’s disease. These stages are as follows:

I. No signs. Signs of memory loss are not yet apparent to a medical professional nor does the patient exhibit any symptoms

II. A subtle cognitive decline. People with dementia may experience some loss of memory such as forgetting familiar names, locations or words. These signs may be observed by family, friends or colleagues.

Alzheimers is a disease of unknown origin in which the cells of the brain die. In its early stages specific abilities like memory and thinking skills are attacked. As the disease progresses cells die in other regions of the brain as well and eventually the patient must be under total care. There is no cure for Alzheimers disease although currently resources are being used with medical imaging to detect the disease at its earliest stages and take steps to prevent it.

III. Mild cognitive decline. The early stages of dementia can be diagnosed only in some individuals with the following symptoms:

• The patient has trouble remembering words or names.


• The patient loses the ability to remember names of individuals newly introduced to him or her.


• Difference in performance can be easily noticeable in work environment, social environment by family, friends or colleagues


• Less retention from articles or stories read in a magazine or book


• The patient misplaces or loses valuable objects


• Decreased ability to plan or organize.

IV. Moderate cognitive decline. This stage exhibits a mild cognitive decline and is still considered early stage dementia with the following clear cut deficiencies being observed:

• The patient fails to remember recent incidents or current events.


• The patient cannot perform a few challenging mental arithmetic such as counting backwards


• The patient is not capable of planning or organizing complex tasks such as arranging a party, planning a picnic etc.,


• The patient tends to remain socially withdrawn and silent in challenging situations.

V. Moderately severe cognitive decline. This stage is a moderate or mid-stage level of Alzheimer’s disease with major gaps in memory and deficits in cognitive function. Assistance with daily activities may be required with the following deficiencies observed:

• The patient fails to recall current address, telephone number and name of the college or school from which they graduated.


• The patient is in a confused state of mind with regards to their current location, date, day of the week, season etc.,


• The patient fails to perform even lesser challenging mental arithmetic such as counting backwards.


• The patient requires help in choosing appropriate clothing for a particular season or occasion


• Generally, the patient retains substantial knowledge and can tell his/her own name, names of their spouse or children.


• The patients typically do not require any assistance for eating or using the toilet.

VI. Severe cognitive decline. This is the next to the last stage and is also called moderately severe or mid-stage of dementia with memory difficulties continuing to worsen. The patient exhibits personality changes on a substantial level requiring a considerable amount of help for carrying out day-to-day activities. The following symptoms are observed in these patients:

• The patient loses track of some of the most recent experiences, events and surroundings. Memory recall of personal history is difficult, though she/he can recall her/his name perfectly. Familiar faces and unfamiliar faces can be distinguished from one another.


• The patient requires some help to dress appropriately because they tend to make minor wardrobe errors such as wearing shoes on the wrong feet


• The patient experiences a disturbance in the normal sleep/waking cycle.


• The patient requires assistance with handling details of toileting such as flushing toilet, wiping and proper disposal of tissue paper.


• The patient exhibits increasing episodes of urinary or fecal incontinence.


• Changes in behavior include suspicion and delusions, such as suspecting the caregiver as an impostor, hallucinations, repetitive behavior such as hand wringing etc.,


• The patient tends to wander and become lost.

VII. Very severe cognitive decline. This is the final stage of dementia and it is referred to as severe or late-stage dementia with the patient losing the ability to respond to the environment, unable to communicate orally and unable to control movements. Patients in this stage often lose the ability to communicate in a recognizable speech even though they do utter phrases occasionally. Patients at this level of decline do need assistance in eating and toileting with “general incontinence of urine.” On a gradual level, patients lose the ability to walk without support, to sit, to smile and hold their head up. Muscles become rigid and reflexes abnormal with a decline in the ability to swallow