The Progression of Dementia

Dementia is not a normal or inevitable part of aging. It is the collective name for conditions associated with damage to the brain; a progressive disorder which affects memory, thought process and behaviour.

The most common type of dementia is Alzheimer’s disease, followed by vascular dementia, dementia with Lewy bodies and frontotemporal dementia. However, there are around 200 different types that can now be diagnosed.

All forms of dementia are progressive which means that symptoms develop and then worsen over time. Regardless of which of the many forms of dementia a person is diagnosed with, symptoms and progression is different for every person.

Sometimes the progression of dementia is discussed as being in distinct stages, either early, middle and late or mild, moderate and severe. Another description of stages that you may come across is the Global Deterioration Scale (GDS) created by Dr Reisberg in 1982, which identifies seven stages of dementia as follows:

1. No cognitive decline

2. Very mild cognitive decline

3. Mild cognitive decline

4. Moderate cognitive decline

5. Moderately severe cognitive decline

6. Severe cognitive decline

7. Very severe cognitive decline

Whilst this can be useful in understanding the progression of dementia, it is very difficult to pinpoint the actual stage a person is at as the disease affects individuals differently and symptoms can fluctuate.

Dementia starts with damage to small specific areas of the brain. Symptoms are related to the area of the brain that is damaged. For example, in Alzheimer’s disease this tends to be the hippocampus, which is responsible for memory, whereas in frontotemporal dementia, damage is more likely to be to the frontal lobe, affecting behaviour or emotion.

The progressive nature of dementia means that more of the brain is damaged over time and therefore the number and severity of symptoms also increases. As more areas are damaged, a person may experience difficulty with memory, behaviour, communication, emotion, physical function and sensory processing difficulties.

Factors which can impact the progression of dementia include the following:

●      When diagnosis takes place

●      Type of dementia diagnosed

●      Age of person

●      Other health conditions

●      Infection and delirium

Supporting a Person Living with Dementia

As the disease progresses, the person may require additional support and eventually be unable to manage independently. However, rather than focusing on a particular stage, it is important to consider their ability to manage their daily life. Consider how the dementia is impacting their function, wellbeing and quality of life and then look at what adaptations can be made to enable them to continue to manage independently.

In order to best support the person to slow the progression of symptoms, it is important to help them to do the following:

●      Stay physically active

●      Stay mentally active

●      Stay socially active

●      Maintain a healthy diet and good levels of hydration

●      Try to avoid smoking and excess alcohol

●      Have regular health check ups

●      Have regular hearing and sight tests and ensure any aids are kept maintained and worn

●      Focus on what the person can do and support them to find ways to manage independently

There are many ways that a person can still live well with dementia. Whilst everyone will need some support at some point, it is important to remember that there is no set pathway as it affects everyone differently.

Following a diagnosis, it is important to include the person with dementia in all plans and enable them to remain as independent and active as possible. Discussions around future care should also be had. This enables the person to identify what is important to them so that their wishes can be met going forwards.

As dementia is a progressive condition it is also important to identify the person's preference for end-of-life palliative care. This can be a difficult conversation but it is important, not only for the person living with dementia to express their wishes, but it can be helpful for carers to know they are making best-interest decisions with the person's wishes also being met.

If you need help, advice and support in navigating the dementia journey, then our Wayfinding team is available to assist you with any matter to do with living with dementia. Get in touch with a member of the team today on 01243 888691, email info@dementiasupport.org.uk or fill in our online contact form.