Symptoms and Progression of Dementia

Often the early signs of dementia may be difficult to detect. Some people experience changes in their short term memory early on, for others changes to mood or to language may be the early signs. Each person’s experience with dementia is unique.

Early signs and symptoms may include:

• Memory loss, particularly for recent events
• Problems with language, difficulty finding the right word
• Changes in personality, mood or behaviour
• Becoming confused in familiar surroundings or situations
• Difficulty in following conversations, TV programmes or reading
• Difficulty managing money and everyday tasks
• Difficulty solving problems or doing puzzles
• Loss of interest in hobbies and pastimes, lack of initiative to start something or go somewhere.
• Repeating a question or story several times without realising
• Misplacing things by putting them in the wrong place

Most people will experience a number of these signs, and they will find they are having increasing difficulty over time. In general, signs and symptoms emerge gradually. This can be difficult for both the person who is experiencing changes and for their family and friends.

Each person’s experience with dementia is unique to them. Dementia may last many years, sometimes progressing faster, sometimes more slowly. This means that no one can tell you exactly how the condition will progress and how long a person can live with dementia.

Many people find it stressful that they do not have answers to these questions, which is normal. It is essential to understand as much as you can about dementia as it can help you to come to terms with the diagnosis and what may lie ahead. It can be helpful to think about the way dementia progresses in stages. However, it is essential to remember that this is only a guide, and some symptoms may appear earlier or later or not at all.

The following provides an outline of the three stages that are associated with Alzheimer’s disease. Following this, there is a note on the progression of vascular dementia, dementia with Lewy body and Frontotemporal dementia, all of which have specific characteristics.

The progression of Alzheimer’s disease

On average, people live eight to ten years from the time the first symptoms emerge. However, life expectancy varies considerably depending on how old a person is when symptoms begin. A person diagnosed in their 60s will live longer than someone diagnosed in their 90s. Life expectancy is also affected by other illnesses the person experiences.

Early Stage

In the early stages of dementia, changes are slight, and it is possible to continue to do lots of things. This typically means a person may:

• Forget things easily or repeat things frequently
• Experience problems with language, such as appearing to be stuck for words or losing track of a conversation
• Find new situations or places confusing
• Show poor judgement or find it hard to make decisions
• Lose interest in other people or activities
• Be unwilling to try new things
• Experience low mood and may become anxious or withdrawn
• Feel frustrated or angry

Many people in the early stages of dementia engage in activities they enjoy, but sometimes they may find it hard and need to rest more frequently.

Middle Stage

As dementia progresses, changes are more significant, and a person will need more support to help manage day-to-day living. As a person finds it harder to do things, they may lose confidence and withdraw or be upset. Others may feel frustrated and angry and be argumentative or quick to lose their temper.

During the middle stage a person may:

• forget recent events completely
• find conversations, television or reading difficult to follow or confusing
• get lost easily, even in familiar places
• find bathing and dressing difficult or confusing
• need reminders to eat, drink and take medication
• find meal preparation and managing money very difficult
• believe things are real even when they are not
• feel restless or agitated
• confuse time and experience difficulties with sleeping

The symptoms and behaviours that can occur during this stage are difficult for both the person with dementia and their families. There are supports and services to help and strategies for coping which are listed at the bottom of this page

Late Stage

During the late stage of dementia, a person will need increasing amounts of support and will gradually become dependent on others for nursing care. A person will become increasingly frail and may walk unsteadily; they may need a wheelchair or be confined to bed. During this stage the ability to fight even simple infections is low.

Typically, a person may:

• have difficulty recognising people, although there may be flashes of recognition
• experience gradual loss of speech
• have difficulty eating and sometimes swallowing
• experience incontinence
• appear restless and seem to be looking for someone or something

While a person with late stage dementia may have difficulty communicating, they will often respond positively to affection, a smile, and a soothing voice. Music, scent and hand massage can bring comfort and enjoyment.

The progression of vascular dementia

Vascular dementia is generally caused by a stroke or a series of small strokes. As a result, this type of dementia may progress in a ‘stepped’ manner, which differs from the more gradual progression of Alzheimer’s disease. Symptoms may suddenly worsen due to a stroke and remain level for some time. It may be months or years until the next stroke occurs, and symptoms can worsen. When vascular dementia is caused by a series of small strokes, then symptoms can emerge more gradually.

People with vascular dementia tend to maintain their personality and emotional responsiveness until the later stages of the condition. This can mean that people are more aware of their condition and can be more prone to depression than people with Alzheimer’s disease.

Generally, people with vascular dementia live for around five years after symptoms begin. In many cases, the person’s death will be caused by a stroke or heart attack.

The progression of dementia with Lewy Bodies

Half or more people with dementia with Lewy Bodies will also develop symptoms of Parkinson’s disease. These include slowness of movement, stiffness and tremor. Other symptoms include difficulty judging distances, falls and fainting. Visual hallucinations, paranoia and delusions may also emerge.

In the early stages of this dementia, the person’s abilities may fluctuate drastically, even during the day. This can be very confusing for all concerned.

In the later stages, this dementia progresses similarly to Alzheimer’s disease. People usually live for six to twelve years following the onset of symptoms.

Each person’s experience with their dementia is unique to them, and there is no way to say precisely how their dementia will progress, which symptoms will emerge and when and how long they may live with their condition. The above is just a guide to help to understand how dementia may progress however it is essential to note that everyone’s experience with dementia is unique to them.