Disease Progression: The 5 Stages of Dementia

Written by Mary Ellen Ellis | Published on August 27, 2013
Medically Reviewed by George T. Krucik, MD, MBA on August 27, 2013

The Truth About Dementia

The word dementia gets used a lot when talking about aging and certain diseases. A common misconception is that dementia is a disease in itself. It is, in fact, a set of symptoms, which can be caused by a number of disorders.

The most common cause of dementia is Alzheimer’s disease. Brain damage from an injury or a stroke can also cause dementia, as can other diseases like Lewy body dementia and Huntington’s disease.

Dementia vs. Old Age

If you notice memory slips in an elderly relative you might automatically assume that they are in the early stages of dementia, but you might be jumping to the wrong conclusion. Some amount of memory loss is normal as we age.

To be considered dementia, your loved one’s symptoms must interfere with his or her daily life. The symptoms also need to affect more than one category of brain function, such as memory, communication, judgment, or language.

Alzheimer’s Effects on the Brain

Alzheimer’s disease causes nerve cell death and shrinkage in the brain. Tangles and plaques made up of abnormal proteins build up around nerves. This prevents communication and causes nerve cell death. When the cortex shrivels, your capacity to think, plan, and remember decreases.

Alzheimer’s often severely damages the hippocampus, inhibiting your ability to form new memories. As the disease progresses, it impairs the areas of the brain involved in processing speech and spatial awareness.

The Stages of Dementia

Progressive dementia, which is dementia that gets worse with time, is the most common type. Five stages of progressive dementia have been outlined. They are part of the Clinical Dementia Rating (CDR), which professionals use to evaluate the progression of symptoms in patients with dementia.

The five stages describe a patient’s ability to perform in six different areas of cognition and functioning: orientation, memory, judgment, home and hobbies, personal care, and community.

Stage 1: CDR-0 or No Impairment

Stage one of the CDR represents no impairment in a person’s abilities. If your loved one gets a score of 0, they have no significant memory problems, are fully oriented in time and place, have normal judgment, can function out in the world, have a well-maintained home life, and are fully able to take care of their personal needs.

Stage 2: CDR-0.5 or Questionable Impairment

A score of 0.5 on the CDR scale represents very slight impairments. Your loved one may have minor memory inconsistencies. They might struggle to solve challenging problems and have trouble with timing. Additionally, they may be slipping at work or when engaging in social activities. At this stage, however, they can still manage their own personal care without any help.

Stage 3: CDR-1 or Mild Impairment

With a score of 1, your loved one is noticeably impaired in each area, but the changes are still mild. Short-term memory is suffering and disrupts some aspects of their day. They are starting to become disoriented geographically and may have trouble with directions and getting from one place to another.

They may start to have trouble functioning independently at events and activities outside the home. At home, chores may start to get neglected, and someone may need to remind them when it is time to take care of personal hygiene.

Stage 4: CDR-2 or Moderate Impairment

A score of 2 means that your elderly relative is moderately impaired. They now need help taking care of hygiene. Although well enough to go out to social activities or to do chores, they need to be accompanied.

At this stage there is more disorientation when it comes to time and space. They get lost easily and struggle to understand time relationships. Short-term memory is seriously impaired and it is difficult to remember anything new, including people they just met.

Stage 5: CDR-3 or Severe Impairment

The fifth stage of dementia is the most severe. At this point your loved one cannot function at all without help. They have experienced extreme memory loss. Additionally, they have no understanding of orientation in time or geography. It is almost impossible to go out and engage in everyday activities, even with assistance. Function in the home is completely gone and help is required for attending to personal needs.

Progressive Dementia

When you learn about the five stages of dementia, you begin to understand how devastating these symptoms can be as they get worse. The majority of dementia cases are progressive, but there are some that are reversible.

If dementia is caused by an infection, a nutritional deficiency, as a side effect of a medication or from brain bleeding, the symptoms can be stopped and reversed as long as the underlying cause is treated.

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