We set out below a brief overview of the four stages.
Stage One – Malorientation, mild confusion
In this stage the person can still maintain a good social facade to hide short-term memory losses. They appear to be orientated, but their attention span is reduced. People in Stage One are aware of ‘mistakes’ such as misplacing or forgetting things and try to hide them. They are often frightened of becoming ‘crazy’, of losing control and their independence. They will often exaggerate their independence to mask their own fears and are frightened by other people in the more advanced stages of dementia. They will experience difficulty in finding some words and may lose the ‘thread’ of a conversation. They may appear frustrated and sometimes become angry, defensive, blaming, tense or anxious.
Stage Two – Time Confusion, moderate confusion
In this stage, people become visibly disorientated and lose their sense of chronological time. They are not always aware of the season or the time of day and may refer to deceased persons, e.g. parents, as being still alive. They start to become disinhibited, losing their sense of social etiquette and starting to say what they are thinking. Language starts to become more obviously affected and people may lose the ‘thread’ of a sentence. They will often invent new words to substitute for lost ones. Attention span is very limited and they will keep misplacing things. However, people in Stage Two are less aware of their memory deficits and ‘mistakes’ so are less tense and anxious. They will often retreat to memories of happier times and are more relaxed than in Stage One.
Stage Three – Repetitive motion, severe confusion
In this stage, verbal ability is limited. Speech is usually in short phrases and sometimes may be just whistling or singing.
Phrases such as ‘Nurse, nurse’ or ‘help, help’ are often repeated throughout the day and efforts to initiate verbal contact are minimal. People in Stage Three often experience severe sensory deficits, especially visual. They will make repeated movements, such as rocking, tapping, patting, polishing or rolling up their dress. They will often sit or lie down for much of the day. They may recognise family members as being familiar, but usually cannot retrieve their names or their relationship to them.
Stage Four – Vegetation
In this stage, people appear to be sleeping for most of the day.
Their muscles are loose, with almost no body movements. They do not appear to recognise family members. They seem to withdraw from the outside world for most of the time.
People in Stage Four are still able to respond to loud noises and unusual stimuli, but mostly to music, a friendly voice tone, favourite foods or a massage.
Notes about staging
Within any of the four stages there can be a range of severity, through low to medium and high level functioning. People in transition between the different stages may exhibit behavioural characteristics of both stages simultaneously for some time, usually a number of months. During lucid moments, it is possible for a person to function at a stage higher than their normal level of functioning. It is not possible to predict how long a person will be in any given stage as this depends not only on how quickly the dementia is progressing, but on physical health, motivation, stimulation, perception, life experience and personality.