The 7 phases of senile and precocious dementia

The concept "senile dementia" is used to refer to degenerative diseases that affect cognitive functioning, particularly of the memory, and that occur in advanced ages. On the contrary, we speak of precocious or presenile dementia when the symptoms occur earlier than would be expected, generally in maturity.

In this article we will describe the 7 phases of senile and precocious dementia indistinctly, since the development of cognitive impairment follows the same approximate general lines regardless of the age at which symptoms begin to appear.

• Related article: "Types of dementias: forms of loss of cognition"

The 7 phases of dementia

There are a large number of diseases that can cause dementia; some of the most common and well-known are that of Alzheimer's, Lewy's and recurrent strokes. Each such disorder initially affects different regions of the brain, although the symptomatic differences are reduced in advanced stages.

Although the symptoms of dementia depend on the specific condition of each patient, the general progress that these diseases follow has been divided into

seven phases depending on the degree of cognitive impairment that the person presents at any given time.

1. Absence of cognitive impairment

The first stage of cognitive impairment corresponds to its absence; therefore, most people are in this phase, which can be encompassed together with the two following in the category “pre-dementia”, characterized by a normal cognitive functioning or practically normal.

A person is considered to be in phase 1 when has no significant cognitive symptoms that could be attributable to a deterioration of the brain, such as memory losses more relevant than those that occur due to lack of energy or attention, among other common factors.

2. Memory deficits associated with age

Aging, and in particular the arrival of senescence, is naturally associated with small memory losses that are manifested mainly in forgetting names or locations of objects. The second phase of cognitive impairment is characterized by the presence of these deficits in a more or less common way.

Although in many cases the appearance of specific forgetfulness is nothing more than a consequence of age, in some cases memory losses may indicate future severe impairment of cognition, especially if the frequency of these is high and if the person is relatively young to have typical forgetfulness of old age.

3. Mild cognitive impairment

The term "mild cognitive impairment" is used to describe cases in which there are notable signs of memory impairment and in the performance of daily tasks. In this phase, cognitive deficits are more marked than would be expected for the person's age, even taking aging into account.

People with mild cognitive impairment are at increased risk of developing dementia than those that do not, although the progress of deficits often stops at this stage. It is common for those who suffer from this type of impairment to have problems retaining information, remembering words, concentrating, or orienting themselves.

• Related article: "Mild Cognitive Impairment (MCI): concept, causes and symptoms"

4. Mild or early dementia

The fourth phase corresponds to the onset of dementia as such. In this stage, which usually lasts about two years, changes in personality and mood begin to appear. Since social skills also deteriorate, it is very common for the frequency of social interaction to decrease.

Cognitive problems become much more apparent from the onset of dementia. Patients usually have some awareness of their illness when they reach this stage, although dementia also affects this recognition. They also tend to deny their symptoms as a defense mechanism.

5. Moderate dementia

During the middle stage of dementia, affected people begin to need the help of other people to carry out daily tasks. As the disease progresses, abilities such as using money, telephones or kitchen tools, reading and writing, remembering information about oneself, and even dressing, deteriorate.

6. Moderately severe dementia

In this phase, memory and cognition problems have worsened to the point that they interfere with the performance of a large number of activities; it will continue to increase as the dementia progresses. The most frequent thing when reaching this stage is that the person need constant supervision from one or more caregivers.

As for the most common symptoms and signs, in addition to the worsening of the problems of memory (which already include the recognition of close people) we find the appearance of feelings of anxiety and agitation, trouble sleeping, wandering, obsessive and repetitive behaviors, delusions or aggressiveness.

7. Severe or advanced dementia

The average duration of the final stage of dementia is approximately two and a half years. Advanced dementia is characterized by generalized loss of psychomotor skills, including those that are necessary to talk, walk, eat or use the bathroom.

Although the progress of each case of dementia depends on the disease that causes it, they are all very similar during the final period because the structural deterioration has spread to all regions of the brain.