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All types of dementia are progressive. This means that while symptoms may at first be mild, they deteriorate with time. As dementia progresses, a person with this condition will need increasingly more help and support with daily living. Dementia affects every individual differently. This includes their experience of the symptoms, the rate at which the condition progresses (which itself varies across the different types of dementia), and the type and level of support required.

There are several stages of dementia. In all types of dementia, memory problems are the early signs. The deterioration in cognitive skills is gradual and in later stages, daily activities will become increasingly challenging without assistance.

Dementia progression can generally be classified into three stages – the mild, moderate, and advanced stages. These stages are a simplified explanation on how dementia symptoms change over time, and can be used as a guide to help persons living with dementia and their loved ones prepare for the future. It may be difficult to place a person’s condition in a specific stage as symptoms may appear in a different order and stages may overlap.1 However, understanding the stages as such helps us see how dementia progresses in general.
The following provides an overall idea of how the symptoms affect a person living with dementia and change across the three stages:
Activities of Daily Living

Mild Dementia

• Still able to care for self in basic activities of daily living, i.e. personal hygiene, dressing

• May have some difficulty with:

⇒ Taking public transportation
⇒ Money management

• May have difficulty planning and managing household tasks such as cleaning and cooking

• May have difficulty initiating activities

Moderate Dementia

• Needs regular reminders and prompts in daily tasks

• Requires assistance with dressing, personal hygiene, going to the toilet, eating, and some other daily activities.

• High risk of falling

Advanced Dementia

• Unable to care for self. Total dependence in taking care of own hygiene, eating, going to the toilet, and taking a shower

• Problems with balance, coordination, resulting in instability and falls

• Likely to have mobility issues, could be bed-bound

• Eating and swallowing problems

• Loss of bladder and bowel control

Behaviours

Mild Dementia

• Apathy; lack of interest in activities they used to engage in

• May become socially withdrawn

• Rapid mood changes or have low mood

Moderate Dementia

• Wandering

• Repetitive actions/ questions

• Sleep reversal

• Frustration at not being able to communicate well

• May appear depressed, and more easily upset, frustrated, agitated, and suspicious

Advanced Dementia

• Crying, shouting or repetitive vocalisation as a means to communicate needs

• Refusing care due to confusion

• Passive/ withdrawn

Cognitive Decline
Memory

Mild Dementia

• Forgetfulness (Difficulty with short-term memory)

• Impaired judgement

• Impaired abstract thinking

• Misplacement of items

Moderate Dementia

• Difficulty with short- and long-term memory

• May begin to forget or be unable to recognise certain family members

• May begin to be unable to remember own address or phone number

Advanced Dementia

• No apparent awareness of past or present

• Inability to recognise current self

• Inability to recognise common objects

Language & Communication

Mild Dementia

• Difficulty in following storylines and conversations

• Difficulty finding the right words or remembering names

Moderate Dementia

• Difficulty in communication due to repetitive speech or inability to understand contexts

• Difficulty in expressing emotions and making needs known

Advanced Dementia

• Unable to communicate through language

• Unable to engage in meaningful conversations

• May not be able to communicate or may be unresponsive at times

• Incoherent speech

• May express needs by yelling

Calculation

Mild Dementia

• Problems with handling finances

Moderate Dementia

• May have problems performing simple calculations

Advanced Dementia

• Unable to perform any calculation

Disorientation

Mild Dementia

• May occasionally feel disoriented, but may be able to navigate frequently visited places

• May get lost in less familiar places

Moderate Dementia

• May experience confusion in general; may have poor orientation to day, date and/or time

• May get lost outdoors, even in familiar places

Advanced Dementia

• Unable to differentiate day and night

• May get lost at home

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Downloadable Resources

The following resources contain bite-sized information on The ABCDs of Dementia Progression that you may download and/ or print: 
Click on the images below to download in English.

Forget Us Not: Building a Dementia Friendly Community

Understanding Dementia

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