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Section 5
ADDITIONAL RESOURCES
5.1 Understanding the progression of dementia
It is important that healthcare staff have a good understanding of how dementia can affect a person as the condition progresses. This sections aims to provide some general information on the typical progression of dementia. It is important to remember that each person with dementia is unique and their experience and journey through their condition will reflect that. Typical Stages and Symptoms To understand dementia, it can be useful to consider the condition in four stages; early, moderate, late and final stage. There are typical traits and symptoms associated with each stage but equally these symptoms and stages can fluctuate and overlap. The chart below describes the changes that may present for the person with dementia in the different stages, and has been copied from a publication from the Alzheimer Association in Illinois, USA (86).
Changes in Memory, Thinking, Language and Mood
Early Stage
Middle Stage
Late Stage
Final Stage
Memory and Thinking Skills
• Difficulty with short-term memory • Loses things • Poor attention • Difficulty with calculations and organizational skills
• Difficulty with short-term and long-term memory • Forget parts of ones history • Has trouble solving simple problems • Becomes disorientated easily
• Mixes up recent and past events • Forgets friends and relatives • Cannot follow a two-step command
• No apparent awareness of past or future
Language
• Unable to carry on a
• Trouble finding words or names • Repeats statements or questions
• Has trouble tracking conversations • Has difficulty forming complete sentences
• Cannot speak or uses only a few words
meaningful conversation • Words and sentences often disconnected
Behaviour/Mood
• May become distressed, withdrawn or irritable
• More easily upset or withdrawn • May express urgent need by yelling/calling out • Difficult to engage
• Severe decline in ability to show emotion
Changes in Ability to Care for Oneself
Early Stage
Middle Stage
Late Stage
Final Stage
• Needs help with household affairs such as cooking and paying bills • Trouble managing money and medications • May get lost or confused when driving
• Needs reminders or practical help with personal care • Slowed walking and reaction time • No longer safe to drive • Fatigues easily
• Loss of control of bowel and bladder • Trouble with balance and coordination • Sleeps often
• Needs total assistance with personal care • Unable to walk and shows little movement • Poor appetite and has swallowing problems • Sleeps most of the time
Facilitating discussions on future and end-of-life care with a person with dementia
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