The progress of dementia in a sufferer is usually seen as having three stages.
First stage of dementia
In the first stage, the person has a marked deterioration of memory, impaired concentration and an increasing tendency to fatigue and anxiety. Nothing more than an obvious failure of memory may be observed for a year or two because of the relatively slow progress of the disease.
However, unusual incidents increasingly occur, giving cause for concern. For example, a cautious business man tells a convincing but false story about a fraudulent transaction involving an associate, or a timid spinster quarrels with her neighbors. Speech disorders in the early stages are usually limited to occasional difficulty in word-finding. Handwriting may be noticeably altered.
Second stage of dementia
In the second stage there is a further deterioration, which is particularly evident around practical everyday skills. At this stage the home begins to take on an air of squalor as the person is no longer able to use the washing machine and the vacuum cleaner. Similar deficits occurring in the workplace tend to lead to early retirement.
Neurological abnormalities begin to appear. For example 5% of people develop epilepsy and other neurological conditions can appear, such as dyspraxia (difficulty in performing tasks that require fine motor skills) and agnosia (loss of the ability to recognize or identify persons or objects). Dressing can become increasingly difficult, with garments put on back to front, a right arm inserted into a left sleeve, or an attempt to put the hand through the cuff rather than the sleeve at the shoulder.
Disorientation in space and time become apparent and the person begins to lose their way in familiar surroundings. They become unable to tell the time or name the day or date. Speech difficulties increase and the person appears to grope for words, to mispronounce words, to reiterate endlessly single syllables or parts of word.
Writing is similarly affected and words tend to be misspelled and parts of words are substituted for others. The impairment of speech is associated with a simultaneous failure to understand the speech of others. Memory loss continues, and begins to include both recent and remote events in the person’s life.
Third stage of dementia
In the third and final stage all intellectual function is grossly impaired.
There is considerable neurological disability, with the possibility of hemiparesis (weakness on one side of the body), decreased muscle tone and a wide-based and unsteady gait. The pre-morbid personality is completely replaced by a ridiculous and gross euphoria. All semblance of communication is lost and patients fail to recognize families, friends and even themselves. Speech is replaced by jargon aphasia (meaningless strings of words or syllables) and towards the end of life, the person loses all semblance of personality and becomes emaciated, incontinent and develops limb contractures without adequate care.
