Disease Progression

How does the disease progress?

In the case of dementia, it is assumed that the disease will last for approximately seven to ten years. The disease progresses slowly and inexorably. The patient first of all forgets the events that happened most recently, and then all memory of the past year and subsequently the last decade. In terms of what he remembers he goes further and further back into the reality of his childhood. This is the reason why dementia patients often behave like children. The course of dementia is divided into three stages:

1st stage: Initial stage, mild dementia

In this stage the symptoms are still slight and often hardly recognizable. This phase is characterized by disturbances of concentration, the feeling that everything is too much, rapid mental exhaustion, lack of drive, lack of interest, vague fears, social withdrawal. It is predominantly the ability to commit new information to memory that is adversely affected – that is, the ability to learn. In this stage the patient is still able to cope with everyday life relatively independently even if he does have to resort to aids such as notes by way of reminder.

2nd stage: moderate dementia

In this stage the symptoms become more marked. Noticeable disturbances of memory and orientation develop. Patients lose themselves in their accustomed environment. They increasingly develop personality changes and may be irritable or aggressive. Their ability to make judgements is restricted. Complex practical instructions can no longer be followed. The patient is no longer able to disguise the loss of his faculties. It is only at this stage that the majority of dementia disorders are identified as such. Household, feeding and personal hygiene are increasingly neglected. The patient enters a phase where he needs increasing help from relatives or carers in carrying out his daily tasks. Distinctive behavioural features such as aggressiveness and restlessness become evident.

3rd stage: severe dementia

In this stage the patient is completely dependent on help from other people. He no longer recognizes the place where he lives as his home, relatives have become strangers. His ability to relate to the present, together with old memories, is increasingly being lost. Eating and drinking are unlikely to be possible without help from someone else, difficulties in swallowing may develop. In this stage – but mostly even before this – the patient loses control over his bladder and bowels and needs to wear incontinence aids (diapers). The patient may become bed-ridden and in care. Not all patients from the disease go through the 3 stages as described. Not every patient finishes up completely in need of care. As far as the patient’s condition is concerned, there are certain distinct variations throughout.

Fig. 1: Course of Alzheimer disease [after Gauthier 1999]

Criteria for the severity of a dementia

Mild

• Work and social activities distinctly limited
• Ability maintained to live independently with appropriate personal hygiene and judgment intact Moderate

Moderate

• Capable of independent living, but with some difficulties
• Certain measure of supervision required Severe

Severe

• Activities of daily life are adversely affected
• Constant care and attention necessary
• Incapable of maintaining minimum standards of personal hygiene