Stages of Dementia Part Two: Moderate

Stages of Dementia

During the different stages of dementia, when you look back at your loved one’s life, you can clearly see the signs of memory loss that were not there before. In the blink of an eye, our loved one’s can go through one or more stages of dementia without us realizing, recognizing, or accepting these changes.

However, once our loved ones go from mild dementia to moderate dementia – their memory loss is now more pronounced. As caregivers, we will need to know what to expect in in each stage in order to be better equipped to care for our loved ones.

In the last section of this series, we went over the mild stage of dementia. In this second section of the Stages of Dementia series, we’ll focus on the moderate stage – where your loved one stands in this stage, what’s to come, and what is required of you as a caregiver. 

As a therapist and daughter, the moderate stage of dementia was the most difficult to deal with. Mom was able to do some things- but not able to do others. Because she could successfully do some things, I mistakenly expected her to be able to do everything.

As I explain in (my book), if mom was driving a car and encountered detours – in the mild stage she’d be able to figure it out. But in the moderate stage – she would have some serious problems. 

So what is moderate dementia?

A person who has moderate dementia is going to have problems successfully performing and doing what they always have done. It will probably be frustrating to you, but remember that it’s more frustrating to the person who is in the moderate stage of dementia.

The person with dementia believes that they are still capable of living independently, and as caregivers we want to believe it too. But in reality, a person with moderate dementia will need additional help and guidance whether they think they need it or not. 

They are now having changes in emotions and insight that can put them in jeopardy. Following conversations will become hard and learning new things will become impossible.

It may be more difficult for them to follow conversations, put ideas in place, express themselves, or even be able to understand and comprehend written words – such as words on a list or a restaurant menu. These changes can cause many with moderate dementia to socially isolate themselves.

What should caregivers expect?

Moderate dementia will be different for everyone. Some of the common signs are:

1. Increased memory loss and confusion (forgetting names, dates, events, places).

2. Problems with language (reading, writing, comprehension, numbers).

3. Angry outbursts due to frustration.

4. Difficulty learning new things and forgetting how to use old things.

5. Restlessness (includes wandering and pacing).

6. Anxiety, hallucinations, paranoia, irritability, delusions.

7. Loss of impulse control.

8. Repetitiveness.

9. Poor judgment – when it comes to important decisions about health, finances and safety.

10. Sleep disruptions.

As a caregiver, you do have some control. Proper medication, environmental changes and training can make this time better for both of you. Calming reactions, distractions, and reminiscence therapy are just some of the tools that can help.

As discussed in the mild stage of dementia post, the MMSE is a test often used to determine someone’s stage of dementia. This is a 30-question examination composed of questions regarding time and place, recall, reading, comprehension, math and visual spatial. The amount of questions answered correctly determines the MMSE score.

The MMSE score of moderate dementia is 20-10. Once again, this test or these scores are not scientifically proven. It’s important to look at your loved one’s day-to-day functioning. How is the person with memory loss getting through the day? What areas of their day are they successful in and where or when do they need more help?

How long will the moderate stage last?

No one knows how long this stage will last. It can be 2-20 years. It all depends on the person, their environment, genes, and personal or emotional history.

Every person is different. Take your time, have patience, and educate yourself on this stage and the stage to come. Stay tuned for the next post in this series on the severe stage of dementia. 

Photo courtesy of Michael Carian

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