The Seven Stages of Dementia and their characteristics are listed below, as reported in the Global Deterioration Scale (Reisberg, Ferris, de Leon, & Crook, 1982). If a person with dementia is in Stage 5 or higher, much care should be taken with their music selection and their responses should be carefully monitored, as they can be considered Significantly Vulnerable.
Stage 1 (No Cognitive Decline)
- These people appear normally clinical; they have no complaints of memory deficit and a detailed conversation does not elicit any evidence of memory deficit
Stage 2 (Very Mild Cognitive Decline)
- The phase of forgetfulness, such as misplacing common objects and forgetting names
- The person may often complain of these, although a detailed conversation does not elicit any evidence of memory deficit
Stage 3 (Mild Cognitive Decline)
- The earliest clear-cut clinical deficits appear at this stage, although these may only appear in detailed conversation
- Decreased ability in remembering names of people they have just been introduced to; they also may read a passage of a book and retain relatively little information
- This decrease in performance may also appear in demanding employment and social situations. Difficulty in finding words and names, misplacing objects of value. Frequently, for the first time the person may become seriously lost when traveling to an unfamiliar location
- Mild to moderate anxiety and denial may also accompany this stage
Stage 4 (Moderate Cognitive Decline)
- Known as the “late confusional stage”, there will be clear-cut clinical deficits in detailed conversation. These deficits will be in many areas, such as in serial subtractions. In particular, complex tasks will see reduced performance, although certain characteristics may remain preserved
- The person will display decreased knowledge in recent events of their own life and current events around them. Detailed conversation will also show deficits in memory of their personal history. Difficulties in traveling alone and managing personal finances may become apparent
- Familiar people can still be distinguished from strangers. Denial may become stronger here, and a flattening of affect (mood) and withdrawal from previously challenging situations may occur
Stage 5 (Moderately Severe Cognitive Decline)
- This is the phase of early dementia. People in this stage will typically require some assistance in daily life. Some serial tasks such as counting backwards from 40 by 4s may prove difficult
- They are often unable to recall a major relevant aspect of their life, and may have difficulty in remembering details such as their address or telephone number, the names of family members and friends, or their high school/college. People in this stage are often somewhat unaware of time (date, day of the week, year, season) and place. People at this stage still retain knowledge of many important facts about themselves and others around them
Stage 6 (Severe Cognitive Decline)
- This is the middle phase of dementia. People in this stage may sometimes forget the names of their spouse, immediate carer, and so on. They are largely unaware of recent events and experiences in their life, and their surroundings (the season, year, and outside events). They retain some knowledge of their past but this is incomplete
- People in this stage will require substantial assistance with daily life. Frequently they will be able to continue distinguishing familiar from unfamiliar persons in their environment
- Personality and emotional changes occur at this stage, although they are quite variable. These include confused behaviour such as believing a spouse is an imposter, or talking to imaginary figures or their reflections; obsessive repetitive acts; anxiety symptoms and agitation; cognitive abulia (i.e., loss of willpower that occurs because they cannot carry a thought long enough to determine a purposeful course of action)
Stage 7 (Very Severe Cognitive Decline)
This is the late dementia phase. All verbal abilities are lost, as are most or all psychomotor skills such as the ability to walk