There are many scales for the different stages of dementia. For the general caregiver or family members, I want to simplify it to thinking of it as a continuum … Some people say mild, moderate, severe, but I try to avoid that because when [someone says], “You have severe dementia,” typically it’s a bit disconcerting, when in reality, some people in the late stage have severe symptoms, but they don’t have severe psychosocial issues. I like to think of it as early, middle and late stages.
One of the things that I’ve found in my practice is that, unlike for example with cancer or other progressive chronic diseases, people don’t think about dementia as stages, when in fact, any progressive chronic disease should be thought of as stages because it allows us to monitor the symptoms, plan for the future, and for health professionals to help educate families of what to expect next. And I think that is truly important.
[Identifying the stages of dementia is] extremely important from a research standpoint. Clinical trials are aimed specifically at specific stages of dementia. A lot of the prevention trials are targeting either [mild cognitive impairment] stage or very early dementia. Knowing what cutting edge treatments or research or clinical trials your loved one might be eligible for, it’s important to know what stage they’re in in order to participate in the scientific process and discovery.
From a practical standpoint, there are characteristics of each stage that will allow one to anticipate the things that they will need, and the things that they should be left to do on their own. A good example would be driving … I have some patients with mild dementia … and they’re still able to drive short distances, in good weather and in daytime. That’s a good example of some things that may be very important to the patient but you don’t want to take it away if they’re still able to do it safely, albeit you have to monitor it.
As much as we want to anticipate where the patient will be, we also want to know what they can still do for themselves so that we can allow them as much independence and ability to do things in their own terms.