The Stages of Dementia: What Families Can Expect at Home

How the stages of dementia are described

Dementia is not a normal part of getting older. It is a loss of thinking, remembering and reasoning that gets in the way of daily life. Learning the stages of dementia helps you plan for what your parent will need at home.

The Alzheimer’s Association describes Alzheimer’s disease in three stages: early, middle and late. Some doctors use a longer scale with seven stages, based on work by Dr. Barry Reisberg. Others group it into mild, moderate and severe. These are simply different ways to describe the same path.

Stages often overlap, and no two people move through them the same way or at the same speed. Other types of dementia can look different from Alzheimer’s, so ask your parent’s doctor what to expect in your parent’s case.

Early stage: still independent, a good time to plan

In the early stage, most people still function on their own. Your parent may still drive, work, volunteer and see friends, and family and close friends may be the only ones who notice changes.

What it can look like at home

• Trouble finding the right word or remembering names.
• Losing or misplacing things that matter, like keys or a wallet.
• More trouble planning, such as following a recipe or keeping up with bills.
• Repeating the same question or story.

Money problems can be an early clue. Research supported by the National Institute on Aging found that people with dementia were more likely to miss credit card and mortgage payments years before a diagnosis.

What to do in the early stage

This is the time to make plans together, while your parent can take part. The Alzheimer’s Association says early diagnosis gives families time to make legal, financial and long-term care plans as a team.

• Talk about who will help with money and health decisions. Our guide to power of attorney for an elderly parent explains the basics.
• Set up automatic bill payments and watch accounts for unusual charges.
• Do a home safety walk-through and fix tripping risks.
• Watch for driving changes, such as new dents, getting lost or near misses.
• Ask about memory programs, support groups and activities your parent enjoys.

Middle stage: more help each day

The middle stage is usually the longest, and it can last for many years. Your parent will need more help with daily tasks, and their needs will keep growing.

What it can look like at home

• Confusion about where they are or what day it is.
• Needing help choosing clothes, bathing or using the toilet.
• Trouble controlling bladder and bowels.
• Changes in sleep, such as sleeping during the day and being restless at night.
• Personality and behavior changes, such as suspicion, anxiety or anger.
• Wandering or getting lost, even in a familiar place.

Safety, driving and money in the middle stage

Safety becomes the main focus. The Alzheimer’s Association notes that a person with Alzheimer’s will need to stop driving during the middle stage. Early in this stage, it also becomes unsafe for them to be left alone.

Wandering is common. About six in 10 people living with dementia will wander at least once, and many do it more than once. Learn the warning signs in our page on dementia wandering.

By now, someone else usually needs to manage bills and paperwork. This step is much smoother if legal papers were signed in the early stage.

What to do in the middle stage

• Build a simple daily routine with meals, activity and rest at the same times.
• Encourage your parent to do as much as they can, and step in when needed.
• Add door alarms, night lights and a safe place for car keys.
• Keep a recent photo and a list of places your parent might go.
• Look into respite care, adult day programs and in-home help so you get breaks.
• Join a caregiver support group. Talking with others who understand can help a lot.

Late stage: comfort and full-time care

In the late stage, your parent may lose the ability to respond to what is around them, carry on a conversation and, in time, control movement. They will need help around the clock with personal care.

What it can look like at home

• Needing help to eat, and trouble chewing or swallowing.
• Needing help to walk, and later being unable to walk.
• Spending most of the day in a bed or chair.
• Being more likely to get infections, especially pneumonia.

The late stage may last from several weeks to several years. Care often becomes more than one family can give at home.

Some families add more in-home help, and others choose a care community. Both are loving choices.

What to do in the late stage

• Focus on comfort, dignity and calm, familiar things like music and gentle touch.
• Change your parent’s position at least every two hours if they spend most of the day in bed or a chair.
• Ask the doctor about soft foods and safe ways to help with eating.
• Ask about hospice. Medicare covers hospice when your parent’s doctors certify a life expectancy of six months or less and your parent, or the person who speaks for them, chooses comfort care.

How fast does dementia progress?

There is no set timeline, and the stages do not come with fixed lengths. On average, a person with Alzheimer’s lives four to eight years after diagnosis, but some live as long as 20 years.

Signs that dementia may be getting worse include new trouble with daily tasks, more confusion or a change in behavior. A sudden change is worth a prompt call to the doctor, because something else may be going on. For example, some medicine side effects can look like memory problems.

Questions families ask next

What should I do about the changes I have noticed?

Write them down. Note what happened, when and how often, and bring the notes to the doctor. Simple, dated notes are more useful than memory alone.

Has a doctor checked your parent’s memory yet?

If not, that is the first step. A primary care doctor can start with an exam, lab tests and memory and thinking tests. Some conditions that look like dementia can be treated, such as low vitamin levels, thyroid problems or medicine side effects. Read more in our guide on how dementia is diagnosed.

Can my parent with dementia stay at home?

Many people with dementia live at home for years, especially in the early and middle stages. It takes planning, a safe home and help for you as well. As needs grow, families often add day programs, in-home help or a move to memory care. Our page on memory care vs assisted living explains the options.

Will Medicare pay for dementia care at home?

Medicare does not pay for long-term custodial care. That means help with daily tasks like bathing and dressing when that is the only care needed. Medicare home health may cover part-time skilled care if a doctor confirms the need and your parent is homebound. Medicaid programs in many states may help pay for care at home, but who qualifies and what is covered vary by state.

Take care of yourself, too

Caring for a parent with dementia is a long road. It is normal to feel tired, sad or even angry at times. Our page on caregiver burnout lists the warning signs and where to find help.

To find support services near your parent, call the Eldercare Locator at 1-800-677-1116. The Alzheimer’s Association also runs a 24/7 helpline for families at 800-272-3900.

This guide is general information, not medical, legal or financial advice.

Frequently asked questions

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