The Stages and Evolutions of Dementia Diagnosis

 

 

 

 

     Dementia is not solely caused by aging, but is also influenced by an individual’s overall lifestyle. Understanding the stages of the disease and seeking medical evaluation before symptoms appear can help us better prepare and prevent its onset.

 

 

6 Stages of Dementia

     The National Institute on Aging – Alzheimer’s Association (NIA-AA) has defined six stages of Alzheimer's Disease (AD), focusing on cognitive function and the ability to perform daily activities as follows:

 

1) Preclinical Stage

• Stage 1 No noticeable cognitive or memory symptoms are present, but brain abnormalities have already begun.
• Stage 2 TCD This stage is called 'Transitional Cognitive Decline', mild forgetfulness may occur, though it does not interfere with daily life.
• Stage 3 MCI At this stage, individuals may have difficulty remembering recent events, making decisions, or performing complex tasks. However, they are still able to live independently but may require support in some areas.

 

 

 

 

 

2) Symptomatic Stage

• Stage 4 Mild Dementia Cognitive and memory functions noticeably decline. Individuals may forget essential life events or people's names and may show mood swings or frequently misplace items.
• Stage 5 Moderate Dementia Cognitive, memory, and emotional functions decline significantly, affecting daily life. Symptoms may include anxiety and depression, requiring closer supervision and care.
• Stage 6 Severe Dementia Significant deterioration in brain function leads to the loss of ability to perform basic activities. The individual becomes completely dependent on others.

 

 

Further Reading: 5 Warning Signs of Dementia — Frequent Forgetfulness and Memory Loss

 

The Evolution of Dementia Diagnosis

     Medical understanding of dementia has evolved alongside technological advancements. Diagnostic methods have been categorized into three periods: the early stage, intermediate stage, and current stage.

 

 

 

 

1) Early Diagnosis (1984 – 1999)

     The NINCDS-ADRDA criteria were the first to be used for diagnosing Alzheimer ’s-type dementia, relying on interviews, medical history, clinical observation, and physical examinations. However, due to technological limitations, detecting biomarkers in blood was not yet possible. Diagnosis was broadly classified based on whether the patient showed symptoms or was likely to develop dementia.

 

 

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During this period, medical professionals observed that many patients also experienced short-term memory loss, known as "Amnestic Syndrome"

 

 

 

 

 

2) Intermediate Diagnosis (2004 – 2014)

     Advances in technology allowed for more in-depth diagnostic testing using biomarkers, such as CSF Aβ42, phosphorylated tau protein (P-Tau), and beta-amyloid in brain tissue. Abnormal levels of these biomarkers can impair brain function and precede noticeable memory loss, such as forgetting recent conversations—collectively known as MCI (Mild Cognitive Impairment).

 

Understanding 'MCI'

     MCI is considered a transitional phase before dementia develops. It is important to recognize bodily abnormalities before MCI occurs and consider other possible causes, such as brain atrophy or cerebrovascular disease.

 

3) Current Diagnosis of Dementia

     With the availability of advanced diagnostic methods, the ATN Framework was introduced. This approach helps identify preclinical disease processes, enabling more accurate diagnoses. It allows for the detection of dementia risk at an early stage, even before symptoms appear, by observing biomarkers in combination with clinical signs.

 

 

Further Reading: Diagnosis and Detection of Dementia Causes

 

 

 

 

 

 

Treatment of Each Stage

Alleviating symptoms of dementia requires a holistic treatment approach, including medication, lifestyle modification, caregiving, and emotional support from family. Physicians develop treatment plans based on the patient’s stage and condition.

 

• Early-stage MCI Focus on lifestyle changes, exercise, cognitive training, and medications to slow symptom progression.
• Moderate Stage Use of Cholinesterase Inhibitors and behavioral management.
• Severe Stage Provide palliative care, manage agitation, and address complications.