The person experiencing dementia has no subjective complaints of memory deficit, and no memory deficit evident on clinical interview.

The person experiencing dementia makes subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. They present no objective evidence of memory deficit on clinical interview, nor do they present objective deficits in employment or social situations.

The person experiencing dementia presents the earliest clear-cut deficits in memory. This may manifestat in more than one of the following areas: (a) patient may have gotten lost when traveling to an unfamiliar location; (b) co-workers become aware of patient’s relatively poor performance; (c) word and name finding deficit becomes evident to intimates; (d) patient may read a passage or a book and retain relatively little material; (e) patient may demonstrate decreased facility in remembering names upon introduction to new people; (f) patient may have lost or misplaced an object of value; (g) concentration deficit may be evidence on clinical testing. Objective evidence of memory deficit may be obtained only with an intensive interview.

The person experiencing dementia will have decreased performance in demanding employment and social settings, and denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms.

The person experiencing dementia shows a clear-cut deficit on careful clinical interview. This deficit manifest in the following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of one’s personal history; (c) concentration deficit elicited on serial subtractions; and (d) decreased ability to travel, handle finances, etc. Frequently the person will have no deficit in the following areas: (a) orientation on time and person; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations. They will demonstrate an inability to perform complex tasks. Denial is the dominant defense mechanism in this stage. Flattening of affect and withdrawal from challenging situations will occur.

The person experiencing dementia can no longer survive without some assistance at this stage. They are unable during an interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), or the name of the high school or college from with they graduated.

Frequently they will have some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s.

People at this stage retain knowledge of many major facts regarding themselves and others. They invariably know their own names and generally know their spouses and children’s names.

The person experiencing dementia may occasionally forget the name of the spouse upon whom they are entirely dependent for survival. They will be largely unaware of all recent events and experiences in their lives. They will retain some knowledge of their past lives but this is very sketchy. They are generally unaware of their surroundings, the year, the season, etc. They may have difficulty counting from 10, both backward and, sometimes, forward. At this stage, they will require some assistance with activities of daily living, e.g., may become incontinent or require travel assistance.

Their diurnal rhythm will be frequently disturbed. They almost always will recall their own name. Frequently they will continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include: (a) delusional behavior, e.g., person may continually repeat simple cleaning activities; (b) anxiety symptoms, agitation and even previously nonexistent violent behavior may occur; (c) cognitive abulia, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action.

The person experiencing dementia will have lost all verbal abilities. Frequently they will have no speech at all—only grunting. They may be incontinent of urine and require assistance toileting and feeding. They may also lose basic psychomotor skills, e.g., the ability to walk. Their brain appears to no longer be able to tell their body what to do. Generalized and cortical neurologic signs and symptoms are frequently present.