Dementia Guidelines


Level 1 – Early Stage Dementia

In each area may exhibit one or more of the following:

Awareness - "Has Knowledge of the past, present, and future"
  • Believes still has responsibilities
  • Doesn’t believe needs assistance or any help
  • Retains some form of thought; i.e. follows through with some thought or action
Behaviors at this stage
  • May get started going or doing something and will lose train of thought
  • May at times be suspicious, show anxious behaviors
  • Some tearfulness, depression, and some catastrophic reactions
  • Environment stimulates behavior
  • Resistance to care/help
  • ADL’s relatively intact…May need some supervision in…
    • Eating
    • Toileting (may be incontinent)
    • Bathing
    • Dressing
    • Grooming
  • Socially interacts best with alert individuals
  • May fear being alone
  • Experiences relocation trauma and/or may have negative reaction to changes in general

Level 2 – Middle Stage Dementia

In each area may exhibit one or more of the following:

Awareness - "Has Knowledge of only past and immediate present"
  • Gives up previous responsibilities
  • Unconcerned about whereabouts
  • No longer able to think abstractly
  • Lives in the past
Behaviors at this stage
  • Wandering (Uncertain where they are – may want to go home)
  • Searching for things/persons
  • May get started going somewhere and lost train of thought
  • Suspicious, anxious related to loss of recognition of loved one
  • Tearfulness, depression, and catastrophic outbursts; related to comprehension and communication deficits and inability to communicate pain and discomfort needs
  • Environment stimulates/prompts negative behaviors
  • Much resistance to caregiving and unfamiliar persons
  • ADL’s require simplification, increased time allowances and assistance
    • Eating
    • Toileting (incontinent)
    • Bathing
    • Dressing
    • Grooming
  • May enjoy holding soft items; i.e. stuffed items
  • May enjoy caring for a “baby doll”
  • Searches for social contact…May develop a “buddy” and spend most of the day with him/her. Nurtures Level III Stage persons and listens to Level I Stage persons

Level 3 – Late Stage Dementia

In each area may exhibit one or more of the following:

Awareness - "Limited to what is in field of vision"
  • Senses are heightened significantly…seeks immediate sensory gratification
  • May retain some over-learned skills from the past
Behaviors at this stage
  • Wandering Patter: Follows others…wants to go home
  • Fluctuating periods of hyper/hypo activity
  • Things go into mouth
  • Environment stimulates behavior
  • Doesn’t recognize loved ones
  • Catastrophic outbursts related to severe comprehension and communication deficits
  • Can’t communicate needs, pain, discomfort
  • ADL’s may require almost total care
    • Eating
    • Toileting (incontinent)
    • Bathing
    • Dressing
    • Grooming