Dementia: Stages, Scales and Progression Models

Dementia experts break down various stages of dementia into anywhere from 3 to 7 phases. Each category is separated according to the level of severity and typical characteristics portrayed. The number of stages varies depending on how the 3 main categories (mild, moderate and severe) are broken down into subcategories.

No matter how the stages are broken down, they all basically equal to the same amount of information. Because people absorb and retain information differently, you may find that one expert explanation is easier to grasp over another. One of my favorite comprehensive dementia breakdowns comes from one of America’s leading educators on dementia, Teepa Snow. Teepa’s enlightening, witty and positive approach to dementia care has made her wildly popular in the healthcare industry.

Below are 3 popular dementia models created by experts and researchers.

Stages and Progression 

The Alzheimer’s Scale

  1. Mild – This is the early stage. Individual may have difficulties but can usually function independently.
  2. Moderate – Typically the longest stage and can last many years. As progression takes place you may see changes in personality, physical function, and mental ability. Assistance is necessary for safety, hygiene and other types of daily care.
  3. Severe/Late – Final stage of a disease. Communication is difficult and extensive care is likely needed.

Teepa Snow’s GEM™ Model

This model is divided into 6 categories using gemstones to symbolize each stage focusing on remaining abilities rather than capacity losses.

  • Sapphires“True blue, optimal cognition, healthy brain.”
  • Diamonds“Clear and Sharp, routines and rituals rule.”
  • Emeralds“Green and on the go with a purpose. Naturally flawed like an emerald.”
  • Aber“Like a particle trapped in an amber, I’m caught in a moment in time. Caution required.”
  • Rubies“Details are masked by my deep and strong in color, others stop seeing what is possible. Although my abilities are limited, you may hear me sing, hum and mimic motions.”
  • Pearls“Hidden within a shell, beautiful moments to behold. Comfort and connect with me, I may recognize a familiar touch, smell, face or voice from time to time.”

Global Deterioration Scale (GDS)

  • No impairment-For scale reference, doctors mark the first stage as a healthy brain with no impairment at all.
  • Very mild-Very mild cognitive decline, age-associated memory impairment. It is common to have difficulty with such things such as remembering names or misplacing items.
  • Mild cognitive impairment (MCI) – Earliest clear-cut deficits of cognitive decline. Remembering everyday things is a challenge.
  • Moderate – Deficit becomes more serious and shows on careful clinical interview. Dementia may manifest in ways such as changes in memory, concentration, recognition and orientation. Denial is common at this level.
  • Moderately severe – Person cannot live without a greater level of assistance. At this stage, most individuals live in a memory care facility with 24 hr. specialized care.
  • Severe – Person is generally unaware of surroundings. Assistance is required with ADLs. Personality and emotional changes are noticeable. Person can only carry a thought for a short period of time.
  • Very severe – This is the end of life stage. All verbal abilities are lost and the brain appears to be unable to tell the body what to do.

Each individual is affected differently by Alzheimer’s and other types of dementia. Talk to a doctor for detailed information on stages and progressions as they relate to your loved one.


By: Kristin Angulo