⚕️Care Handbook

Types & Stages of Dementia

Understanding the different types of dementia and how the condition progresses is fundamental to delivering person-centred care. Every person's experience of dementia is unique.

Key Statistics (UK)

944,000

People estimated to be living with dementia in the UK (Alzheimer's Society, 2023)

1 in 14

People over 65 have dementia; this rises to 1 in 3 over 95

70%+

Of care home residents have dementia or severe memory problems

Types of Dementia

Dementia is an umbrella term for a range of progressive conditions that affect the brain. Knowing the type of dementia helps you understand the person's symptoms, anticipate challenges, and tailor your care approach. Below are the most common types encountered in UK care homes.

Alzheimer's Disease

60-70% of all dementia cases

The most common type of dementia. Caused by abnormal protein deposits (amyloid plaques and tau tangles) that damage brain cells, leading to progressive memory loss and cognitive decline.

Common Symptoms:

  • Difficulty remembering recent events
  • Problems with language and word-finding
  • Disorientation in time and place
  • Poor or impaired judgement
  • Changes in mood and personality
  • Difficulty with familiar tasks
  • Misplacing items or putting them in unusual places

Vascular Dementia

15-20% of all dementia cases

Caused by reduced blood flow to the brain, often following a stroke or series of mini-strokes (TIAs). Symptoms may appear suddenly or progress in steps rather than gradually.

Common Symptoms:

  • Problems with planning and organisation
  • Slowed thinking speed
  • Difficulty with concentration and attention
  • Physical weakness or paralysis (on one side)
  • Problems with walking and balance
  • Mood changes, including depression
  • Urinary incontinence (in some cases)

Dementia with Lewy Bodies (DLB)

10-15% of all dementia cases

Caused by abnormal protein deposits (Lewy bodies) inside brain cells. Shares symptoms with both Alzheimer's and Parkinson's disease. Fluctuating cognition is a hallmark feature.

Common Symptoms:

  • Fluctuating attention and alertness (good days and bad days)
  • Visual hallucinations (often people or animals)
  • Parkinson's-type symptoms (tremor, stiffness, slow movement)
  • Sleep disturbances (REM sleep behaviour disorder)
  • Falls and fainting
  • Severe sensitivity to antipsychotic medication
  • Problems with spatial awareness

Frontotemporal Dementia (FTD)

5-10% of all dementia cases

Caused by damage to the frontal and temporal lobes of the brain. Often affects people at a younger age (45-65) than other dementias. Personality and behaviour changes are typically the first signs.

Common Symptoms:

  • Personality changes and inappropriate behaviour
  • Loss of social awareness and empathy
  • Difficulty with language (speaking or understanding)
  • Obsessive or repetitive behaviours
  • Changes in eating habits (cravings, overeating)
  • Lack of insight into own condition
  • Movement problems in some variants

Mixed Dementia

Up to 50% of dementia in people over 85 may involve mixed pathology

A combination of two or more types of dementia, most commonly Alzheimer's disease and vascular dementia. Mixed dementia is increasingly recognised and may be more common than previously thought, especially in people over 85.

Common Symptoms:

  • Combination of symptoms from the different types present
  • Memory problems (Alzheimer's component)
  • Step-like deterioration (vascular component)
  • May present with more complex symptom patterns
  • Progressive but with variable speed of decline

Stages of Dementia

Dementia is progressive, but the rate and pattern of decline varies greatly between individuals and between types. These stages provide a general framework — every person's journey is different.

1

Early / Mild

The person may still be largely independent but begins to experience noticeable difficulties. Symptoms may be subtle and attributed to normal ageing at first.

Key Features:

  • •Forgetfulness, especially recent events
  • •Difficulty finding the right words
  • •Losing track of conversations
  • •Difficulty managing finances or complex tasks
  • •Getting lost in familiar places occasionally
  • •Mood changes — anxiety, frustration, withdrawal

Care Focus:

  • Support independence and choice
  • Use memory aids (labels, reminders, calendars)
  • Encourage social engagement and routine
  • Involve the person in care planning (Mental Capacity Act)
  • Provide information in accessible formats
  • Signpost to support services (Alzheimer's Society, Age UK)
2

Middle / Moderate

Symptoms become more pronounced. The person needs increasing support with daily activities. Behavioural and psychological symptoms (BPSD) may emerge.

Key Features:

  • •Increasing confusion and disorientation
  • •Difficulty recognising familiar people
  • •Problems with personal care and dressing
  • •Behavioural changes — agitation, aggression, wandering
  • •Delusions or hallucinations may develop
  • •Sleep disturbance and sundowning
  • •Difficulty communicating needs

Care Focus:

  • Person-centred care — know the person's history and preferences
  • Simplify communication — short sentences, one idea at a time
  • Maintain a calm, consistent environment and routine
  • Use distraction and validation rather than confrontation
  • Assess and address unmet needs (pain, hunger, boredom)
  • Support with nutrition and hydration
  • Implement falls prevention measures
  • Complete ABC charts for distressed behaviour
3

Late / Severe

The person is highly dependent on others for all aspects of care. Communication may be very limited. Physical symptoms become more prominent.

Key Features:

  • •Very limited verbal communication
  • •Unable to recognise close family members
  • •Increasingly immobile — may become bedbound
  • •Difficulty swallowing (dysphagia)
  • •Incontinence
  • •Vulnerability to infections (especially chest and urinary)
  • •Weight loss and frailty

Care Focus:

  • Focus on comfort, dignity, and quality of life
  • Palliative care approach — symptom management
  • Pain assessment using appropriate tools (e.g., Abbey Pain Scale)
  • Support nutrition with texture-modified food and thickened fluids (IDDSI)
  • Regular repositioning for pressure area care
  • Maintain sensory connections — music, touch, scent
  • Support families and facilitate end of life conversations
  • Anticipatory care planning and DNACPR discussions

Important Considerations

  • •Person-centred approach: Always see the person first, not the dementia. Their life history, preferences, and personality remain central to who they are.
  • •Delirium vs. dementia:Delirium is a sudden-onset confusional state, often caused by infection, pain, or medication changes. It is a medical emergency and must always be ruled out when a person's condition changes rapidly.
  • •Mental Capacity Act 2005: Always assume a person has capacity unless assessed otherwise. Support people to make their own decisions wherever possible.
  • •Individual variation: No two people experience dementia the same way. Always tailor your approach to the individual.

Further Reading

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Important Notice

Care Handbook is a guidance resource only. It does not replace your organisation's policies, formal training, or current CQC standards. Always follow your employer's specific procedures and consult your line manager or the relevant professional body if you are unsure. The information here is based on current CQC frameworks and UK legislation but may not reflect the very latest updates. Always verify with cqc.org.uk and alzheimers.org.uk for the most current guidance.