In the mild stages of dementia it is above all cognitive skills (especially short-term memory), incipient language deficits (e.g. anomia, repetition of words) and growing difficulties with organizational tasks that are symptomatic. These deficits in performance perceivable by the patient can lead to depressive episodes, particularly at the start of the disease. However, the person concerned is still generally able to live alone or independently and to maintain personal hygiene. Information from other sources provides useful support in assessing the patient.
In the moderate stages, the emphasis is clearly on the restriction of activities of everyday life. They necessitate increasingly intensive care for the patient who is now continually losing the ability to get dressed, eat or concentrate, for example, and can generally no longer perform everyday tasks at all, or not unaided. In the moderate stages of the disease, attempts at providing care are increasingly hampered by behavioral disorders such as aggression, restlessness, wandering around and failure to respond to environmental stimuli.
In the severe stages, full-time nursing care is needed as a result of the severe impairment of the ability to perform everyday activities (e.g. getting dressed, eating) and in cognitive functions. However, the progressive loss of the ability to speak and apparently insensitive or mute behavior (mutism) should not lead people to assume that patients are unable to perceive emotional signals. The severe stages are often also accompanied by urinary and fecal incontinence and neurological disorders such as myoclonus and parkinsonoid rigidity.