Middle-stage dementia — also called moderate dementia — can last for years, and it often brings new challenges for both the caregiver and the person living with the disease. Your loved one’s symptoms will likely be more noticeable, to the point where you may feel like you don’t recognize them anymore.

The demands involved with caring for someone with middle-stage dementia can be overwhelming to take on alone. You may question whether you can carry out these tasks while remaining resilient as your loved one’s care needs continue to increase. Try to remember it’s normal to feel these emotions  — and that your own physical and mental health shouldn’t be neglected.

Behavior changes

Changes in behavior are often the most challenging middle-stage dementia symptoms to handle. These changes can appear in the following ways:

Dementia patients often refuse assistance, and some may become aggressive or violent in certain situations. This type of behavior interferes with providing necessary care, contributes to caregiver burnout, and may indicate a need to introduce other care options. Although it’s hard not to take these behaviors personally, try to be mindful that these changes are part of dementia progression and aren’t a reflection of you personally.

Communication difficulties

Middle-stage dementia can make it difficult for your loved one to communicate and understand others. It can seem impossible at times to have a conversation with a dementia patient when communication issues begin, which can include:

These difficulties may lead to mutual frustration, isolation, and outbursts. Your loved one may experience an outburst when they’re trying to express a care need they can’t communicate. These outbursts can be scary and difficult, and it’s hard not to feel attacked or tempted to argue back. Try to identify the cause of the outburst, as it could be an indication of pain or a medical issue.

Changes in functional abilities

As dementia progresses into the middle stages, your loved one may experience a decline in functional abilities. This may be due to physical and mental changes. During this stage, they may begin to rely on you for more one-on-one care and help with activities of daily living (ADLs), such as eating and getting dressed.

Providing hands-on assistance with ADLs is time-consuming, personal, and can be uncomfortable for both patients and caregivers. Bathing and toileting/incontinence issues are two common reasons caregivers begin to seek tips and care options.

Not only can tasks such as those be physically demanding, but it can also be emotionally devastating to grapple with the fact that the same person you may have relied on as a child or infant now depends on you in the same ways.

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Does dementia come and go?

Dementia itself doesn’t go away, but many factors and symptoms influence whether a dementia patient has a “good” or “bad” day.

Changes in behavior and functional abilities are the most pronounced symptoms of middle-stage dementia. Caregivers often find themselves confused and frustrated by fluctuations in lucidity. These changes can point to serious underlying health problems that warrant medical attention, such as a urinary tract infection (UTI).

People living with middle-stage dementia may:

  • Experience even greater memory loss
  • Show increased poor judgment and confusion
  • Need help with daily activities
  • Exhibit changes in personality and behavior

Middle-stage dementia often seems like the longest stage for everyone involved, lasting from two to four years on average. Every dementia patient is unique, and there’s no given timeline for middle-stage dementia symptoms as the disease progresses. However, it’s certain that progressive dementias will cause impairments that require increasing care and supervision.

Keeping your loved one safe through middle-stage dementia

Safety issues are especially important to pay attention to in the middle stages of dementia. In general, people living with middle-stage dementia shouldn’t drive, as their symptoms can seriously affect their memory and decision-making skills.

Falls, sleep disturbances, and getting lost are just a few of the safety concerns at the top of caregivers’ minds. Trying to singlehandedly provide around-the-clock supervision can leave caregivers feeling drained and burned out. Making respite arrangements with in-home care or adult day centers can provide a short-term break from caregiving responsibilities.

Caregiver resources

Caregivers attribute a decline in their health to care responsibilities, according to the Centers for Disease Control and Prevention. The middle stages of dementia can be the most challenging for caregivers, and providing care will likely become more difficult as your loved one’s needs increase.

You may find yourself in need of extra support if your loved one has middle-stage dementia, and you’ll no doubt continue to need guidance and resources throughout the duration of your caregiver journey. Taking the following steps can help you avoid caregiver burnout while supporting your loved one’s evolving care needs.

  • Seek out and consider hiring at-home care support.
  • Arrange regular respite services, such as adult day programs.
  • Join a caregiver support group.
  • Maintain social connections and activities as much as possible to avoid isolation.
  • Improve home safety with modifications, such as grab bars.
  • Learn your loved one’s routines and schedule activities around them.
  • Break down daily activities into small steps.
  • Adapt activities to accommodate their abilities.

Your loved one’s care needs will increase as the disease progresses, so it’s important to plan accordingly. Even if some long-term care options like memory care aren’t the right fit at the moment, it’s a good idea to research alternate care options sooner rather than later.

Sources:
2021 Alzheimer’s disease facts and figures (https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12328)
Driving Safety and Alzheimer’s Disease  (https://www.nia.nih.gov/health/driving-safety-and-alzheimers-disease)
Progression – The middle stage (https://alzheimer.ca/sites/default/files/documents/Progression-middle-stage--Alzheimer-Society_0.pdf)
Supporting Caregivers (https://www.cdc.gov/aging/healthybrain/issue-maps/supporting-caregivers.html)
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia (https://www.fhca.org/members/qi/clinadmin/global.pdf)

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