The short answer
- Seven stages, grouped into three bandsStages 1 to 3 are the early band, 4 and 5 the middle, 6 and 7 the late. The scale describes what a person can and cannot do, not how long anything takes. Some people stay in one stage for years and some show signs from two at once.
- Dementia is usually named at stage 4Stages 1 and 2 are ordinary memory and ordinary forgetfulness. Stage 3 is where the family notices and a GP can measure a change. Stage 4 is where money, travel and complicated tasks slip, and it is usually where the diagnosis comes.
- Do the paperwork at stage 3 or 4Lasting Power of Attorney for finances and for health while your parent can clearly decide for themselves, then Attendance Allowance once daily help is needed. Both get harder to arrange the longer they are left.
- Care grows from £15 an hour to £1,340 a weekCompany a few times a week in the early stages, daily visits with the same carer in the middle, then nights and usually live-in care in the late stages. All of it can be arranged at home, and the NHS or the council may pay for some of it.
Clinical descriptions follow the Alzheimer's Society and the NHS. Prices are what carers on PrimeCarers charge, with our fee included, September 2026. Your parent's GP or memory clinic is the place to ask which stage applies to them.
The seven stages
The seven stages, from ordinary memory to needing someone there all the time
Each stage below sets out what is usually still there, what has changed, what families tend to notice first, what a carer does at that point, the paperwork worth doing, and the signs that the next stage has started. Most families first look this up at stage 4, which is where a diagnosis is usually made.
Early stage: stages 1 to 3
Stage 1 of 7 · No cognitive decline
Nothing has changed
Early stage, about two years on average. Nobody moves through on a schedule.
Usually still there
- Remembers, plans, finds words and manages the house as they always have
- No difference a doctor or the family would pick up
What has changed
- Nothing. Everyone without dementia sits at stage 1 of the scale, which is why it is there
What families usually notice first
Nothing to notice. The scale starts here so that the later stages can be measured against ordinary memory.
What a carer does at this stage
There is nothing for a carer to do. If you are reading this because a parent has been given a diagnosis, they are not at this stage; the scale only starts to describe dementia at stage 3 or 4.
Paperwork for this stage
- This is the stage most of us are at, and it is the easiest time to set up a Lasting Power of Attorney for anyone in the family. Nobody needs a diagnosis to make one.
The care that fits
No paid care yet
Nothing to arrange
Signs the next stage has started
Occasional forgetfulness that a person notices in themselves before anyone else does.
Stage 2 of 7 · Very mild cognitive decline
Forgetful, in the way most older people are
Early stage, about two years on average. Nobody moves through on a schedule.
Usually still there
- Works, drives, shops, cooks and keeps appointments
- Holds a conversation and follows the news
- Manages money and medication without help
What has changed
- Forgets a name and it comes back later
- Misplaces glasses, keys or the remote more than they used to
- Notices it themselves, and may worry about it
What families usually notice first
Usually nothing. At this stage the changes are not obvious to family or to a GP, and they are also what ordinary ageing looks like. Stage 2 is not dementia and most people at stage 2 never develop it.
What a carer does at this stage
No carer is needed. What helps is a calm response if your parent raises it: worrying about memory is common, and a GP can rule out the things that mimic dementia, such as thyroid problems, low B12, depression and the side effects of some medicines.
Paperwork for this stage
- If your parent is worried, a GP appointment. A memory test at the surgery takes ten minutes and is the first step of any diagnosis.
- A Lasting Power of Attorney is still easy to make at this stage and gets harder later.
The care that fits
No paid care yet
Nothing to arrange
Signs the next stage has started
Other people start to notice: repeated questions, a lost word in the middle of a sentence, or getting muddled on a familiar journey.
Stage 3 of 7 · Mild cognitive decline
The family notices, and the GP can too
Early stage, about two years on average. Nobody moves through on a schedule.
Usually still there
- Lives independently and does most things for themselves
- Knows where they are, who people are and what day it is
- Manages washing, dressing and meals
What has changed
- Repeats questions and stories without realising
- Struggles to find the right word, and loses the thread of a plan
- Concentration slips: a recipe, a bill or a form takes several attempts
- Gets lost on a route they have driven for years
- Work, if they still work, starts to suffer
What families usually notice first
The repeated question is the thing families remember. A daughter is asked about the weekend three times in an hour. This is the point at which doctors can often measure a change, and it is where many diagnoses of mild cognitive impairment, and some of early dementia, are made.
What a carer does at this stage
Most families do not arrange paid care yet, and they do not need to. The useful things are a routine, a diary and reminders on the phone, and somebody keeping a gentle eye on the post and the bills. Where a parent lives alone and is becoming isolated, a companionship carer once or twice a week can keep them out and about and give you a second pair of eyes.
Paperwork for this stage
- Ask the GP for a referral to the memory clinic. A diagnosis opens doors: support, benefits and a named nurse in many areas.
- Lasting Power of Attorney, for finances and for health, while your parent can clearly decide for themselves. This is the single most useful piece of paper on this page.
- Talk about what they would want later, while it is still an ordinary conversation.
Signs the next stage has started
Difficulty with money and travel is usually the sign. Bills go unpaid or are paid twice, a familiar journey becomes frightening, and your parent starts to avoid things they used to enjoy.
Middle stage: stages 4 and 5
Stage 4 of 7 · Moderate cognitive decline
Money, travel and complicated tasks slip
Middle stage, two to four years on average, usually the longest. Nobody moves through on a schedule.
Usually still there
- Knows family and close friends
- Manages washing, dressing and the toilet
- Enjoys company, music, familiar places and old stories
What has changed
- Cannot manage finances: bills, the bank, the pension
- Cannot travel alone to somewhere new
- Forgets recent events, sometimes the whole of yesterday
- Withdraws from friends and groups, often to hide the difficulty
- May insist nothing is wrong
What families usually notice first
This is usually the stage at which the word dementia is first said out loud. Families tend to notice the bank letters, the missed appointments and the way a parent has stopped answering the phone to friends.
What a carer does at this stage
Company and a safety net, rather than personal care. A carer who comes at the same time on the same days can take your parent shopping, sit with them over lunch, keep the diary straight, watch that tablets are taken and notice what is changing between your visits. The aim at this stage is to keep life as it was for as long as it can be.
Paperwork for this stage
- Attendance Allowance, if your parent is over State Pension age. It is not means-tested and most people with a diagnosis who need daily help qualify.
- Lasting Power of Attorney now, if it has not been done. Capacity to sign one usually remains at this stage, but it will not always.
- A council tax discount for severe mental impairment once there is a diagnosis, and a word with the DVLA about driving.
- A dementia assistance card for their pocket or bag.
Signs the next stage has started
Needing prompting to wash or dress, confusion about the time of day or where they are, and the first difficult evenings.
Stage 5 of 7 · Moderately severe cognitive decline
Needs help with the day, and evenings get hard
Middle stage, two to four years on average, usually the longest. Nobody moves through on a schedule.
Usually still there
- Knows their own name and usually recognises husband, wife and children
- Eats and uses the toilet without help, most of the time
- Responds to a familiar face, a routine and a calm room
What has changed
- Cannot choose clothes for the weather, or manage a wash without prompting
- Forgets the address, the phone number and which year it is
- Confuses time and place; may not recognise their own house
- Sundowning: agitation, pacing and confusion as the light goes
- Asks the same question many times an hour
What families usually notice first
The house is where families see it. Clothes worn for days, food going off in the fridge, the heating on in July, and a parent who is frightened after dark. If one of you is doing the mornings and evenings yourself, this is the stage at which it stops being sustainable.
What a carer does at this stage
Daily visits from the same carer, built around a fixed routine: up, wash, dress, breakfast and medication at the same time each day, and an evening visit that draws the curtains before dusk and settles the house. A carer who knows your parent can head off agitation before it starts and redirect rather than argue. Many families add a sleeping night or two when the evenings become hard.
Paperwork for this stage
- A care needs assessment from the council. It is free whatever your savings, and if your parent qualifies the money can come as a direct payment to spend on a carer you choose.
- A carer’s assessment for whoever in the family is doing the caring.
- Check the Attendance Allowance rate: help through the night as well as the day moves it to the higher rate.
Signs the next stage has started
Needing help to use the toilet, accidents, disturbed nights and wandering, or a family carer who is no longer sleeping.
Late stage: stages 6 and 7
Stage 6 of 7 · Severe cognitive decline
Personal care, disturbed nights and a changed personality
Late stage, one to two years on average. Nobody moves through on a schedule.
Usually still there
- Responds to touch, music, a familiar voice and being spoken to kindly
- Often still recognises the people closest to them, if not always by name
- Can walk, with somebody there
What has changed
- Needs help to wash, dress and use the toilet; incontinence is usual
- Forgets the names of a husband, wife or child at times
- Sleeps badly, is up in the night and may wander
- Suspicion, anxiety, delusions and sometimes hallucinations
- Repeats an action over and over, and may become upset or aggressive when frightened
What families usually notice first
Nights. The family member sleeping in the spare room is woken two or three times, and by the end of a fortnight nobody is coping. The accusation that somebody has stolen the purse is common and painful, and it is the illness talking.
What a carer does at this stage
Visits through the day and cover at night, or a live-in carer, depending on the house and the budget. The work is now personal care, done with patience and a fixed routine, plus the watching that keeps somebody safe: doors, the cooker, medication, fluids and skin. Nights are the deciding factor. A waking-night carer means the family sleeps, and a live-in carer with dementia experience often costs less than three visits a day plus nights.
Paperwork for this stage
- Ask the GP or district nurse for an NHS Continuing Healthcare checklist. Where the need is as much health as daily living, the NHS can fund the whole package at home.
- Respite: a fortnight of live-in cover, or a few nights a week, so the family carer gets a proper break.
- Review the direct payment or council package; the hours agreed at stage 5 will not be enough now.
The care that fits
Visits through the day, and nights
nights from £130, waking nights from £150
Signs the next stage has started
Speech reduced to a few words, help needed with eating, and difficulty walking.
Stage 7 of 7 · Very severe cognitive decline
Needs someone there all the time
Late stage, one to two years on average. Nobody moves through on a schedule.
Usually still there
- Hears a familiar voice and feels a hand held
- Responds to music, warmth, taste and being comfortable
- Is still the same person, and still needs to be known
What has changed
- Speech reduced to a few words, or none
- Needs help with eating and drinking, and swallowing becomes difficult
- Loses the ability to walk, then to sit up without support
- More infections, particularly chest and urine, and more hospital visits
- Needs full help with all personal care
What families usually notice first
A care home is usually being suggested by now. Some families choose one. Many keep a parent at home with round-the-clock care, and both are reasonable decisions that depend on the house, the money and the people.
What a carer does at this stage
Round-the-clock care, usually a live-in carer with dementia experience, sometimes two in rotation, with a waking-night carer if nights are disturbed. The work is skilled and physical: hoisting, repositioning, mouth care, spotting an infection early, and keeping your parent comfortable and known. Nurses come in for what carers cannot do. If comfort becomes the main aim, palliative care at home is the same carers with a different emphasis, and the GP and district nurses alongside.
Paperwork for this stage
- A full NHS Continuing Healthcare assessment if the checklist has not already led to one, and a fast-track assessment if the need is urgent.
- A conversation with the GP about what your parent would have wanted, using the things they said earlier and any advance decision they made.
The care that fits
Live-in care with dementia experience
from £1,260 a week, typically £1,340
What comes next
There is no stage 8. The task at this stage is comfort, familiarity and being looked after by people who know them.
If your parent has just been diagnosed, please read stages 1 and 2 as what they describe: ordinary memory and ordinary forgetfulness. They are on the scale so that the later stages have something to be measured against. The scale starts to describe dementia at stage 3, and it is stage 4 where a doctor can usually be confident. Many people never move beyond the middle stages, and the different types of dementia progress differently, so treat the scale as a description of what can happen rather than a prediction of what will happen to your parent.
Seven stages or three
Why your GP says early, middle and late, and this page has seven
Both descriptions are of the same illness. The seven-stage scale was written in 1982 by Dr Barry Reisberg to give clinicians a common language for how far dementia has progressed. In the UK, the Alzheimer's Society, the NHS and most memory clinics use three bands instead, because three is easier to talk about and the boundaries between the seven are blurred in real life.
The seven stages against the three bands, and the care that usually fits
| Band, and how long it lasts on average | What the day looks like | Care that fits | |
|---|---|---|---|
| Stages 1 and 2 | Early. Not dementia: ordinary memory and the forgetfulness most older people have. | Independent. Forgets a name and it comes back; misplaces things more than before. | None. A GP visit if your parent is worried. |
| Stage 3 | Early. about two years on average for the band as a whole. | Independent, but the family notices repeated questions, lost words and a muddled familiar journey. | Company a few times a week if they live alone. The paperwork. |
| Stages 4 and 5 | Middle. two to four years on average, usually the longest. | Cannot manage money or travel alone at 4; needs prompting to wash and dress, and evenings are hard, at 5. | Companionship visits, then daily visits with the same carer, £15 to £25 an hour. |
| Stages 6 and 7 | Late. one to two years on average, and usually the shortest. | Full help with personal care, disturbed nights and a changed personality at 6; few words, help with eating and difficulty walking at 7. | Nights from £130, then live-in dementia care from £1,260 a week. |
Stages 1 and 2
- Band, and how long it lasts on average
- Early. Not dementia: ordinary memory and the forgetfulness most older people have.
- What the day looks like
- Independent. Forgets a name and it comes back; misplaces things more than before.
- Care that fits
- None. A GP visit if your parent is worried.
Stage 3
- Band, and how long it lasts on average
- Early. about two years on average for the band as a whole.
- What the day looks like
- Independent, but the family notices repeated questions, lost words and a muddled familiar journey.
- Care that fits
- Company a few times a week if they live alone. The paperwork.
Stages 4 and 5
- Band, and how long it lasts on average
- Middle. two to four years on average, usually the longest.
- What the day looks like
- Cannot manage money or travel alone at 4; needs prompting to wash and dress, and evenings are hard, at 5.
- Care that fits
- Companionship visits, then daily visits with the same carer, £15 to £25 an hour.
Stages 6 and 7
- Band, and how long it lasts on average
- Late. one to two years on average, and usually the shortest.
- What the day looks like
- Full help with personal care, disturbed nights and a changed personality at 6; few words, help with eating and difficulty walking at 7.
- Care that fits
- Nights from £130, then live-in dementia care from £1,260 a week.
Average lengths are the Alzheimer's Society's for each band. They are averages across a great many people, and the Society is careful to say that dementia does not follow the same steps in the same order for everyone.
The number that matters least on this page is the stage number. What a memory clinic is doing when it places your parent on the scale is describing the help they need today, and that is also what you need to arrange. Two people at stage 5 can have very different weeks: one still walks to the shop with a list, the other cannot be left in the evening. The stage number tells you which questions to ask. What your parent can and cannot do this week is what the care has to be built around.
How care grows
How care at home usually grows through the stages
Almost nobody starts with a live-in carer. Care at home tends to be added a piece at a time as the stages move on, and each piece can be arranged in a week or two. This is the order most families follow.
- 1
Company, and a second pair of eyes
Stages 3 and 4A companionship carer once or twice a week, at £15 to £20 an hour. They take your parent out, sit over lunch, keep the diary straight and notice what is changing between your visits. This is also the stage to do the paperwork and to get the memory clinic referral. - 2
Daily visits, the same carer, the same time
Stage 5An hour every morning to get up, washed, dressed and fed with the tablets taken, and often an evening visit to settle the house before dark. £18 to £25 an hour, typically about £20. A fixed routine with a familiar face does more for the middle stage than any other single thing. - 3
Nights
Stages 5 and 6When your parent is up in the night, or the family member sleeping in the spare room stops sleeping. A sleeping night from £130, a waking night from £150. Two or three nights a week is often enough to keep a family going. - 4
Live-in care with dementia experience
Stages 6 and 7One carer living in, from £1,260 a week and typically £1,340, sometimes two in rotation, with a waking-night carer if nights are disturbed. Past about 35 hours of visits a week live-in usually costs less, and it keeps the same person there through the day, which matters more with dementia than with any other condition. - 5
Nurses in for what carers cannot do
Stage 7District nurses, the GP and sometimes a specialist nurse come in alongside the carers for the clinical parts. If the main need has become health rather than daily living, NHS Continuing Healthcare can fund the whole package at home.
Paperwork by stage
The paperwork to do at each stage
Everything on this list is easier at an earlier stage than a later one, and two items become impossible once your parent can no longer decide for themselves. Tick off what is done and print the rest.
Have you done these?
0 of 14 ticked
Stages 2 and 3: while your parent can clearly decide for themselves
Stage 4: once there is a diagnosis
Stage 5: when daily help is needed
Stages 6 and 7: when the need becomes health as well as daily living
When a stage changes
Signs the next stage has started, and what to rule out first
Dementia usually moves slowly. A sudden change over a few days is more often something else, and most of those somethings can be treated. Check the right-hand list before deciding that your parent has moved on a stage.
Signs the arrangement needs to grow
- Help is needed with a task your parent managed last month: washing, dressing, choosing clothes, eating.
- Confusion about time and place at home, not only somewhere new.
- Nights are disturbed for more than a week or two, or your parent is up and wandering.
- A fall, a kitchen near-miss, or getting lost.
- Weight is dropping, or food in the fridge is going off.
- The family carer is not sleeping, or is doing personal care they did not sign up for.
Check these first, because they can look like a new stage
- A urine or chest infection. Sudden confusion in an older person is an infection until a doctor says otherwise.
- Delirium after a hospital stay or an operation, which can take weeks to clear.
- A new medicine, or a changed dose. Sleeping tablets and some painkillers are common culprits.
- Dehydration and not eating, which are easy to miss and quick to put right.
- Constipation, pain, or a tooth that hurts and cannot be described.
- Grief, a house move, or a change of carer. Familiarity is doing more work than you think.
What each stage costs
What care at home costs at each stage
Five weeks of care, from a couple of visits at stage 4 to a live-in carer at stage 7. All of these are what carers on PrimeCarers charge, with our fee included, and all can be reduced by Attendance Allowance, council funding or NHS Continuing Healthcare.
- Two visits a week£60–£80
- An hour every morning£126–£175
- Morning and evening, daily£252–£350
- Morning, evening and seven nights£1,162–£1,260
- Live-in dementia care£1,260–£1,340
Two-hour companionship visits at £15 to £20 an hour; hourly visits at £18 to £25; sleeping nights from £130; live-in dementia care from £1,260 a week and typically £1,340. Weekends carry no uplift; bank holidays are charged at one and a half times the carer's rate.
The figure that surprises families is the middle one: morning, evening and seven nights adds up to £1,162 to £1,260 a week, which is more than a live-in carer, for less cover. When nights come into it, live-in care is usually the cheaper way to get somebody there all the time, and it is the arrangement that keeps one familiar face through the day.
Questions
Questions families ask about the stages of dementia
They are the seven points on the Global Deterioration Scale: 1, no cognitive decline; 2, very mild decline, the ordinary forgetfulness of later life; 3, mild decline, where the family notices and a doctor can measure a change; 4, moderate decline, or mild dementia, where money, travel and complicated tasks slip; 5, moderately severe decline, or moderate dementia, where help is needed with the day; 6, severe decline, with full help needed for personal care and disturbed nights; and 7, very severe decline, where the person needs someone there all the time. Stages 1 and 2 are not dementia.
They describe the same thing at different levels of detail. Stages 1 to 3 are the early band, 4 and 5 the middle, 6 and 7 the late. The seven-stage scale was written for clinicians in 1982; the Alzheimer's Society, the NHS and most UK memory clinics use the three bands day to day because the lines between the seven are blurred in real life. How they line up.
There is no timetable, and anyone who gives you a firm number for your parent is guessing. The Alzheimer's Society gives averages for the bands: the early stage about two years, the middle stage two to four years and usually the longest, the late stage one to two years and usually the shortest. Some people stay in one stage for many years, and different types of dementia progress differently. Dementia life span looks at this in more detail.
Only a doctor can say. A GP or the memory clinic will use a memory test and what you tell them about the day, and they will more often describe the stage as early, middle or late. What you can do is write down what has changed over the last six months, particularly with money, washing and dressing, nights and getting lost, and take that list with you. The explorer above will help you put words to it.
Sundowning, the agitation and confusion that arrives in the late afternoon and evening, most often appears in the middle stage, around stages 5 and 6, and can continue into the late stage. A fixed evening routine, curtains drawn before dusk, lights on and something to occupy the hands prevents a good deal of it, and a carer who knows your parent can settle the rest. What is sundowning?
Most families arrange the first paid help in stage 4 or 5: a companionship carer a few times a week when a parent is isolated or the family cannot keep an eye on everything, then daily visits once washing, dressing and meals need prompting. Nights and live-in care usually come at stage 6. Arranging a little help early, with a carer who can grow into the role, is easier on everyone than a crisis at stage 6. How care grows.
There is no stage at which a care home becomes necessary. People at stage 7 are cared for at home with live-in and waking-night carers, and people at stage 5 move into a home because the family cannot manage. The decision depends on the house, the money, the people and what your parent said they wanted. At what point should someone with dementia go into care? sets out the questions, and care at home or a care home compares the two.
Someone there all the time. Usually a live-in carer with dementia experience, from £1,260 a week, sometimes two in rotation, with a waking-night carer if nights are disturbed. The work is hoisting, repositioning, help with eating and drinking, mouth and skin care, spotting an infection early, and keeping your parent comfortable and known. District nurses and the GP come in for the clinical parts. Where the need has become mainly health, NHS Continuing Healthcare can fund all of it. NHS Continuing Healthcare explained.
Dementia itself cannot be reversed, but a sudden step down often can be, because it is frequently an infection, a new medicine, dehydration or delirium after a hospital stay rather than the illness moving on. Treat those and your parent often comes back to where they were. Beyond that, routine, company, activity, good food and fluids, and the same familiar carer keep people at their best for longer at every stage. What to rule out first.