Dementia Abilities Continuum

The Dementia Abilities Continuum can help families assess

where their loved one might be with their dementia and what
symptoms to expect. This continuum has three stages, which
are meant as a general guide and not as absolutes. At diͿerent
points in your loved one’s illness, he may vacillate between one
stage and another.

Mostly-Abled
,n this Àrst stage, your loved one most liNely will have
di΀culty with shortterm memory. ,t is common for her to
be aware of these memory challenges and try to cover them
up. It is not unusual for a person to become less aware of her
cognitive and physical decline. This in turn can make it more
di΀cult for her to accept help or to consider moving into a
facility. You might notice the following symptoms:
‡ More forgetfulness than usual. She might misplace items
more frequently, repeatedly ask the same question and not
remember what has been said to her.
‡ More confusion.
‡ More di΀culty with focusing.
‡ Struggling with tasks she was always able to accomplish,
such as failing to keep up with bank accounts, bills or taxes.
‡ Struggling with Ànding the correct word.
‡ Experiencing feelings of embarrassment or shame from not
remembering a familiar person’s name.
‡ Beginning to withdraw from social functions, especially
those in which she used to participate.
‡ Compensating for memory problems by trying to change the
topic or by answering a question in a more generalized way.

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 For example, if asked how long she has lived in her home,
instead of saying “30 years,” she might say, “for a long time.”
‡ Experiencing some paranoia, for example, accusing you or
others of taking her money or jewelry.

Less-Abled
During this second stage, your loved one’s long-term memory
will become more impaired and her cognitive skills become
more compromised. She may also begin to have some physical
issues with balance, walking, and perception. She may have
bladder incontinence. She may experience more confusion
with performing her “activities of daily living” or ADL’s,
such as bathing, dressing, grooming, and food preparation.
+er personal hygiene may suͿer, along with her ability to
stay properly nourished and maintain a clean and safe home
environment. Some examples include:
‡ Being increasingly forgetful and unaware that she is not
remembering, or asking the same questions over and over.
‡ Becoming more easily and more frequently confused. She
may forget how to use the remote control or even get lost
while driving to familiar places.
‡ Needing reminders to take a shower or change stained or
dirty clothes.
‡ +aving more di΀culty with her attention span and
following directions.
‡ Substituting the wrong word and jumbling her words in
sentences.
‡ Beginning to lose some of her long-term skills and
functioning. For example, she may not be able to remember
easy tasks, such as how to follow a recipe or how to Àx
things in the house.
‡ Forgetting family members’ names or details about her past.
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 ‡ +aving more di΀culty with sitting still.
‡ Needing more supervision around safety. For example, your
loved one might leave the stove on or have spoiled food in
the refrigerator. She might make impulsive decisions due
to an inability to think through the consequences, such as
letting a stranger in the house.

Un-abled
At this third stage, your loved one’s symptoms of dementia
are quite severe. She now requires complete help with her
ADLs and cannot function without continual supervision. The
following typically characterize this stage:
‡ Mainly communicates through body language.
‡ Not aware of time, place or person.
‡ Being incontinent of bladder and bowel.
‡ +aving more di΀culty with eating and swallowing.
‡ Having more health problems, such as frequent infections.
Urinary Tract Infections (UTIs) are particularly common
due to incontinence.
‡ Not being able to walk, either needing to be in a wheel chair
or recliner.
‡ Becoming bed-ridden.

In Summary
Understanding your loved one’s abilities and strengths
can help you identify more meaningful ways to be together.
Assessing which stage your loved one is in can help you know
what to expect, as well as help you engage most appropriately.
The next chapter will oͿer tips and ideas about how to spend
the best possible time with one another, regardless of the stage
of dementia.

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Learning to Observe
It is essential for care partners to learn to be good observers
and pay attention to their loved ones’ physical, cognitive,
and social well-being. The questions below can help you
determine their abilities.
As you work through these questions, I suggest that you
write down your answers. This will help you consider ways
to tailor your visit and interactions. Be mindful that over time,
your loved one’s abilities and capabilities will change and so
will your answers.

Physical Questions
What physical challenges does your loved one have that can
impact her ability to participate in activities and engagement?
– Does she have trouble hearing? Hearing abilities can
certainly inÁuence how well she will understand the
information shared.
– Is her eyesight impaired? If she has trouble seeing, she can
become more easily frightened or fearful, especially by
sudden movements.
– Does she have special dietary requirements, such as a soft
diet? This might mean planning ahead for outings that
include meals.
– Is she prone to wandering or pacing? If so she can be at risk
for getting lost or hurt.
– Does she have balance issues? Lack of balance can increase
her risk for falling.
– Is she incontinent of bowel or bladder? This can restrict
where you are able to take her.

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Cognitive Questions
There are many cognitive symptoms of dementia that can
impact engagement.
– Does he have short-term memory issues such as forgetting
appointments, forgetting what you just talked about, or
asking the same questions over and over?
– Can he follow conversations or understand verbal
information? Is he able to process the information?
– Does he exhibit long-term memory issues, such as not
remembering his family members, being unable to share
where he grew up, or forgetting what career he had?
– Does he remember to take his medications as prescribed?
Is he able to manage having medicines reÀlled in a timely
manner?
– How long is his attention span? Can he remember what he
has just read? Can he watch a movie or program through its
entirety? Does he become easily distracted?
– Does he exhibit confusion and disorientation such as
not knowing where he is, thinking he is still working, or
thinking it is nighttime when it is daytime?
– Does he have di΀culty with verbal expression? Does he mix
up words in sentences, call objects by the wrong names, or
struggle with expressing himself?
– Does he have some challenges with what are labeled as
executive functions? For example, does he have di΀culty
with judgement and reasoning? Does he make impulsive
decisions? Is he able to assess his safety?
– Does he have trouble performing familiar or routine tasks,
such as keeping track of Ànances, paying bills, working the
stove or microwave, or using the TV remote?

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Social Questions
Researchers have demonstrated the importance of social
interaction and engagement. Finding ways to keep your loved
one engaged and involved in activities can have numerous
positive eͿects. Here are some questions for your consideration
about your loved one’s social interactions.
– Is she still socially appropriate or has she lost her social
Àlters? Social Àlters keep people from touching people or
objects without permission, saying inappropriate things,
cursing or swearing, or taking oͿ their clothes in public.
– Is she able to initiate social activity? Often as someone loses
more cognitive capacity, it becomes more di΀cult to initiate
social activity.
– Is she able to function well in group activities? Does being in
small or large groups cause your loved one to become more
anxious or agitated?
– Does taking her out of her residential community or home
cause anxiety or agitation? For example, does she get anxious
in the days and hours leading up to a trip or outing? Is she
uncomfortable and restless in a new environment?

As you keep these answers in mind, the “Dementia Abilities

Continuum” is a tool that I created to help families understand
common patterns of dementia and the disease progression.