What Are Signs That Dementia Is Getting Worse?

Watching someone you love live with dementia is heartbreaking. The gradual changes can feel unbearable, and recognising when the condition is progressing helps you prepare, adjust care plans, and ensure your loved one receives appropriate support at each stage.

Dementia doesn’t progress in a straight line. Some days will be better than others, and deterioration isn’t always obvious or dramatic. However, certain patterns and changes typically indicate the condition is advancing. Understanding these signs helps you make informed decisions about care whilst ensuring your loved one maintains the best possible quality of life.

Understanding Dementia Progression

Dementia is generally described in three stages—early, middle and late—though the boundaries between stages aren’t always clear. Each person’s experience is unique, and progression speed varies enormously depending on the type of dementia, overall health, and individual factors.

Some people remain in early-stage dementia for years, whilst others progress more rapidly. There’s no way to predict exactly how quickly someone’s dementia will advance, which makes recognising the signs of progression even more important.

The signs we’ll discuss here indicate movement from one stage to the next, or general worsening within a stage. Not everyone will experience all these changes, and the order may vary.

Memory and Cognitive Changes

Memory loss is often the first symptom families notice, but as dementia progresses, the nature of memory problems changes significantly.

Forgetting Close Family Members

In early dementia, someone might forget recent conversations or misplace items. As the condition worsens, they begin forgetting people. This typically follows a pattern: acquaintances first, then more distant relatives, then close family members.

When your mother no longer recognises you as her daughter, or mistakes you for someone from her past, this indicates significant progression. She may still recognise you as someone safe and familiar, even if she can’t recall exactly who you are.

Confusion About Time and Place

Disorientation worsens noticeably as dementia advances. Someone who previously knew what year it was but occasionally got confused about the day might now be unable to distinguish morning from evening, or become distressed because they think they’re in a completely different decade.

They may not recognise their own home, insisting they need to “go home” even when they’re sitting in the living room they’ve occupied for 40 years. This isn’t stubbornness—their brain genuinely doesn’t recognise the environment as familiar.

Losing Track of Conversations

If conversations that were once meandering but followable become impossible to track, this suggests progression. They might start a sentence and forget what they were saying mid-thought, or cycle through the same three sentences repeatedly without any awareness of the repetition.

Questions become more frequent and repetitive. Rather than asking “What day is it?” a few times, they might ask every five minutes for hours.

Difficulty with Familiar Tasks

Tasks they could manage with minor help—making tea, getting dressed, using the toilet—become impossible without significant assistance. Someone who could follow simple instructions now struggles to understand even basic requests.

Decision-making becomes severely impaired. Choices that would have taken a moment now cause distress and confusion, or they become unable to make decisions at all.

Changes in Daily Living Skills

Practical abilities decline as dementia progresses, and these changes are often more noticeable than cognitive symptoms.

Personal Care Difficulties

Needing help with washing, dressing and toileting represents a significant stage of progression. In early dementia, someone might need reminders. In middle stages, they need hands-on assistance. In late stages, they become entirely dependent on others.

Watch for:

• Wearing the same clothes for days without awareness they need changing
• Poor personal hygiene despite reminders
• Incontinence becoming more frequent or starting for the first time
• Resistance to bathing or changing clothes, possibly due to not understanding what’s being asked
• Inability to recognise when they need the toilet

Eating and Drinking Problems

Appetite changes and weight loss often signal progression. They might forget to eat, forget they’ve already eaten, or lose the ability to use cutlery properly.

More concerning signs include:

• Difficulty chewing or swallowing
• Refusing food without clear reason
• Forgetting how to eat (picking up food with hands when cutlery is provided, or staring at food without understanding what to do with it)
• Eating non-food items
• Significant unintentional weight loss

Mobility Issues

Physical abilities often decline alongside cognitive function. Someone who was steady on their feet becomes unsteady. Falls become more frequent. Eventually, walking without assistance becomes impossible.

Look for:

• Shuffling gait rather than normal walking
• Difficulty with stairs or uneven surfaces
• Getting up from sitting becomes laborious
• Increased falls, even in familiar environments
• Eventually, needing a wheelchair or becoming bedbound

Behavioural and Personality Changes

Dementia affects personality and behaviour in ways that can be distressing for families, and worsening behaviour often indicates progression.

Increased Agitation and Aggression

Someone who was occasionally irritable becomes frequently agitated. Verbal outbursts become more common. In some cases, physical aggression appears—hitting, pushing, or kicking carers, which is particularly difficult when they’re family members.

This isn’t malice—it’s fear, confusion and frustration manifesting as aggression. They may not recognise the person helping them and perceive care as an attack.

Sundowning Becomes More Severe

Sundowning—increased confusion, agitation and restlessness in late afternoon and evening—often worsens as dementia progresses. What started as mild evening confusion might become severe distress, pacing, shouting or trying to leave the house.

Hallucinations and Delusions

Seeing things that aren’t there, or developing fixed false beliefs, can occur in middle and late-stage dementia. They might see people in the room, have conversations with deceased relatives, or become convinced someone is stealing from them.

These experiences are very real to the person with dementia. Arguing doesn’t help—they genuinely perceive these things.

Loss of Inhibitions

Socially inappropriate behaviour may emerge or worsen: undressing in public, sexual behaviour that’s out of character, inappropriate comments, or childish behaviour.

This results from damage to the part of the brain that regulates social behaviour. The person isn’t choosing to behave this way—they’ve lost the ability to filter actions and thoughts.

Withdrawal and Apathy

Conversely, some people become increasingly withdrawn. Activities they once enjoyed no longer interest them. They sit passively rather than engaging. Initiating any activity becomes impossible—they need prompting for everything.

This profound apathy is dementia-related, not depression, though the two can coexist.

Communication Deterioration

Language abilities decline as dementia advances, making communication increasingly difficult.

Finding Words Becomes Harder

Early difficulties finding the right word progress to losing words entirely. They might say “the thing” instead of specific objects, or describe items (“the thing you drink from”) rather than naming them.

Eventually, vocabulary shrinks dramatically. Sentences become shorter, simpler, then fragment into isolated words.

Comprehension Declines

Not only do they struggle to express themselves, but understanding others becomes harder. Instructions need to be simpler and simpler. Complex sentences become incomprehensible. Eventually, even simple statements aren’t understood.

Speech Becomes Muddled or Stops

Speech might become garbled, mixing up words until sentences make no sense. In late-stage dementia, some people stop speaking entirely, communicating only through sounds, facial expressions or body language—if at all.

Sleep Disturbances

Sleep patterns often deteriorate significantly as dementia progresses.

Common changes include:

• Waking frequently during the night, often confused about where they are
• Day-night reversal: sleeping during the day, awake and active at night
• Wandering during the night, sometimes trying to leave the house
• Increased restlessness and agitation overnight
• Very early morning waking, sometimes convinced it’s time to go to work (even if they retired decades ago)

These disruptions are exhausting for family carers, particularly when the person with dementia needs supervision during wakeful periods.

Physical Health Decline

Dementia is ultimately a terminal condition, and physical health typically declines as it advances.

Increased Infections

Urinary tract infections, chest infections and other illnesses become more frequent. Someone with advanced dementia might develop recurrent UTIs due to incontinence and poor hygiene, or chest infections from difficulty swallowing.

Swallowing Difficulties

Dysphagia (difficulty swallowing) appears in later stages, creating serious risks. Food or drink might “go down the wrong way,” potentially causing aspiration pneumonia.

Signs include:

• Coughing or choking whilst eating or drinking
• Taking much longer to eat meals
• Refusing certain foods, possibly because they’re too difficult to swallow
• Recurrent chest infections
• Significant weight loss

General Physical Frailty

Overall physical condition deteriorates. They become weaker, more prone to illness, and slower to recover from any health issue. Skin becomes more fragile. Pressure sores might develop if mobility is severely limited.

Increased Care Needs

Perhaps the clearest sign that dementia is worsening is that your loved one simply needs more help with everything.

If you’re spending more time caring, if tasks that once took minutes now take an hour, if you’re exhausted from providing 24-hour supervision, if you’re helping with things they could manage six months ago—these all indicate progression.

There often comes a point when one person can no longer provide adequate care alone. This isn’t failure—it’s the reality of advancing dementia.

When Progression Happens Suddenly

Sometimes dementia seems to worsen suddenly rather than gradually. This might indicate:

A urinary tract infection. UTIs commonly cause dramatic, temporary cognitive decline in people with dementia. Treating the infection often restores them to their previous baseline, though not always completely.

Other infections or illnesses. Any physical illness can trigger what appears to be sudden dementia progression.

Medication changes. New medications or interactions between medicines can affect cognition.

A change in environment. Moving house, hospital admission, or even changes to daily routine can cause temporary worsening.

Dehydration. Insufficient fluid intake significantly impacts cognitive function.

If you notice sudden deterioration, always consult a GP to rule out treatable causes before assuming it’s dementia progression.

What to Do When You Notice These Signs

Recognising that dementia is worsening is difficult, but it’s important to act on what you’re seeing.

Talk to Healthcare Professionals

Your GP should be aware of changes so they can:

• Rule out other causes like infections
• Review medications
• Adjust care plans
• Provide referrals to specialist services
• Discuss advance care planning

Review the Care Plan

As needs change, care must adapt. This might mean:

• Increasing care hours at home
• Introducing specialist dementia care services
• Modifying the home environment for safety
• Considering assistive technology
• Reassessing whether home care is still manageable

Consider Future Needs

Late-stage dementia requires round-the-clock care from people trained in dementia support. Many families find that residential care becomes necessary, not because they want to “put someone in a home,” but because that’s where their loved one can receive appropriate care whilst family members can return to being family rather than exhausted carers.

Look After Yourself

Caring for someone with advancing dementia is physically and emotionally exhausting. You cannot pour from an empty cup. Accepting help isn’t selfish—it’s necessary.

When Home Care Is No Longer Enough

There’s often a moment when you realise that despite your best efforts, love isn’t enough to provide the level of care someone with advanced dementia needs.

Signs that residential care should be considered include:

• You’re providing care 24 hours a day with no meaningful breaks
• Your own health (physical or mental) is suffering significantly
• The person with dementia is at risk at home despite your efforts
• They need two people for personal care and you’re doing it alone
• Behaviour has become dangerous to them or others
• You’re no longer able to manage their complex care needs
• The person with dementia seems distressed or anxious despite all your efforts
• Your relationship has become solely about caregiving, with no positive interactions remaining

This isn’t giving up. It’s recognising that the best care for advanced dementia comes from trained professionals in an environment designed for that purpose.

What Quality Dementia Care Looks Like

When dementia reaches advanced stages, the right care environment becomes crucial. Specialist dementia care homes offer:

Trained staff who understand dementia behaviour, can spot signs of distress, and know how to provide comfort and reassurance.

Secure environments designed to prevent wandering whilst feeling comfortable and homely, not institutional.

Person-centred approaches that see the individual beyond the diagnosis and maintain dignity throughout.

24-hour care from teams who can manage complex needs including mobility assistance, personal care, feeding support and end-of-life care.

Support for families so you can visit as a loved one rather than an exhausted carer, often improving your relationship in the final months or years.

Activities and stimulation appropriate to the person’s abilities, providing meaningful engagement without frustration.

Finding the Right Support

Watching dementia progress is heartbreaking. Each new sign of decline feels like another loss. But ensuring your loved one receives appropriate care at each stage—and recognising when you need more help—is one of the most loving things you can do.

At Living Developments, we specialise in dementia care across all stages, with staff trained to recognise subtle changes and adapt care accordingly. Our small, family-run homes mean we know every resident personally and notice when things change.

The Millfield in Keswick features a dedicated 10-bed secure dementia unit designed specifically for people with moderate to advanced dementia. The Willows provides ground-floor boutique care with specially trained dementia staff in a calm, reassuring environment. Elmtree House in Newton-le-Willows offers intimate care where residents with dementia are treated as individuals, not just patients.

We understand that choosing residential care feels impossibly difficult. Many families tell us they wished they’d made the decision sooner—not because they didn’t love their relative, but because both they and their loved one would have benefited from professional support earlier.

If you’re noticing signs that dementia is worsening and wondering whether you can continue managing alone, we’d welcome the opportunity to talk. There’s no pressure—sometimes just discussing your situation with someone who understands makes everything feel more manageable.