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The Four Stages of Cognitive Functioning
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The Four Stages of Cognitive Functioning

As a general term, cognitive impairment, or CI, refers to difficulty with memory, understanding, and other critical functions. These troubles will generally be a result of underlying disorders related to aging, but aren’t a normal or expected part of aging itself. In other words, plenty of people grow old without experiencing any cognitive impairment at all.

Those who do experience CI need care and support to help them live happy, engaged lives. An important part of determining the right level of care is knowing each person’s cognitive state. At Town Square Princeton, our unique, therapeutic, and community-based approach to senior day care benefits seniors at all levels of cognitive ability and their families. Contact us to learn more or read on to find out about the degrees of cognitive functioning.

Stage 1 – No Cognitive Impairment (NCI)

No cognitive impairment refers to normal cognitive functioning — an ordinary capacity for problem-solving, information recall, and short and long-term memory. People may find themselves slowing down, having trouble multitasking, or becoming more forgetful as they get older, but this is not the same thing as cognitive impairment, nor is it an indicator that they are at risk for a cognitive disorder. However, while “no cognitive impairment” might mean an individual has a healthy brain, there is also still the possibility they have underlying health problems that are asymptomatic at this time.


The first stage at which cognitive impairment can be noticed is referred to as subjective cognitive impairment, or SCI. Even the mildest levels of true cognitive impairment are beyond the effects of normal aging: They inherently indicate a medical disorder. People with a subjective level of cognitive disability may forget more and more things and struggle with day-to-day tasks, but may still have full levels of ability in other areas of their lives. For example, someone might begin forgetting meals but still be able to manage their finances. In Alzheimer’s disease and other dementias, this phase may last for up to 15 years.

Stage 3 – Mild Cognitive Impairment (MCI)

Mild cognitive impairment, or MCI, is sometimes used as its own medical diagnosis, distinct from a diagnosis of dementia. People with mild cognitive impairment tend to have difficulties in more areas of their life than people with subjective cognitive impairment. They might be sometimes unable to learn and use new information, remember some events, and follow instructions. However, this level is still milder than dementia, and people with mild cognitive impairment can live normally with the right support.

Some people will have this diagnosis without ever progressing to dementia, some might remain at this level for up to 7 years before being diagnosed with dementia, and some may have these symptoms as a result of a curable physical condition called normal pressure hydrocephalus. Only a medical diagnosis from a doctor specializing in dementia can tell the actual causes and status of a cognitive impairment.

Stage 4 – Dementia

Dementia is the most severe form of cognitive impairment. Individuals with dementia may experience all of the difficulties associated with MCI, but in a more serious manner. This can result in even basic daily tasks becoming impossible. Changes in personality and physical complications like reduced mobility and risk of falling may also be seen.

How Town Square Benefits Seniors at All Levels of Cognitive Function

Town Square’s innovative programs have something to offer seniors who have no cognitive health issues, those who may have a milder form of cognitive impairment, and those living with dementia alike. People who are cognitively healthy can still benefit psychologically and socially from guided reminiscence – practices like these can help all of us internalize the lessons of our past and find closure in many ways. And anyone can enjoy days of laughter, learning, and connection with us.

Those with a mild level of cognitive impairment can find Town Square’s programming especially helpful. Town Square helps people experiencing this degree of cognitive symptoms maintain a higher level of cognitive and memory function for as long as possible through engagement and enrichment.

At Town Square, our reminiscence-focused adult day programming allows the compassionate and highly trained dementia professionals to deliver the best possible care, all while offering our members a fun and engaging experience filled with friendship, creativity, socialization, and memories.

Reach out to us at Town Square Princeton and we can help you schedule a tour of our location for you and your loved one, to help you better understand how we benefit our members and their families every single day.