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Greetings,
I use the 7-stage model for dementia, but keep in mind it is sometimes easier to gauge stages in hindsight rather than while you are in the arena. Sounds a bit like Stage 4 or even 5, which for me as a caregiver was the most difficult transition. Perhaps because at this time our loved one has progressed beyond the simpler "I forgot your birthday" stages.

For reference, here is a very simplified explanation of the 7-Stage Model for Alzheimer’s and Dementia.
Stage 1: All is well. No dementia.
Stage 2: You notice something is “off” with your loved one, but no one else does. Very mild cognitive decline. You may notice, but doctors, loved ones, and friends do not.
Stage 3: You know something is wrong, and others sense something is “off.” Mild cognitive decline. Loved ones begin to notice, decreased performance at work.
Stage 4: Everyone notices. You enter panic mode and begin seeking help from doctors. This is your transition from spouse to caregiver. Early-stage dementia, moderate cognitive decline. Difficulty socializing, concentrating, forgets recent events, trouble with finances. Day/date/time difficulties. Caregiver(s) becoming more involved in managing tasks for the patient.
Stage 5: Your loved one can no longer manage alone. Mid-stage dementia. Needs assistance with all activities of daily living. No short-term memory. Confusion and forgetfulness. Urinary incontinence may begin. Caregivers seek hands-on help. This is when caregivers seem to discover this forum, many of them already desperate and exhausted.
Stage 6: Speech makes no sense, personality and memories are completely gone. Mid-to-late-stage dementia. Does not know anyone’s name. Communication difficulties, both in speaking and understanding the spoken word, inappropriate behavior, may be agitated, wandering, no longer recalls personal history, address, or phone number. Double incontinent. Must be supervised and managed 24/7. Caregiver(s) require help now.
Stage 7: Can no longer walk unassisted, nor eat or drink without assistance. May be bedridden. Late-stage dementia: Difficulty eating and swallowing, angry outbursts, loss of speech. Must be supervised and managed 24/7. This is the final stage before death.

I hope you find this helpful, and I am sorry you are on this awful journey with us.
Love Bill2001

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Replies to "Greetings, I use the 7-stage model for dementia, but keep in mind it is sometimes easier..."

@bill2001
Hi definitely sounds like late stage 4. During the mid day she is rational and very functional but after a certain time at night and now in the morning it all goes to “ delusion and paranoia, toss in agitation and just plain nastiness.”
It’s been a good 6 years since the changes began. Although she is now past the age of when her mother passed from Alzheimer’s.

@bill2001 -thank you for this. I wish it were printable.

@bill2001
I think my husband is at stage 5 dementia. My question is--when would it be best to move him to a memory care facility rather than keeping him at home? He is "okay" much of the time. The worst time is overnight when he wakes up (and is still dreaming?)and takes off his clothes and now the bedsheets, etc. I would prefer him to be at home. We have 24-hr care given support.
I would prefer to keep him home if possible.

@bill2001
Hello!
Thank you for the description of the stages of cognitive decline. I would just like to point out that much like the stages of grief, the symptoms can move back and forth sort of like on a sliding scale I guess between stages. Sometimes I think my husband is at stage 3 but then he will exhibit symptoms of stage four also. It gets kind of confusing doesn't it? I think we are all kind of desperate to pinpoint what exactly is going on with our loved one, but sometimes there's a bit of a gray area too. Sometimes I just don't know what to do because I think maybe he's getting worse and then I think well we had a good day so maybe he's not. Feedback is always welcome! Thank you thank you

@bill2001 This is heartbreaking to read but very helpful. It shows your compassion and experience. Thank you for posting it. My own wife is Stage 4.