Stages of Alzheimer's Disease: 7 Stage Model
Global Deterioration Scale for Assessment of Primary Degenerative Dementia
1) No Cognitive Decline
- No subjective complaints of memory loss.
- No memory deficit evident on clinical interview.
2) Very Mild Cognitive Decline (Forgetfulness)
- Subjective complaints of memory deficit, most frequently in the following areas:
- Forgetting where one has placed familiar objects
- Forgetting names one formerly knew well.
- No objective evidence of memory deficit on clinical interview.
- No objective deficits in employment or social situations.
- Appropriate concern with respect to symptomatology.
3) Mild Cognitive Decline (Early Confusional)
- Earliest clear-cut deficits. Manifestations in more than one of the following areas:
- Patient may have gotten lost when traveling to an unfamiliar location
- Co-workers become aware of patient's relatively poor performance
- Word and name finding deficit becomes evident to intimates
- Patient may read a passage or book and retain relatively little material
- Patient may demonstrate decreased facility in remembering names upon introduction to new people
- Patient may have lost or misplaced an object of value
- Concentration deficit may be evident in clinical testing
- Objective evidence of memory deficit obtained only with an intensive interview.
- Decreased performance in demanding employment and social settings.
- Denial begins to become manifest in patient.
- Mild to moderate anxiety accompanies symptoms.
4) Moderate Cognitive Decline (Late Confusional)
- Clear-cut deficit on careful
clinical interview. Deficit is manifest in the following areas:
- Decreased knowledge of current and recent events
- May exhibit some deficit in memory of one's personal history
- Concentration deficit elicited on serial subtractions
- Decreased ability to travel, handle finances, etc.
- Frequently no deficit in following areas:
- Orientation to time and person
- Recognition of familiar persons and faces
- Ability to travel to familiar locations
- Inability to perform complex tasks.
- Denial is the dominant defense mechanism.
- Flattening of affect and withdrawal from challenging situations occur.
5) Moderately Severe Cognitive Decline (Early Dementia)
- Patient can no longer survive without some assistance.
- Patient is unable, during interview, to recall a major relevant event of their current lives, e.g., an address or telephone number of many years, the names of the high school and/or college from which they graduated, or the names of close family members such as grandchildren.
- Frequently some disorientation to time (day of the week, season, etc.) or place.
- An educated person may have difficulty counting back from 40 by fours or from 20 by twos.
- A patient at this stage retains knowledge of many facts regarding themself and others. They invariably know their own name and generally know their spouse's and children's names.
- They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear.
6) Severe Cognitive Decline (Middle Dementia)
- May occasionally forget the name of the spouse upon whom they are entirely dependent for survival.
- Will be largely unaware of all recent events and experiences in their lives. May retain some knowledge of their past lives, but this is sketchy.
- Generally unaware of their surroundings: the year, the season, etc.
- May have difficulty counting from 10 both backwards and, sometimes, forward.
- Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will display ability to recognize familiar locations.
- Diurnal rhythm frequently disturbed.
- Almost always recalls their own name.
- Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment.
- Personality and emotional changes occur. These are widely variable and include:
- Interaction with nonexistant figures in the environment, or may talk to their own reflection in the mirror
- Obsessive symptoms, e.g., person may continually repeat simple cleaning activities
- Anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur
- Cognitive abulla i.e., loss of will power because an individual cannot carry through long enough to determine a purposeful course of activity.
7) Very Severe Cognitive Decline (Late Dementia)
- All verbal abilities are lost. Frequently there is no speech at all - only grunting.
- Incontinent, requires assistance toileting and feeding.
- Lose basic psychomotor skills, e.g. ability to walk. The brain appears to be no longer able to tell the body what to do.
- Generalized and cortical neurological signs and symptoms are frequently present.
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