Dementia Support Group

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language and problem solving, although particularly in the later stages of the condition, affected persons may be disoriented in time, place and person (not knowing who they are).

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The 7 Stages of Dementia

The 7 Stages of Dementia

Global Deterioration Scale

The Global Deterioration Scale (GDS), developed by Dr. Barry
Reisberg, provides caregivers an overview of the stages of cognitive
function for those suffering from a primary degenerative dementia
such as Alzheimer's disease. It is broken down into 7 different
stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the
dementia stages. Beginning in stage 5, an individual can no longer
survive without assistance. Within the GDS, each stage is numbered (1-
7), given a short title (i.e., Forgetfulness, Early Confusional, etc
followed by a brief listing of the characteristics for that stage.
Caregivers can get a rough idea of where an individual is at in the
disease process by observing that individual's behavioral
characteristics and comparing them to the GDS. (From geriatric-
resources)
_____________________________

The Global Deterioration Scale for Assessment of Primary Degenerative
Dementia

Level 1 NO COGNATIVE DECLINE: No subjective complaints of memory
deficit. No memory deficit evident on clinical interview.

Level 2 VERY MILD COGNATIVE DECLINE (Age Associated Memory
Impairment):
Subjective complaints of memory deficit, most frequently in following
areas: (a) forgetting where one has placed familiar objects; (b)
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.

Level 3 MILD COGNATIVE DECLINE (Mild Cognitive Impairment):
Earliest clear-cut deficits. Manifestations in more than one of the
following areas: (a) patient may have gotten lost when traveling to
an unfamiliar location; (b) co-workers become aware of patient's
relatively poor performance; (c) word and name finding deficit
becomes evident to intimates; (d) patient may read a passage or a
book and retain relatively little material; (e) patient may
demonstrate decreased facility in remembering names upon introduction
to new people; (f) patient may have lost or misplaced an object of
value; (g) concentration deficit may be evident on 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.

Level 4 MODERATE COGNITIVE DECLINE (Mild Dementia):
Clear-cut deficit on careful clinical interview. Deficit manifest in
following areas: (a) decreased knowledge of current and recent
events; (b) may exhibit some deficit in memory of ones personal
history; (c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc. Frequently no
deficit in following areas: (a) orientation to time and place; (b)
recognition of familiar persons and faces; (c) ability to travel to
familiar locations. Inability to perform complex tasks. Denial is
dominant defense mechanism. Flattening of affect and withdrawal from
challenging situations frequently occur.

Level 5 MODERATELY SEVERE COGNITIVE DECLINE (Moderate Dementia):
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years,
the names of close family members (such as grandchildren), the name
of the high school or college from which they graduated. Frequently
some disorientation to time (date, day of week, season, etc.) or to
place. An educated person may have difficulty counting back from 40
by 4s or from 20 by 2s. Persons at this stage retain knowledge of
many major facts regarding themselves and others. They invariably
know their own names and generally know their spouses' and children's
names. They require no assistance with toileting and eating, but may
have some difficulty choosing the proper clothing to wear.

Level 6 - SEVERE COGNITIVE DECLINE (Moderately Severe 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. Retain some knowledge
of their past lives but this is very sketchy. Generally unaware of
their surroundings, the year, the season, etc. May have difficulty
counting from 10, both backward and, sometimes, forward. Will require
some assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will be
able to travel to familiar locations. Diurnal rhythm frequently
disturbed. Almost always recall their own name. Frequently continue
to be able to distinguish familiar from unfamiliar persons in their
environment. Personality and emotional changes occur. These are quite
variable and include: (a) delusional behavior, e.g., patients may
accuse their spouse of being an impostor, may talk to imaginary
figures in the environment, or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple
cleaning activities; (c) anxiety symptoms, agitation, and even
previously nonexistent violent behavior may occur; (d) cognitive
abulla, i.e., loss of willpower because an individual cannot carry a
thought long enough to determine a purposeful course of action.

Level 7 - VERY SEVERE COGNITIVE DECLINE (Severe Dementia):
All verbal abilities are lost over the course of this stage.
Frequently there is no speech at all -only unintelligible utterances
and rare emergence of seemingly forgotten words and phrases.
Incontinent of urine, requires assistance toileting and feeding.
Basic psychomotor skills, e.g., ability to walk, are lost with the
progression of this stage. The brain appears to no longer be able to
tell the body what to do. Generalized rigidity and developmental
neurologic reflexes are frequently present.
__________________

The alzheimers association now has a plain English version of the
seven stages, available at http://www.alz.org/AboutAD/Stages.asp

From Act mental health consultants--
A simplified version of 7 stages. Seems to describe the problems and
care requirements seen in the nursing home. Very understandable. Also
gives range of time duration for each stage.
http://www.actmentalhealth.com/News%202000,%2011-12.htm
__________________

By the way, most doctors do not bother trying to determine the stage
the person is in - except that they might indicate mild, moderate or
severe. The doctors are more interested in treating the individual
patient and the problems he/she is having at the time of the visit.
They find no value in staging the dementia patient.
Caregivers tend to want the staging system to get an idea of where
their LO is in the process and what lies ahead.
-----------------------------------------

A simplified checklist version of the seven stages is the Functional
Assessment Staging Test (FAST). Note that stages 6 and 7 are broken
down into smaller steps.

1 No difficulties, either subjectively or objectively
2 Complains of forgetting location of objects; subjective word
finding difficulties only.
3 Decreased job functioning evident to coworkers; difficulty in
traveling to new locations.
4 Decreased ability to perform complex tasks (e.g., planning dinner
for guests; handling finances; marketing).
5 Requires assistance in choosing proper clothing for the season or
occasion.

6a Difficulty putting clothing on properly without assistance.
6b Unable to bathe properly; may develop fear of bathing. Will
usually require assistance
adjusting bath water temperature.
6c Inability to handle mechanics of toileting (i.e., forgets to
flush; doesn't wipe properly).
6d Urinary incontinence, occasional or more frequent.
6e Fecal incontinence, occasional or more frequent.

7a Ability to speak limited to about half a dozen words in an average
day.
7b Intelligible vocabulary limited to a single word in an average
day.
7c Nonambulatory (unable to walk without assistance).
7d Unable to sit up independently.
7e Unable to smile.
7f Unable to hold head up.

Comment on the FAST by dementia expert Geri Hall

"You look for the stage which is the highest number where your person
has symptoms because the losses are cumulative. If a patient is in
stage 3, I expect them to have some issues with money, working,
driving, shopping, short-term memory, time sense, etc -- In stage 4 I
see issues with driving, shopping, cooking, cleaning, doing chores,
participating in higher level activities and social affairs. But the
person brings the deficits from stage 3 with them into stage 4. The
deficits don't resolve.

And, there are those of us who work with these patients day to day
who strongly disagree with several points on the FAST Scale. The one
major issue is bathing. Problems with bathing are the hallmark of the
beginnings of stage 5.

G Hall recaps the seven stages ---
Problems with driving, managing money, and shopping = stage 3. If you
notice she can't cook, clean, or do the laundry = stage 4. If she
requires help (or strong encouragement to bathe, clean her teeth, or
select different clothing each day = stage 5. If she has trouble with
falling or bowel and bladder control and/or falling, she is in stage
6. If she can no longer walk, stage 7. The losses are cumulative and
not every patient has exactly the same losses.

Replies

deleted_user
deleted_user

Thanks so much for posting this it has been very helpful to us my mom is at the stage where she can no longer live alone and now we will know what to expect to come with her. mb.
deleted_user
deleted_user

Thank you for the list and the links.

I'm going to make one objection to something you said. My husband is certainly stage 5, but has no problems with bathing or other grooming issues. The Alzheimer's Association puts that at stage 6 for a reason. That is where it belongs. If there are bathing issues, that is the beginning of stage 6.
deleted_user
deleted_user

Thank you for this. I have had my grandmother here for about a month and quickly became aware of sundowners and the intense denial. However, until yesterday, I didn't fully realize how impaired she is.

She is between stage 6 and 7 but with blindness and being wheelchair bound, I may as well consider it stage 7.

Bless you for posting this!!!
deleted_user
deleted_user

Now you can describe the situation rationally to her doctors. You might want to ask about Hospice as well if she is that far along. I've read that these days Hospice wants to see dementia patients earlier than other kinds of patients.

Even if it is too early for them to help you, they might be willing to do an assessment.
deleted_user
deleted_user

what a great help. I think my mom is between 4 and 5 but no bathroom issues yet. This really is a help. God bless
deleted_user
deleted_user

Please help me understand. I am assisting my mother and father with her various conditions, which appear to include a form of dementia. I'm just now learning about dementia, and wonder about 'primary degenerative dementia
such as Alzheimer's disease,' mentioned above. Does the scientific/medical community understand these conditions? How can I reliably learn more?

Thanks
deleted_user
deleted_user

ellenag, go to the Alzheimer's Society web page. They advertise here a lot, and that is how I found them. They have loads of free information including a free book that made what was going to happen brutally clear. And in this case brutally is a good thing. It gets you past the denial.

Dementia is a group of diseases. They can't really diagnose Alzheimer's until after death. Some of the others show up on Cat Scans and MRIs. It doesn't matter. They look at the symptoms of the various stages and go from there.

There is a much more complete list of these stages at the Alzheimer's Society web page. What I did was read down the list until I came to the stage my husband was most likely in and checked off each of the symptoms. He had none of the symptoms of the following stage.

A patient will have symptoms from all of the earlier stages, but none of the later stages when you figure out which stage it really is.
deleted_user
deleted_user

This was great info I had read some of it before and now I am sure that my mom is closer to stage 7 than I thought. All the other paterns fall into place she is now waslking veryslow and does have trouble getting up and down I do the bathng and cutting her food so she doesn't put so much in her mouth she is having trouble taking her meds and the wandering about because she has no clue where she is going the bathroomseems to be the easiset to say for her even though she has just gone but it is a place she remembers. I am placing her in a nursing home because it is taking its toll I feel like a failure but the time is right for her she needs more than I can possibly give her and it is killing me - yes I now she will be close and I can see her all the time but it isn't the same as the everyday routine. I will go back to work I can't sit here and not see mom. This is very helpfulto those that are just begining the process and each person is different may touch on some butnot the others but in the whole of the matter you can rally understand the stages thanky you for writing this
Carol
Thriver
Thriver

Thank you for posting this. I will pass it on to my family members who aren't able to admit that my mom is experiencing dementia.
deleted_user
deleted_user

Wow, this is great. My mom is on either step 5 or 6 right now. This was very helpful.
deleted_user
deleted_user

I am so glad that this is helping others. I know it was a real blessing to me when I read it. My husband is in stage 5, although since Friday he seems to be getting worse. I will keep each of you in my prayers. Hugs & Blessings
deleted_user
deleted_user

Thank you for listing the categories and information. I still can't figure out which stage each of my parents are in, but this is great reference information, and I know more about what to expect. It is really frightening and I really am afraid of what the future will bring them, but I know I must be strong.
zzzjoy
zzzjoy

I hadn't seen this info before. I'm not much of a "researcher", but I found it very helpful and thought by writing a reply it would bring it to the attention of others who might find it useful. Lord knows, we need all the help we can get! Joy
deleted_user
deleted_user

OMG I have been looking for something in laymens terms..It all makes sense...

Thank You
tattyhead184
tattyhead184

My Mum's at stage 3 or 4 at the moment I think. Her memory's down to a couple of minutes, she slurs on words every now and then and we have the same conversations every day now.
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