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Deterioration Scale for Dementia and Related Disorders

If you are a caretaker for someone with dementia or have a loved one who is going through the early stages of dementia, it is important that you learn to recognize the stages of mental deterioration that accompanies Alzheimer’s. Though it can be heartbreaking to watch someone you love suffer from dementia, you will feel much better knowing that you are carefully monitoring your loved one’s condition and getting him or her help when the time comes.

Below, we have listed the commonly recognized stages of mental decline. At Stage 5, a person can no longer survive without assistance. Make sure you stay in contact with your loved one’s physician so that they can help you make plans for long-term care when it is necessary.

STAGE 1: No Cognitive Decline

  • No demonstrated memory deficits
  • No subjective cases of memory deficit
  • Functions independently

STAGE 2: Forgetfulness (Very Mild Cognitive Decline)

  • Patient complains of memory loss, especially forgetting where objects were placed or familiar names
  • No memory loss evidenced during interview
  • No problems completing tasks or at social functions

STAGE 3: Early Confusion (with Mild Cognitive Decline)

  • Memory loss is evident on testing
  • Decreased ability to remember names of new people
  • Family members are aware of memory problems
  • Associated concern or denial by patient

STAGE 4: Early Confusion (with Moderate Cognitive Decline)

  • Decreased knowledge of current and recent events
  • Memory deficits regarding personal history
  • Decreased ability to concentrate on serial subtractions
  • Remains oriented to time and place
  • Trouble concentrating on a task
  • Denial is a prominent defense mechanism

STAGE 5: Early Dementia (Moderately Severe Cognitive Decline)

  • Unable to recall major events of current life
  • Disoriented to time and place
  • Needs assistance in choosing clothing
  • Occasionally dresses improperly
  • Feeds and toilets independently
  • Wanders, looking for a way out
  • Tearfulness
  • Some resistance to care giving
  • Sleep disturbance

STAGE 6: Middle Dementia (Severe Cognitive Decline)

  • Unable to recall most recent events
  • Repetitiveness
  • Removes or will not wear clothing appropriately
  • Refuses to change clothing
  • Bathing problems
  • Feeds self with set-up, cues or assistance
  • Sleep/wake cycle disturbances
  • Catastrophic reactions
  • Great resistance to care giving
  • Purposeless wandering
  • Cannot complete two-step commands

STAGE 7: Late Dementia (Very Severe Cognitive Decline)

  • Speaks only one word in an average day
  • No verbalization
  • Unable to smile
  • Cannot feed self
  • Cannot complete simple tasks
  • Unable to sit up independently
  • Cannot walk without assistance
  • Unable to hold head up

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