Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The global deterioration
scale for the assessment of primary degenerative dementia. American Journal
of Psychiatry, 1982.
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decline - (or Normal Adult). No subjective complaints of memory deficit.
No memory deficit evident on clinical interviews.
- Level 2
- Very mild
cognitive decline (forgetfulness or normal older adult). Subjective
complaints of memory deficit, most frequently in the following area: (a)
forgetting where one has placed familiar objects; (b) forgetting names
on formerly knew well. No objective evidence of memory deficit on clinical
interview. No objective deficits in employment or social situations. Appropriate
concern regarding symptoms.
- Level 3
- Mild cognitive
decline (early confusional or Early AD). 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 low performance; (c) word and name
finding deficit becomes evident to intimates; (d) patient may read a passage
of 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. Denial begins to become
manifest in patient. Mild to moderate anxiety accompanies symptoms.
noticed in demanding employment situations.
- Level 4
cognitive decline (Late Confusional or Mild AD). 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 one's personal history; (c) concentration deficit
elicited on serial subtractions; (d) decreased ability to travel, handle
finances, etc. Frequently no deficit in the following areas: (a) orientation
to time and person; (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 withdrawl
from challenging situations occur.
- Level 5
severe cognitive decline (Early Dementia or moderate AD). 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 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.
- Level 6
cognitive decline (Middle Dementia or Moderately Severe AD). 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 display ability 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., paatients 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.
- 6a - Requires
- 6b - Requires
Assistance bathing properly
- 6c - Requires
Assistance with mechanics of toileting
- 6d - Urinary
- 6e - Fecal
- Level 7
- Very severe
cognitive decline (Late Dementia or Severe AD). All verbal abilities
are lost. Frequently there is no speech at all - only grunting. Incontinent
of urine, requires assistance toileting and feeding. Lose basic psychomotor
skills, e.g., ability to walk, sitting and head control. The brain appears
to no longer be able to tell the body what to do. Generalized and cortical
neurologic signs and symptoms are frequently present.
- 7a - Speech
ability limited to about a half-dozen intelligible words
- 7b - Intelligible
vocabulary limited to a single word
- 7c - Ambulatory
- 7d - Ability
to sit up lost
- 7e - Ability
to smile lost
- 7f - Ability
to hold up head lost
© 1984 by Barry Reisberg, M.D.
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