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.
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
- 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
- Severe 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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