Dementia & Alzheimer's Disease
The framework for Dementia and Azheimer's Disease Strages was compiled from the American Speech and Hearing Association (ASHA), the Global Deterioration Scale, and The Fisher Center for Alzheimer's Research Foundation.
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There are several scales used to stage an individual's level of dementia. These include: the Global Deterioration Scale (GDS), Functional Assessment Staging Test (FAST), Clinical Dementia Rating (CDR). You can find more information about each of these scales here.
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Dementia is an umbrella term describing a group of symptoms that negatively affects memory that is caused by diseases or other brain conditions like: Parkinson's Disease, Vascular Dementia, Lewy Body Dementia, alcohol addiction, brain tumors, drug addiction, Huntington's Disease, etc. Alzheimer's Disease is one of the diseases that falls within the Dementia umbrella and is the most common cause of Dementia.
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"No Cognitive Decline" Stage 1 GDS.
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No difficulty with memory, reasoning, and planning skills.
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Appears to be functioning normally.
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"Very Mild Cognitive Decline" Stage 2 GDS.
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Normal Aged Forgetfulness.
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Complaints of mild forgetfulness.
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No evidence of forgetfulness during interview or conversations.
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No evidence of forgetfulness at work or with in social contexts.
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Individual responds appropriately to their minor forgetfulness.
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Normal word finding difficulty.
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Frequently misplaced items.
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"Mild Cognitive Decline" Stage 3 GDS.
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This stage may last around 2 to 7 years.
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This is when the individual's forgetfulness becomes subtlety more apparent to those closes to them.
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The individual will demonstrate difficulty with concentration.
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The individual may have trouble remembering the names of people they recently met.
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Difficulty recalling detailed information from print.
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Job performance may start to decline.
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Individuals at Stage 3 may now have trouble with complex tasks and activities like:
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organizing events
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traveling to unfamiliar places
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high intensity and demanding occupations
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Difficulty completing tasks efficiently and accurately
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Trouble multi-tasking.
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Word-finding difficulty.
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Denial of challenges.
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"Moderate Cognitive Decline" Stage 4 GDS.
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This stage may last around 2 years.
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Accurate diagnosis of Alzheimer's Disease at this stage.
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Decreased ability to complete complex daily activities such as:
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paying bills​
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cooking
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writing checks
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grocery shopping
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Trouble remembering the date.
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Difficulty recalling details of recent and major events.
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Difficulty recalling personal history.
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Substantial trouble with traveling alone.
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May not recognize unfamiliar people.
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Individual may be in denial of these cognitive changes although they are aware of them. ​
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Individual may withdraw or isolate themselves from social situations to avoid revealing these deficits.​
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"Moderately Severe Cognitive Decline" Stage 5 GDS.
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This stage may last around 1 to 2 years.
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Requires assistance and supervision.
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Challenges with judgement such as:
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selecting the appropriate clothing for the weather​
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paying bills on time
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planning a grocery trip when they need to restock food items
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Cannot remember major events.
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Difficulty with orientation​​. Cannot recall or inconsistently recalls things like:​​
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current president​
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address
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date
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season/weather
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Knows their own name and those of their close friends and family.
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Individuals may exhibit increased anger and suspicion.
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Cannot be left alone because the individual is at risk for Elopement (leaving).
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"Severe Cognitive Decline" Stage 6 GDS.
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This stage may last 2 to 3 years.
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May forget names of family members or confuse family members.
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Trouble dressing themselves and completing daily hygiene tasks (like toileting, bathing, brushing teeth, etc.).
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Requires significant assistance with Activities of Daily Living (ADLs).
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Incontinence.
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Little to no recall of recent events and personal history.
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Little to no orientation to self, time, place, and situation.
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Difficulty reciting rote tasks (counting, address, home number, alphabet, nursery rhymes, etc.).
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Sleep cycle is disrupted.
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“Word salad” (random words linked together) speech.
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Personality/emotional changes may include:
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Delusions
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Obsessive symptoms (fidgeting, pacing, moving objects around to locations they do not belong)
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Anxiety, agitation, violent behavior, verbal outbursts
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Fear
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Frustration
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Shame
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Loss of motivation and willpower.
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"Very Severe Cognitive Decline" Stage 7 GDS.
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This stage may last 1 to 3 years.
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Limited speech skills.
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They need complete and total assistance for ADLs.​​
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They have difficulty consuming meals/snacks and medication
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Aspiration pneumonia is common and frequent​
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Weight loss and Dehydration
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Little to no appetite
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Both fine and gross motor skills are gone.
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"Baby Reflexes" return
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grasp reflex​
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sucking reflex
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Babinski plantar extensor reflex
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Physical rigidity and subsequent contractures (joint deformities that limit the range of motion and cause pain)
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