Stages of Alzheimer's Disease: 7 Stage Model

Global Deterioration Scale for Assessment of Primary Degenerative Dementia

1) No Cognitive Decline

• No subjective complaints of memory loss.
• No memory deficit evident on clinical interview.

2) Very Mild Cognitive Decline (Forgetfulness)

• Subjective complaints of memory deficit, most frequently in the following areas:
  • Forgetting where one has placed familiar objects
  • 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.

3) Mild Cognitive Decline (Early Confusional)

• Earliest clear-cut deficits. Manifestations in more than one of the following areas:
  • Patient may have gotten lost when traveling to an unfamiliar location
  • Co-workers become aware of patient's relatively poor performance
  • Word and name finding deficit becomes evident to intimates
  • Patient may read a passage or book and retain relatively little material
  • Patient may demonstrate decreased facility in remembering names upon introduction to new people
  • Patient may have lost or misplaced an object of value
  • Concentration deficit may be evident in 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.

4) Moderate Cognitive Decline (Late Confusional)

• Clear-cut deficit on careful clinical interview. Deficit is manifest in the following areas:
  • Decreased knowledge of current and recent events
  • May exhibit some deficit in memory of one's personal history
  • Concentration deficit elicited on serial subtractions
  • Decreased ability to travel, handle finances, etc.
• Frequently no deficit in following areas:
  • Orientation to time and person
  • Recognition of familiar persons and faces
  • Ability to travel to familiar locations
  • Inability to perform complex tasks.
• Denial is the dominant defense mechanism.
• Flattening of affect and withdrawal from challenging situations occur.

5) Moderately Severe Cognitive Decline (Early Dementia)

• Patient can no longer survive without some assistance.
• Patient is unable, during interview, to recall a major relevant event of their current lives, e.g., an address or telephone number of many years, the names of the high school and/or college from which they graduated, or the names of close family members such as grandchildren.
• Frequently some disorientation to time (day of the week, season, etc.) or place.
• An educated person may have difficulty counting back from 40 by fours or from 20 by twos.
• A patient at this stage retains knowledge of many facts regarding themself and others. They invariably know their own name 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.

6) Severe Cognitive Decline (Middle 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. May retain some knowledge of their past lives, but this is sketchy.
• Generally unaware of their surroundings: the year, the season, etc.
• May have difficulty counting from 10 both backwards 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 recognize familiar locations.
• Diurnal rhythm frequently disturbed.
• Almost always recalls their own name.
• Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment.
• Personality and emotional changes occur. These are widely variable and include:
  • Interaction with nonexistant figures in the environment, or may talk to their own reflection in the mirror
  • Obsessive symptoms, e.g., person may continually repeat simple cleaning activities
  • Anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur
  • Cognitive abulla i.e., loss of will power because an individual cannot carry through long enough to determine a purposeful course of activity.

7) Very Severe Cognitive Decline (Late Dementia)

• All verbal abilities are lost. Frequently there is no speech at all - only grunting.
• Incontinent, requires assistance toileting and feeding.
• Lose basic psychomotor skills, e.g. ability to walk. The brain appears to be no longer able to tell the body what to do.
• Generalized and cortical neurological signs and symptoms are frequently present.

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