A Deterioration Scale For Stages of Alzheimers

No Cognitive Decline
Level 1

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

Very Mild Forgetfulness
Level 2

Subjective complaints of memory deficit, most frequently in 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 subjective deficits in employment or social situations. Appropriate concern with respect to symptomatology.

Mild (Early Confusional)
Level 3

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 : Patient may read passages in a 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.

Moderate (Late Confusional)
Level 4

Clear-cut deficit on careful clinical interview. Deficit manifest in 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 sub-tractions: 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 dominant defense mechanism. Flattening of affect and withdrawal from challenging situations occur.

Moderately severe (Early Dementia)
Level 5

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 4’s or from 20 by 2’s.
Persons at this stage retain knowledge of many major facts regarding themselves and others. They invariably know their own names and generally know their spouses’ and children’s names. They require no assistance with toileting and eating, but may have some difficulty choosing proper clothing to wear.

Severe (Middle Dementia)
Level 6

May occasionally forgets 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 life, but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. Diurnal rhythm frequently disturbed. (Daytime). Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will 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: Delusional behavior, e.g., patients may accuse their spouse of being an imposter, may talk to imaginary figures in the environment, or to their own reflection in the mirror. Obsessive symptoms: e.g., person may continually repeat simple cleaning activities. Anxiety symptoms: Agitation and even previously non-existent violent behavior may occur. Cognitive abulla: i.e., loss of willpower because and individual cannot carry a thought long enough to determine a purposeful course of action

Very severe (Late Dementia)
Level 7

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. 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. The disease ends with death.