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The Global Deterioration Scale - ALZHEIMERS DISEASE


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Adapted from

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,

Level 1
No cognitive 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.
Deficits noticed in demanding employment situations.

Level 4
Moderate 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
(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
Moderately 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 Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

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 ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost

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