This may have been posted before...but anyway it may help some members understand where their loved ones are at and what to possibly expect in the future. It has helped me. it breaks down the early, moderate and severe into 7 stages rather than 3. 7 Stages of ALZHEIMER'S kind regards, Jo -------------------------------------------------------------------------------- Stage 1 - NO SYMPTOMS OF ALZHEIMER'S ARE SEEN. Stage 2 - FORGETFULNESS: Very mild cognitive decline. For example, problems such as: vagueness of where familiar objects are, complaints about not remembering well, forgetting names once well known. There is however, no loss of abilities in social interactions or in employment situations. Stage 3 - CONFUSION EARLY STAGE: Mild cognitive decline. For example, problems such as: getting lost when traveling to a familiar location; noticeably lowered performance level at work; trouble finding words and names; little retention from reading; little or no ability to remember names of new people; loss of valued objects and trouble concentrating. Stage 4 - CONFUSION LATE STAGE: Moderate cognitive decline. For example, problems such as: decreased knowledge of current and recent events; loss in memory of personal history; decreased ability to handle travel or finances; and inability to perform complex tasks. Appropriate responsiveness to outside stimulation decreases sharply. Denial of any problem, and withdrawal from challenging situations are common. Stage 5 - DEMENTIA EARLY STAGE: Moderate severe decline. For example: the person can no longer survive without some assistance. Patients can't remember names of people or places in their lives. They may be disoriented about time and dates. However, they will require no assistance when using the bathroom or eating, but may need help getting dressed. Stage 6 - DEMENTIA MIDDLE STAGE: Severe cognitive decline. For example: the person may forget the name of the spouse and be unaware of events in his or her life. They are entirely dependent on others for survival. They may have trouble sleeping in a regular pattern. Stage 7 - DEMENTIA LATE STAGE: Very severe cognitive decline. For example: all verbal abilities are lost and he or she needs help eating and using the bathroom. Eventually they lose ability to walk, the brain appears to no longer be able to tell the body what to do. ---------------------------------------------------------------------------------------- Level 1 – NO COGNATIVE DECLINE: No subjective complaints of memory deficit. No memory deficit evident on clinical interview. Level 2 – VERY MILD COGNATIVE DECLINE (Age Associated Memory Impairment): Subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) 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. Level 3 – MILD COGNATIVE DECLINE (Mild Cognitive Impairment): 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 poor performance; (c) word and name finding deficit becomes evident to intimates; (d) patient may read a passage or 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. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms. Level 4 – MODERATE COGNITIVE DECLINE (Mild Dementia): 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 ones personal history; (c) concentration deficit elicited on serial subtractions; (d) decreased ability to travel, handle finances, etc. Frequently no deficit in following areas: (a) orientation to time and place; (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 withdrawal from challenging situations frequently occur. Level 5 – MODERATELY SEVERE COGNITIVE DECLINE (Moderate Dementia): 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 spouses' 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 (Moderately Severe 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. 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 be able to travel 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., patients 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. Level 7 - VERY SEVERE COGNITIVE DECLINE (Severe Dementia): All verbal abilities are lost over the course of this stage. Frequently there is no speech at all -only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage. The brain appears to no longer be able to tell the body what to do. Generalized rigidity and developmental neurologic reflexes are frequently present.