Week 6: How is dementia graded in terms of severity?

A common system for describing the different phases or stages of Alzheimer’s disease was developed by Dr. Barry Reisberg of New York University.

There are seven stages of Alzheimer’s disease but the precise number of stages is arbitrary. Each patient experiences the disease differently.

Stage 1: No Impairment

There is no memory problem or other symptoms of dementia evident. It is important to remember that the brain pathology of Alzheimer’s disease can typically begin 10-15 years before any signs of the illness are evident.

Stage 2: Very Mild Decline

The patient may notice minor memory problems or misplace things around the house. The memory loss may not be distinguished from normal age related memory loss. The disease may not be noticed by physicians or family members.

Stage 3: Mild Decline

The family members may begin to notice memory and cognitive problems. Performance on memory and cognitive tests are definitely affected. Physicians will detect impaired cognitive function. Patients will have difficulty in finding the right word during conversations and remembering names of new acquaintances. They may also frequently lose personal possessions.

Stage 4: Moderate Decline

There will be clear cut symptoms of Alzheimer’s disease. Patients will have difficulty with simple arithmetic, managing finance and paying bills. They will suffer from short term memory impairment and forget details about their life histories.

Stage 5: Moderately Severe Decline

Patients begin to need help with many daily activities. They may experience significant confusion, difficulty dressing appropriately and cannot recall simple details such as their own phone number. They can still bathe and toilet independently. They still know their family members and some details about their childhood and youth.

Stage 6: Severe Decline

Patients need constant supervision and frequently require professional care. They may suffer confusion, major personality changes and potential behavior problems. They also need assistance with all activities of daily living such as dressing, toileting and bathing. They cannot recognize faces except closest friends and relatives nor remember most details of personal history. They may have loss of bowel and bladder control. They may wander too.

Stage 7: Very Severe Decline

This is the final stage of Alzheimer’s disease and patients are nearing death. They lose ability to respond to their environment or communicate. They may still be able to utter words and phrases but have no insight into their condition. They need assistance with all activities of daily living. They may lose the ability to walk and swallow.

Please refer to www.alzheimers.net for further information.

Some experts use a simple three-phase model (early, moderate and end). The simple three-phase model according to the Alzheimer's Association is as follows:

In “early” or “mild” Alzheimer's, a person may still be able to drive, work and interact socially. The patient may forget where something is placed. There may be difficulty remembering names shortly after being introduced to someone new and material just read. There may be challenges in planning, organizing, and thinking of the correct name or word.

Moderate Alzheimer's disease can last many years. The patient may become more irritable, behave in unusual ways or mix up language. Becoming moody or withdrawn in social situations can be common. During this stage, the patient is likely to wander and unable to recall personal details including phone numbers and home address. Complex daily activities such as banking, driving, cooking will usually be significantly impaired, though many basic activities such as dressing, bathing and toileting, may still be possible.

Severe Alzheimer's necessitates full-time care as the patient is unable to participate in meaningful conversation, or complete any activities of daily without significant assistance. Personality changes are obvious. The patient forgets both recent and past experiences and is especially vulnerable to infections.