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  LEVEL 1 – NORMAL AGING
  CLINICAL CHARACTERISTICS
No cognitive changes evident. Normal aging, normal brain function.
  LEVEL 2 – EARLY STAGE
  Mild Cognitive Impairment (MCI)
Unknown timeline, possibly from age 40 to age 55/60
Minimal brain tissue loss
  CLINICAL CHARACTERISTICS
Subjective cases of memory deficits
Recovers relatively quickly from mistakes, may correct self
Misplaces familiar objects
Forgets names he/she knows well
No problems completing tasks or at social functions
Exhibits appropriate concern over memory function
Vacillates between seeking medical care and ignoring symptoms
Functions effectively at work
Highly functional social skills
Requires complete cognitive testing to determine challenges
Anticipate cognitive medication administration
Scores well on orientation test, requires cognition exam for diagnosis
Amnesia beginning to be expressed
  LEVEL 3 – MIDDLE STAGE
  Beginning Dementia
Stage may be 1 - 4 years or more
Minimal brain tissue loss
  CLINICAL CHARACTERISTICS
Memory deficit evident on intensive interview
Attempts to conceal deficits
Expresses concern regarding deficits (mild/moderate anxiety)
Problems performing in demanding situations (work or social)
Co-workers/family members aware of increasing challenges
Gets lost traveling to new areas
Exhibits signs of cognition (reading) but retains little information
Name/word finding difficulty more frequent
Challenged to remember new names
Denies any cognition difficulties
Demonstrates high social skill level
Uses humor to avoid answering questions
No noticeable physical changes
Beginning to skip steps in tasks
Able to score well on orientation test, but not on cognition exam
At times appears befuddled
Amnesia, aphasia, agnosia present
  LEVEL 4 – MIDDLE STAGE
  Moderate Dementia
Stage may be 1 - 4 years or more
4 ounces brain tissue loss
Equivalent to 12 year old to adulthood
  CLINICAL CHARACTERISTICS
Decreased knowledge of current and recent events
Memory deficits regarding personal history
Decreased ability to perform serial subtractions
Difficulty with immediate recall
Difficulty with complex tasks
Denial of deficits, with or with out agitation and annoyance
Withdraws from challenging situations
Increased anxiety/frustration over abilities or loss thereof
Difficulty telling jokes, stories
Decreased facial affect
Increased appearance of depressive symptoms
Begins incorrectly identifying family members
Fluctuation in functioning can appear great at times
May become lost in tasks
Greater language challenges, word-finding
Challenges in driving/operating car
No weight loss or physical changes in appearance
Begins keeping lists of family names, phone numbers, etc.
Exhibits greater desire for sweet foods
May score well on orientation test, deficits on cognition exam
Amnesia, Aphasia, Agnosia and Apraxia present
  LEVEL 5 – LATE STAGE
 

Moderately Severe Dementia
All Dressed Up, Ready To Go
Stage may be 1-3 Years
½ to 1 pound brain tissue loss
Equivalent to 8 – 12 year old
*Equivalent to 4– 8 year old

  CLINICAL CHARACTERISTICS
Disorientation to time (date, day of week, season, etc.) or place
Immediate memory relatively intact
Needs assistance choosing clothing, layers clothing
May crave sweets over other foods
Denies need for assistance with ADLs/IADLs
Hunting and Gathering Stage
Urinary Incontinence begins –monthly to weekly to daily
Wears clothing appropriately (hearing aid, glasses, carries purse)
Feeds self (may need meal set-up)
Sleep disturbances
Can score well on an orientation test
Wanders looking for a way out (purposeful wandering/ Sun-downing)
Follows simple instructions for ADLs, verbal cues needed for tasks
Unexplained tearfulness or extreme laughter
Catastrophic reactions
Some resistance to care giving
*May begin chronic Urinary Tract Infections
*Appears severely depressed
*Increased loss of facial affect
*Coordinated movement/function beginning to be affected
*Begins to be lost in current time
*Difficulty recognizing self in a mirror
*Challenged to recall family members
*Accuses family members, caregivers of theft, infidelity, lying
*Automatic “yes/no” speech functions, but without understanding
*May begin using curse words as temporal lobes become damaged
*Changes in visual perception increasing
*Difficulty interpreting background noise
*Challenged to perform rehab for injuries, may appear stubborn
*Cannot give accurate information
*Caregivers may confuse behavior for purposeful action – lying, etc.
*Physical appearance beginning to be affected
*Pilling or rubbing motions common, may enjoy folding items
*Amnesia, Aphasia, Agnosia and Apraxia evident to outsiders
  LEVEL 6 – LATE STAGE
 

Severe Dementia
In My Own Little World
Stage may be 1 - 3 Years
1 to 1½ pounds of brain tissue loss
Equivalent to 2 – 4 year old

 

CLINICAL CHARACTERISTICS
Unable to recall most recent events
Repetitiveness in motion or speech or memory
May be in constant motion, wanders/walks for hours
Removes/won’t wear clothing appropriately (glasses, hearing aid)
Refuses to change clothing
Feeds self with set-up; cues; assist
Bowel incontinence begins
Sleep disturbances, may increase sleep, may require little sleep
Catastrophic reactions, great resistance to care giving, bathing
Purposeless wandering/Sun-downing (wandering without an agenda)
Cannot complete a two-stage command
Apraxia advanced, gait altered (small shuffling steps)
Aphasia increased, great language loss
Weight loss beginning
Difficult to engage with caregiver, challenged to initiate conversation
Disregards eyeglasses, dentures, hearing aids (agnosia)
Disheveled appearance
May begin sleeping for longer periods of time
Difficult to perform rehab for injuries
Almost total loss of facial affect
May suddenly use complete sentence, then only words or sounds

  LEVEL 7 – LATE STAGE
 

Very Severe Dementia
Bedbound
Total Care Required
Stage may be 1 to 2 years
1½ to 2 pounds brain tissue loss
Equivalent to Infants – 2 year old

  CLINICAL CHARACTERISTICS
Unable to recall most recent events
Repetitiveness in motion or speech or memory
May be in constant motion, wanders/walks for hours
Removes/won’t wear clothing appropriately (glasses, hearing aid)
Refuses to change clothing
Feeds self with set-up; cues; assist
Bowel incontinence begins
Sleep disturbances, may increase sleep, may require little sleep
Catastrophic reactions, great resistance to care giving, bathing
Purposeless wandering/Sun-downing (wandering without an agenda)
Cannot complete a two-stage command
Apraxia advanced, gait altered (small shuffling steps)
Aphasia increased, great language loss
Weight loss beginning
Difficult to engage with caregiver, challenged to initiate conversation
Disregards eyeglasses, dentures, hearing aids (agnosia)
Disheveled appearance
May begin sleeping for longer periods of time
Difficult to perform rehab for injuries
Almost total loss of facial affect
May suddenly use complete sentence, then only words or sounds
Frequently no speech at all – mostly grunting
Cannot feed self --- Chipmonking, high choking risk
Unable to sit up independently, unable to hold head up
Loss of basic psychomotor skills (unable to walk w/o assistance)
Hyper oral (may put everything in mouth)
Requires total care, Displays great muscular flexation
Extreme risk for skin breakdown
Spends majority of day asleep or semi-alert
Loss of ability to smile – indicative death is near
   
 

 

DOWNLOAD

DBAT

Download this free tool to track the
Stages of Dementia or the Stages of Alzheimer's

 


DOWNLOAD

DBAT

Download this free tool to track the Stages of Dementia or the Stages of Alzheimer's.

 

ADAT

Download this free Actively Dying Assessment Tool.








































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