What is the Dementia Rating Scale?
Dementia gets worse over time, so health professionals use a dementia rating scale to help determine the stages of dementia. Alzheimer’s disease is the most common type of dementia and the Global Deterioration Scale for Assessment of Primary Degenerative Dementia is often used when assessing the Alzheimer’s disease progression.
The Reisberg Scale
The GDS scale, also known as the Reisberg Scale, is broken down into seven stages of cognitive impairment.
- Stage 1: A person in this stage has no memory loss or cognitive impairment. A person can function normally in everyday activities and does not have dementia.
- Stage 2: In this stage a person has minimal cognitive impairment that is normal in the aging process. For example, a person might forget names or where they put their keys but other people do not notice the symptoms, and the person does not have dementia.
- Stage 3: A person has mild cognitive impairment associated with forgetting things more often, may find it difficult to concentrate and becomes less productive at work. Loved ones will begin to notice that a person gets lost more often or has difficulty finding the right words when talking. At this stage, the person does not have dementia but will develop the disease on average within seven years.
- Stage 4: This is the early stage of dementia and a person will exhibit moderate cognitive impairment. A person has more difficulty concentrating and begins to forget recent events. Taking care of personal finances and traveling alone to new places becomes difficult. A person may deny their symptoms, refuse a test for dementia and begin to withdraw from family and friends because socialization becomes a challenge. A physician can detect cognitive declines through a patient interview and exam and this stage lasts an average of two years.
- Stage 5: A person in is the mid-stage of dementia and has moderately severe impairment. The person will need help completing everyday tasks such as dressing, bathing and fixing meals. A person has major memory loss and may forget important information like their address and phone number or the time of day and where they are. The symptoms of this stage last an average of one and a half years.
- Stage 6: A person is still in the mid-stage of dementia however exhibits severe impairment and needs extensive help with daily activities. They begin to forget easy things like names of friends and family and often forget things they did recently but can only remember some details from when they were younger. Counting backward from ten, speaking and completing a task are difficult for them and will have bladder and bowel control issues. The patients will have personality changes including delusions, compulsive behavior, anxiety and agitation. These symptoms last on an average for two and a half years.
- Stage 7: The final stage is the late-stage of dementia in which a person has very severe brain impairment and needs extensive dementia care. A person needs constant assistance with most activities including eating and going to the bathroom. They lose their ability to communicate and psychomotor skills like walking decline. The average duration of this stage is two and a half years.
Functional Assessment Staging
Dr. Barry Reisberg developed the Functional Assessment Staging Test, another dementia rating scale. It is different from GDS because it rates a person’s functioning level and their ability to carry out daily living verses their cognitive decline. A person with dementia may be at a different stage functionally than cognitively.
- Stage 1: Exhibits a normal adult with no functional decline.
- Stage 2: Exhibits an older adult with awareness of normal age appropriate functional decline.
- Stage 3: Exhibits a person with early dementia who notices a difficulty in a demanding job.
- Stage 4: Exhibits mild dementia and needs help with complicated tasks like finances or planning events.
- Stage 5: Exhibits moderate dementia and needs help with simpler tasks like choosing clothes to wear.
- Stage 6: Exhibits moderately severe dementia and needs more help with simple daily tasks and may have problems with bladder and bowel control.
- Stage 7: Exhibits severe dementia and has major trouble speaking and controlling body to walk, sit up, smile and eat.
A caregiver or informant who can interview the person and accurately report information should administer the FAST dementia rating scale to determine the stages of dementia.
Critical Dementia Rating Scale
The third most common dementia rating scale is the Clinical Dementia Rating Scale. It is a five-stage scale that combines the cognitive abilities and functional abilities of a person who may have dementia. The person is evaluated in six domains:
- Loss of memory
- Knowledge of time and place
- Problem solving skills
- Community affairs
- Home and hobbies
- Personal care
The person is assigned a CDR rating from zero indicating no dementia to three indicating severe dementia.
If you notice a change in behavior or personality of your loved one take them to a physician to get evaluated. No single test will prove that a person has Alzheimer’s or dementia, however, a doctor will consider all the possible causes and administer a dementia rating scale to help make a diagnosis.