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What are the Stages of Alzheimer's Disease?

Reisberg Scale

What are the stages of Alzheimer’s disease?

Understanding the Progression: Stages of Alzheimer’s Disease

Numerous testing methods and procedures exist in neurology and psychiatry to determine the stages or severity of dementia. The most common procedures include the Mini-Mental Status Test (MMST), the Dementia Detection Test (DemTect), the Montreal Cognitive Assessment (MoCA), various ADL scales, the CERAD test collection and others.

In this context, we would like to highlight the GDS-Reisberg Scale (GDS = Global Deterioration Scale), as it differentiates between several stages and enables affected persons to assess the stage of the disease more accurately. The professional assessment is done by neurologists as well as family members and/or caregivers.

The scale was developed by Barry Reisberg, Clinical Director of the Silberstein Aging and Dementia Research Center at New York University School of Medicine (for more information on Prof. Reisberg, see: https://med.nyu.edu/faculty/barry-reisberg).

The following is a brief overview of the GDS Reisberg scale:

Dementia Stage 1

The person concerned does not show any impairment in his/her cognitive abilities.

Dementia Stage 2

At this stage, a slight decrease in mental capacity can be observed, but it often appears at first as simple forgetfulness. If diagnosed neurologically, this is the earliest stage of dementia or Alzheimer’s dementia.

For example, the affected person repeatedly forgets names or familiar objects.

However, such changes could also be merely age-related and not related to Alzheimer’s or dementia. Therefore, an assessment, even by experts, is often difficult.

Dementia Stage 3

In the early stages of Alzheimer’s dementia or dementia, the first, but still minor, cognitive impairments appear, such as problems finding words, difficulties describing objects, decreasing verbal fluency when speaking, reduced ability to concentrate and work, declining memory for recently read material, frequent forgetting of names and appointments, misplacing and losing valuables, and a tendency to depressive moods.

Dementia Stage 4

From this stage onwards (mild or early Alzheimer’s dementia or dementia), family members, friends or colleagues also notice that the person affected shows behavioural abnormalities that go beyond simple forgetfulness or typical signs of old age:

The affected person forgets recent events, is no longer able to do complex arithmetic or count backwards, has difficulties paying bills and managing finances, and forgets parts of their personal history.

These problems are often accompanied by a gradual withdrawal from social life and depressed moods.

Dementia Stage 5

This stage shows a moderate decline in perceptual ability, characteristic of moderate to moderately severe Alzheimer’s dementia or dementia.

Noticeable memory and thinking deficits as well as the need for support from third parties in daily life characterise this stage.

The person is sometimes no longer aware of where he or she is, can usually no longer give his or her own address, is unsure of the current day of the week, time of day or season, no longer recognises friends and relatives and remembers less and less about his or her own life.

The withdrawal into one’s own world of thoughts increases and is no longer comprehensible for relatives.

One could say: time and space change for the affected person, and the “outside world” becomes increasingly closed off.

Dementia Stage 6

At this stage, there is a severe decline in the ability to perceive, indicating moderate Alzheimer’s dementia or dementia.

The person’s personality changes noticeably or even drastically, and help is needed with almost all daily activities such as dressing, undressing and eating.

The affected person can no longer store or recall even recently experienced events and no longer recognises closest relatives, partners, children or siblings.

Delusions, mistrust, compulsive behaviour and frequent mood swings characterise everyday life.

On a physiological level, there is a loss of control over the bowels and bladder and altered sleep patterns.

There may be aimless wandering and temporary complete confusion.

Dementia Stage 7

In the advanced or late stages of Alzheimer’s disease or dementia, the ability to perceive is severely impaired and the affected person is in the final stages of the disease.

Communication with the environment is hardly possible any more, although words or even whole sentences can still be spoken sporadically.

Complete care is essential, as neither washing, toileting, eating nor drinking can be done independently.

Often, the affected person is also no longer able to sit alone; reflexes atrophy, muscles stiffen, swallowing is impaired, and finally the head can no longer be held.

The smile goes out, attention disappears, the mind is completely turned inwards, and the outside world – as far as this can be judged – no longer seems to be present.

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