Global Deterioration Scale
A Widely Used 7-stage Scale for Measuring Cognitive Decline
Who developed it?
Dr. Barry Reisberg , a psychiatrist and dementia researcher, who specializes in cognitive decline and Alzheimer’s disease.
Where is this used?
This scale is used in medical, therapeutic, and research settings to describe a person's cognitive function. Physicians, nurses, nurse practitioners, speech therapists, occupational therapists, physical therapists, and clinical researchers have all likely had exposure to this scale. It is not only utilized in the US but around the world.
How does this help those living with dementia and their caregivers?
Having this scale as a reference not only helps those living with dementia and their caregivers prepare for the current stage(s) of cognitive function, but can help prepare for the progressive decline of dementia. This can give caregivers the opportunity to seek out agencies that can provide assistance in the future, get legal and financial arrangements made ahead of time to reduce stress in the future when the disease has progressed, and time to practice functional communication and lifestyle modifications to implement as the disease progresses.
What is it?
This is a simple scale with 7 levels/stages that describe cognitive function along the continuum of cognitive decline associated with mild and major neurocognitive disorders (Mild Cognitive Impairment and Dementia). While originally developed for Alzheimer’s disease specifically, it is now commonly applied across many types of dementia.
Stages 1-3: Pre-Dementia Stages
Stage 1: Normal Cognitive Function
No Impairment at all.
Stage 2: Very mild cognitive decline associated with normal aging.
Difficulties are only noticed by the person living with these symptoms. Any symptoms at this stage are linked with NORMAL aging function such as OCCASIONALLY forgetting someone's name or appointment, occasional difficulty finding the right word, and very subtle lapses in judgement that do not affect safety or independence.
Stage 3: Mild Cognitive Impairment
This is a stage of cognitive impairment that lies between normal aging cognitive impairments and a diagnosis of dementia. At this stage, difficulty with thinking skills (cognitive function) can be noticed by both the person living with dementia AND those closest to them including friends, family, and coworkers. At this level, a person can still function safely during daily life but will very likely require some forms of assistance to improve memory and language: written/visual aids, alarms, calendars, etc. Mild Cognitive Impairment can be detected with extensive formal and informal assessments completed by a physician. IF there are concerns for cognitive impairment, this would be an ideal time to meet with a specialist/physician to identify deficits early. The earlier an impairment is identified, the better chances of lifestyle change and medical treatment have at slowing the rate of progression and, in some cases, preventing progression to dementia.
MCI does not always progress to dementia.
Stage 4: Early Stage Dementia
At this stage, a doctor can detect cognitive impairments severe enough to warrant a diagnosis of dementia. Symptoms are severe enough to interfere with daily life. Someone living with dementia will need assistance with Instrumental Activities of Daily Living (IADL). These are complex daily activities such as medication management, money management, traveling to new places, etc. We often see those living with dementia in denial in this stage as their deficits are becoming more severe which is upsetting due to loss of independence and difficulty caring for self.
Stage 5 and 6: Middle Stages of Dementia
Stages 5 and 6 present with increasing impairments of both IADL's and general Activities of Daily Living (ADL). A person living in these stages would require assistance with both complex activities (i.e., medication management) as well as basic ADL's (i.e., bathing, dressing, walking safely in environment). We begin to see a lot more behaviors as forms of communication as language/communication declines. Caregivers will have to be more creative and investigative to deduce what their loved ones are needing as their communication skills decline.
Stage 7: Late-Stage Dementia
In this final stage, someone living with dementia will be totally dependent on caregivers for all life tasks. They are often bedbound or require extensive assistance with mobility. Weight loss is likely to occur due to lack of appetite, decline in swallowing function, and decreased alertness.
For tips/recommendations on improving approach to care and communication as disease progresses, please follow my events page for upcoming workshops. During my educational workshops, I provide functional information and strategies you can take home with you to improve connection as the disease progresses.