From my experience... needing complete care with incontinence,
inability to ambulate, loss of appetite and eventually unable to
eat/swallow and increased lethargy with almost constant sleeping
increasing to continuous sleeping or almost coma-like state. This
presumes no other process (i.e. pneumonia) sets in.

Bud

Here is the most commonly used set of stage descriptions. Keep in mind
that not everyone is going to fit perfectly in a category (i.e. they
may straddle categories). Just from what you have said, I'd say your
mom is in stage 6. Being in a particular stage also doesn't predict
how long they will live, or or how fast the illness will progress. The
stages just give you a pretty good handle on what to expect in terms
of general behaviours and abilities (so you aren't totally shocked at
what happens next!).

M.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of
Psychiatry,
1982.

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following
area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well.
No objective evidence of memory deficit on clinical interview. No
objective deficits in employment or social situations. Appropriate
concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-
cut deficits. Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive
interview. Denial begins to become manifest in patient. Mild to
moderate anxiety accompanies symptoms. Deficits noticed in demanding
employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD).
Clear-cut deficit on careful clinical interview. Deficit manifest in
following areas:
(a) decreased knowledge of current and recent events;
(b) may exhibit some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc.
Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense
mechanism. Flattening of affect and withdrawal from challenging
situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know their own
names and generally know their spouse's and children's names. They
require no assistance with toileting and eating, but may have some
difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD).
May occasionally forget the name of the spouse upon whom they are
entirely dependent for survival. Will be largely unaware of all recent
events and experiences in their lives. Retain some knowledge of their
past lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to orient in familiar locations. Diurnal rhythm
frequently disturbed. Almost always recall their own name. Frequently
continue to be able to distinguish familiar from unfamiliar persons in
their environment. Personality and emotional changes occur. These are
quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment,
or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple
cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.

             6a - Requires Assistance dressing
             6b - Requires Assistance bathing properly
             6c - Requires Assistance with mechanics of toileting
             6d - Urinary incontinence
             6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD).
All verbal abilities are lost. Frequently there is no speech at all -
only grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control. The brain appears to no longer be able to tell the
body what to do. Generalized and cortical neurologic signs and
symptoms are frequently present.

      7a - Speech ability limited to about a half-dozen intelligible
words
      7b - Intelligible vocabulary limited to a single word
      7c - Ambulatory ability lost
      7d - Ability to sit up lost
      7e - Ability to smile lost
      7f - Ability to hold up head lost

© 1984 by Barry Reisberg, M.D.