The Global Deterioration Scale and the Dementia Stages

Posted by on Mar 31, 2012

The Global Deterioration Scale and the Dementia Stages

 

Dementia is a condition that can be assessed by using the Global Deterioration Scale (GDS). It describes outlines the seven dementia stages and what symptoms to look for in each stage.

Dementia refers to a loss of normal brain function.  It tends to adversely affect memory, thinking skills, the ability to mufti-task and can lead to several other disorders. The most common form of Dementia is the Alzheimer’s disease.

There are seven stages of Dementia. These Dementia stages have a progressive nature, meaning each stage is more severe than the previous one. For example, during the first dementia stage there are no such signs of memory loss. It is at this time however, that Dementia is said to be taking its root through memory loss. Followed by the second stage where memory loss becomes slightly more noticeable, and then the next where deficits become clearly evident and then at each stage the severity level
exceeds and eventually the patient needs a higher level of help.


The Global Deterioration Scale (GDS) was developed by Dr. Barry Reisberg is a scale that helps examine whether one is suffering from dementia and helps to assess any symptoms related to it. (See tabbed content below) It is a seven stage scale. Signs and symptoms that are found in the 4-7 stages are a clear indicator of the person’s likeliness of being affected by dementia. However, stages 2-3 signify that the person has a mild cognitive impairment which may transform into dementia. Actually, it could be said that we all fit into the first stage since it reflects that there is no cognitive impairment.

The Global Deterioration Scale

Click tabs to view each stage
NO COGNITIVE DECLINE: Duringf the first of the Dementia Stages there is no subjective complaints of memory deficit. No memory deficit evident on clinical interview.
VERY MILD COGNITIVE DECLINE (Age Associated Memory Impairment): Subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. No objective evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern with respect to symptomatology.
MILD COGNITIVE DECLINE (Mild Cognitive Impairment): During this stage of the dementia stages one might observe 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 poor performance; (c) word and name finding deficit becomes evident to intimates; (d) patient may read a passage or 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. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms.
MODERATE COGNITIVE DECLINE (Mild Dementia): 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 following areas: (a) orientation to time and place; (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 frequently occur.
MODERATELY SEVERE COGNITIVE DECLINE (Moderate Dementia): 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 spouses’ and children’s names. They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear.
SEVERE COGNITIVE DECLINE (Moderately Severe Dementia): 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 be able to travel to 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.
VERY SEVERE COGNITIVE DECLINE (Severe Dementia): Here in the last stage of the dementia stages all verbal abilities are lost over the course of this stage. Frequently there is no speech at all -only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage. The brain appears to no longer be able to tell the body what to do. Generalized rigidity and developmental neurologic reflexes are frequently present.

 

The Global Deterioration Scale can also be used to assess what kind of nursing is required at each respective dementia stage. It is the Global Deterioration Scale that breaks down the dementia stages into seven stages naming each stage with the main signs and symptoms associated with it. For example, forgetfulness, confusion etc. Also, it tends to divide these stages further in three categories- mild, moderate and severe. Except for a few cases dementia  is irreversible. That is, once a person becomes a dementia patient, it is hard or more appropriately impossible to avoid the dementia stages as the disorder cannot be stopped or reversed.

Although the GDS has become an increasingly popular way of testing dementia, there are some factors it fails to reflect. The symptoms and even the effects of dementia are more or less the same. For example, the problem of memory loss, lack of thinking skills, the deteriorating ability to make decisions, eating disorders etc. Empirically, all these syndromes are also a prominent sign of aging. Yet, GDS fails to take into account whether the dementia stages can be associated with an individual’s age. Furthermore the knowledge of how long it has been that the patient is suffering from even one of the possible symptoms could be another determining point ignored by the GDS. Critics of GDS also say that the validity regarding the GDS results assuming the occurrence of symptoms and disorders leading to dementia are questionable.

Now although dementia is a severe form of illness, and needs to be diagnosed at the right time where it hasn’t actually developed, because of its irreversible and unstoppable nature- one should not solely be dependent on what GDS has to suggest but pursue other measures in order to possibly prevent dementia.

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