The Seven Levels of Dementia

EARLY STAGES

Level 1 - No Cognitive Decline
Clinical characteristics:

• No demonstrated memory deficits
• No subjective cases of memory deficits
• Functions independently

Level 2 - Very Mild Cognitive Decline (Forgetfulness)
Clinical characteristics:

• Subjective cases of memory deficits (misplacement of objects, forgetting familiar names)
• No problems at social functions or completing tasks

MIDDLE STAGES

Level 3 - Mild Cognitive Decline (Early Confusional)
Clinical characteristics:

• Memory deficit evident on intensive interview
• Attempts to conceal deficits
• Expresses concern regarding deficits (mild/moderate anxiety)
• Problems performing in demanding situations (work or social)

Level 4 - Moderate Cognitive Decline (Late Confusional)
Clinical characteristics:

• Decreased knowledge of current and recent events
• Memory deficits regarding personal history
• Decreased ability to concentrate on serial subtractions
• Difficulty with complex tasks
• Denial of deficits
• Withdrawal from challenging situations

LATE STAGES

Level 5 - Moderately Severe Cognitive Decline (Early Dementia)
Clinical characteristics:

• Disorientation to time (date, day of week, season, etc.) or place
• Immediate memory relatively intact
• Needs assistance choosing clothing
• Wears clothing appropriately (hearing aid, glasses, carries purse)
• Feeds self (may need meal set-up)
• Sleep disturbances
• Wanders, looking for a way out (purposeful wandering)
• Tearfulness
• Catastrophic reactions
• Some resistance to care giving
• Needs verbal cues for ADL’s – follows simple instructions

Level 6 - Severe Cognitive Decline (Middle Dementia)
Clinical characteristics:

• Unable to recall most recent events
• Repetitiveness
• Removes/won’t wear clothing appropriately (glasses, hearing aid)
• Refuses to change clothing
• Bathing results in challenging behavior
• Feeds self with set-up; cues; assist
• Sleep disturbances
• Catastrophic reactions
• Great resistance to care giving
• Purposeless wandering (Wandering without an agenda)
• Cannot complete a two-stage command

Level 7 – Very Severe Cognitive Decline (Late Dementia)
Clinical characteristics:

• Frequently no speech at all – mostly grunting
• Cannot feed self
• Cannot complete even simple meaningful tasks
• Unable to sit up independently
• Loss of basic psychomotor skills (unable to walk w/o assistance)
• Unable to hold head up
• Hyper oral (may put everything in mouth)
• Long term memory severely affected