Post by Neo on Jan 20, 2005 17:01:19 GMT -5
Seven Stages of Alzheimers
Stage 1 - NO SYMPTOMS OF ALZHEIMER'S ARE SEEN.
Stage 2 - FORGETFULNESS: Very mild cognitive decline. For example, problems such as: vagueness of where familiar objects are, complaints about not remembering well, forgetting names once well known. There is however, no loss of abilities in social interactions or in employment situations.
Stage 3 - CONFUSION EARLY STAGE: Mild cognitive decline. For example, problems such as: getting lost when traveling to a familiar location; noticeably lowered performance level at work; trouble finding words and names; little retention from reading; little or no ability to remember names of new people; loss of valued objects and trouble concentrating.
Stage 4 - CONFUSION LATE STAGE: Moderate cognitive decline. For example, problems such as: decreased knowledge of current and recent events; loss in memory of personal history; decreased ability to handle travel or finances; and inability to perform complex tasks. Appropriate responsiveness to outside stimulation decreases sharply. Denial of any problem, and withdrawal from challenging situations are common.
Stage 5 - DEMENTIA EARLY STAGE: Moderate severe decline. For example: the person can no longer survive without some assistance. Patients can't remember names of people or places in their lives. They may be disoriented about time and dates. However, they will require no assistance when using the bathroom or eating, but may need help getting dressed.
Stage 6 - DEMENTIA MIDDLE STAGE: Severe cognitive decline. For example: the person may forget the name of the spouse and be unaware of events in his or her life. They are entirely dependent on others for survival. They may have trouble sleeping in a regular pattern.
Stage 7 - DEMENTIA LATE STAGE: Very severe cognitive decline. For example: all verbal abilities are lost and he or she needs help eating and using the bathroom. Eventually they lose ability to walk, the brain appears to no longer be able to tell the body what to do.
=============================================
Global Deterioration Scale
(this is the original, more clinical version of the 7 level scale)
The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. It is broken down into 7 different stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. Beginning in stage 5, an individual can no longer survive without assistance. Within the GDS, each stage is numbered (1-7), given a short title (i.e., Forgetfulness, Early Confusional, etc followed by a brief listing of the characteristics for that stage. Caregivers can get a rough idea of where an individual is at in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS. (From geriatric-resources)
_____________________________
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia
Level 1 – NO COGNATIVE DECLINE: No subjective complaints of memory deficit. No memory deficit evident on clinical interview.
Level 2 – VERY MILD COGNATIVE 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.
Level 3 – MILD COGNATIVE DECLINE (Mild Cognitive Impairment):
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 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.
Level 4 – 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 ones 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.
Level 5 – 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.
Level 6 - 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.
Level 7 - VERY SEVERE COGNITIVE DECLINE (Severe Dementia):
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 alzheimers association has developed a plain english version of the 7 stages, available at www.alz.org/AboutAD/Stages.asp
From Act mental health consultants--
A simplified version of 7 stages. Seems to describe the problems and care requirements seen in the nursing home. Very understandable. Also gives range of time duration for each stage.
www.actmentalhealth.com/News%202000,%2011-12.htm
---------------------------------------
By the way, most doctors do not bother trying to determine the stage the person is in - except that they might indicate mild, moderate or severe. The doctors are more interested in treating the individual patient and the problems he/she is having at the time of the visit. They find no value in staging the dementia patient.
Caregivers tend to want the staging system to get an idea of where their LO is in the process and what lies ahead.
-----------------------------------------
A simplified checklist version of the seven stages is the Functional Assessment Staging Test (FAST) developed by the same doctor. It is available at
www.geriatric-resources.com/html/fast.html
1 No difficulties, either subjectively or objectively
2 Complains of forgetting location of objects; subjective word finding difficulties only.
3 Decreased job functioning evident to coworkers; difficulty in traveling to new locations.
4 Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances; marketing).
5 Requires assistance in choosing proper clothing for the season or occasion.
6a Difficulty putting clothing on properly without assistance.
6b Unable to bathe properly; may develop fear of bathing. Will usually require assistance
adjusting bath water temperature.
6c Inability to handle mechanics of toileting (i.e., forgets to flush; doesn't wipe properly).
6d Urinary incontinence, occasional or more frequent.
6e Fecal incontinence, occasional or more frequent.
7a Ability to speak limited to about half a dozen words in an average day.
7b Intelligible vocabulary limited to a single word in an average day.
7c Nonambulatory (unable to walk without assistance).
7d Unable to sit up independently.
7e Unable to smile.
7f Unable to hold head up.
Comment on the FAST by dementia expert Geri Hall
"You look for the stage which is the highest number where your person has symptoms because the losses are cumulative. If a patient is in stage 3, I expect them to have some issues with money, working, driving, shopping, short-term memory, time sense, etc -- In stage 4 I see issues with driving, shopping, cooking, cleaning, doing chores, participating in higher level activities and social affairs. But the person brings the deficits from stage 3 with them into stage 4. The deficits don't resolve.
And, there are those of us who work with these patients day to day who strongly disagree with several points on the FAST Scale. The one major issue is bathing. Problems with bathing are the hallmark of the beginnings of stage 5.
G Hall recaps the seven stages ---
Problems with driving, managing money, and shopping = stage 3. If you notice she can't cook, clean, or do the laundry = stage 4. If she requires help (or strong encouragement to bathe, clean her teeth, or select different clothing each day = stage 5. If she has trouble with falling or bowel and bladder control and/or falling, she is in stage 6. If she can no longer walk, stage 7. The losses are cumulative and not every patient has exactly the same losses.
--------------------------.
Geri Hall posed the following checklist on Alz.org message board Sept. 11, 2009
The following will help your family pinpoint the stage.
Evaluating the Stages of Alzheimer’s Disease
Stage vs. Functional Losses
The person will have some or all of the losses
Check if any symptoms are present
1 Forgetful but no real functional loss
2 Short-term memory or a decreased ability to learn and retain new information
Symptoms of depression or apathy
Become angry more easily; may have new conflicts with others
Increased frustration
Increase in intensity of emotions including sadness or happiness over seemingly minor things
More willful, purposeful,
Increasingly self-absorbed
If still employed, problems with employer or have poorer job performance
3 Plan for investments, pay bills, balance the checkbook, and generally manage complicated financial responsibilities.
Driving changes
Make decisions about purchases and shop
Counting change -- may hand billfold to a clerk to take the amount needed
Planning vacations, trips.
Understanding, remembering written materials.
Buys more with credit card purchases, magazine subscriptions, telephone calls, on TV or mail order products.
Victim of phone or internet scams.
Dialing the phone in an emergency.
3 Plan for investments, pay bills, balance the checkbook, and generally manage complicated financial responsibilities.
Driving changes
Make decisions about purchases and shop
Counting change -- may hand billfold to a clerk to take the amount needed
Planning vacations, trips.
Understanding, remembering written materials.
Buys more with credit card purchases, magazine subscriptions, telephone calls, on TV or mail order products.
Victim of phone or internet scams.
Dialing the phone in an emergency.
Power implements (snow blowers, saws, gas tanks); unsafe with firearms.
4 Decreased time sense - obsessing over appointment times, getting dressed early, worrying about when things will occur.
Loss of reading comprehension, unable to remember what they have read.
Dial the phone
Determine clean versus dirty: stop cleaning; clean obsessively; linens unchanged; stop using the washing machine, and wash clothing by hand.; soiled bathroom; House develops clutter or develop a dusty “no one lives here” look.
Changes in cooking abilities, storing food, stove on
The thermostat settings are either too hot or too cold.
The person begins to withdraw from complex tasks: social or religious organizations; preparing for holidays; service clubs, holding an office in an organization; or participation in a card club.
Loss of the sense of “risk,” knowing that things are dangerous and/or having “close calls.”
Increased irritability, frustration with activities, and self-absorption.
5 Bathing, starting with the person failing to bathe regularly or becoming resistant when bathing is suggested
Grooming –clean their teeth, comb their hair, shave, or apply makeup, and/or clothing is soiled from spilled food.
Selecting clothing - wear the same clothing day after day, becoming angry when change is suggested or the clothing is laundered, change clothing frequently throughout the day , or begin to select odd combinations of clothing.
Dressing – The person may need actual direction in order to get clothing on in the correct manner.
Intermittent difficulty with recognizing friends or family members.
Non-recognition of TV, mirrors, pictures, objects – The person may report extra people or animals in the house
Clings to caregiver, fearful whenever the caregiver leaves, even for a short time.
Repetitive behaviors –Ask the same question repeatedly or endlessly repeat a particular activity.
Ability to hold a conversation is notably poor and understanding decreased
Regular behaviors including one or more of the following:
Pacing – walking back and forth without a real destination.
Wandering – walking without a purpose or goal.
Sleep disturbances – usually waking at night thinking it is morning or waking in the night confused.
Late day confusion or agitation.
Belligerence when asked to bathe
Demanding to leave social events early.
Agitation.
Aggression – usually related to resisting care.
Having illusions of children or adults in the house.
Not recognizing family or home when tired or stressed.
6 Toileting
Walking
Shuffling.
Coasting from object to object.
Difficulty rising from chair.
Feet getting “glued” to the floor.
Falling
Toddler-like emotions.
Eating
Failing to eat unless served.
Eating with fingers.
Easily distracted when eating
May put non-food items in mouth.
Regular non-recognition of family.
Very poor language ability, may not make sense
7 Loss of ability to move about purposefully, i.e. pushing a wheelchair
Loss of regular verbal communication.
Dependence in all activities of daily living.
Must be fed
Loss of recognition of most family members except during moments of clarity.
Stage 1 - NO SYMPTOMS OF ALZHEIMER'S ARE SEEN.
Stage 2 - FORGETFULNESS: Very mild cognitive decline. For example, problems such as: vagueness of where familiar objects are, complaints about not remembering well, forgetting names once well known. There is however, no loss of abilities in social interactions or in employment situations.
Stage 3 - CONFUSION EARLY STAGE: Mild cognitive decline. For example, problems such as: getting lost when traveling to a familiar location; noticeably lowered performance level at work; trouble finding words and names; little retention from reading; little or no ability to remember names of new people; loss of valued objects and trouble concentrating.
Stage 4 - CONFUSION LATE STAGE: Moderate cognitive decline. For example, problems such as: decreased knowledge of current and recent events; loss in memory of personal history; decreased ability to handle travel or finances; and inability to perform complex tasks. Appropriate responsiveness to outside stimulation decreases sharply. Denial of any problem, and withdrawal from challenging situations are common.
Stage 5 - DEMENTIA EARLY STAGE: Moderate severe decline. For example: the person can no longer survive without some assistance. Patients can't remember names of people or places in their lives. They may be disoriented about time and dates. However, they will require no assistance when using the bathroom or eating, but may need help getting dressed.
Stage 6 - DEMENTIA MIDDLE STAGE: Severe cognitive decline. For example: the person may forget the name of the spouse and be unaware of events in his or her life. They are entirely dependent on others for survival. They may have trouble sleeping in a regular pattern.
Stage 7 - DEMENTIA LATE STAGE: Very severe cognitive decline. For example: all verbal abilities are lost and he or she needs help eating and using the bathroom. Eventually they lose ability to walk, the brain appears to no longer be able to tell the body what to do.
=============================================
Global Deterioration Scale
(this is the original, more clinical version of the 7 level scale)
The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. It is broken down into 7 different stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. Beginning in stage 5, an individual can no longer survive without assistance. Within the GDS, each stage is numbered (1-7), given a short title (i.e., Forgetfulness, Early Confusional, etc followed by a brief listing of the characteristics for that stage. Caregivers can get a rough idea of where an individual is at in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS. (From geriatric-resources)
_____________________________
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia
Level 1 – NO COGNATIVE DECLINE: No subjective complaints of memory deficit. No memory deficit evident on clinical interview.
Level 2 – VERY MILD COGNATIVE 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.
Level 3 – MILD COGNATIVE DECLINE (Mild Cognitive Impairment):
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 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.
Level 4 – 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 ones 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.
Level 5 – 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.
Level 6 - 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.
Level 7 - VERY SEVERE COGNITIVE DECLINE (Severe Dementia):
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 alzheimers association has developed a plain english version of the 7 stages, available at www.alz.org/AboutAD/Stages.asp
From Act mental health consultants--
A simplified version of 7 stages. Seems to describe the problems and care requirements seen in the nursing home. Very understandable. Also gives range of time duration for each stage.
www.actmentalhealth.com/News%202000,%2011-12.htm
---------------------------------------
By the way, most doctors do not bother trying to determine the stage the person is in - except that they might indicate mild, moderate or severe. The doctors are more interested in treating the individual patient and the problems he/she is having at the time of the visit. They find no value in staging the dementia patient.
Caregivers tend to want the staging system to get an idea of where their LO is in the process and what lies ahead.
-----------------------------------------
A simplified checklist version of the seven stages is the Functional Assessment Staging Test (FAST) developed by the same doctor. It is available at
www.geriatric-resources.com/html/fast.html
1 No difficulties, either subjectively or objectively
2 Complains of forgetting location of objects; subjective word finding difficulties only.
3 Decreased job functioning evident to coworkers; difficulty in traveling to new locations.
4 Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances; marketing).
5 Requires assistance in choosing proper clothing for the season or occasion.
6a Difficulty putting clothing on properly without assistance.
6b Unable to bathe properly; may develop fear of bathing. Will usually require assistance
adjusting bath water temperature.
6c Inability to handle mechanics of toileting (i.e., forgets to flush; doesn't wipe properly).
6d Urinary incontinence, occasional or more frequent.
6e Fecal incontinence, occasional or more frequent.
7a Ability to speak limited to about half a dozen words in an average day.
7b Intelligible vocabulary limited to a single word in an average day.
7c Nonambulatory (unable to walk without assistance).
7d Unable to sit up independently.
7e Unable to smile.
7f Unable to hold head up.
Comment on the FAST by dementia expert Geri Hall
"You look for the stage which is the highest number where your person has symptoms because the losses are cumulative. If a patient is in stage 3, I expect them to have some issues with money, working, driving, shopping, short-term memory, time sense, etc -- In stage 4 I see issues with driving, shopping, cooking, cleaning, doing chores, participating in higher level activities and social affairs. But the person brings the deficits from stage 3 with them into stage 4. The deficits don't resolve.
And, there are those of us who work with these patients day to day who strongly disagree with several points on the FAST Scale. The one major issue is bathing. Problems with bathing are the hallmark of the beginnings of stage 5.
G Hall recaps the seven stages ---
Problems with driving, managing money, and shopping = stage 3. If you notice she can't cook, clean, or do the laundry = stage 4. If she requires help (or strong encouragement to bathe, clean her teeth, or select different clothing each day = stage 5. If she has trouble with falling or bowel and bladder control and/or falling, she is in stage 6. If she can no longer walk, stage 7. The losses are cumulative and not every patient has exactly the same losses.
--------------------------.
Geri Hall posed the following checklist on Alz.org message board Sept. 11, 2009
The following will help your family pinpoint the stage.
Evaluating the Stages of Alzheimer’s Disease
Stage vs. Functional Losses
The person will have some or all of the losses
Check if any symptoms are present
1 Forgetful but no real functional loss
2 Short-term memory or a decreased ability to learn and retain new information
Symptoms of depression or apathy
Become angry more easily; may have new conflicts with others
Increased frustration
Increase in intensity of emotions including sadness or happiness over seemingly minor things
More willful, purposeful,
Increasingly self-absorbed
If still employed, problems with employer or have poorer job performance
3 Plan for investments, pay bills, balance the checkbook, and generally manage complicated financial responsibilities.
Driving changes
Make decisions about purchases and shop
Counting change -- may hand billfold to a clerk to take the amount needed
Planning vacations, trips.
Understanding, remembering written materials.
Buys more with credit card purchases, magazine subscriptions, telephone calls, on TV or mail order products.
Victim of phone or internet scams.
Dialing the phone in an emergency.
3 Plan for investments, pay bills, balance the checkbook, and generally manage complicated financial responsibilities.
Driving changes
Make decisions about purchases and shop
Counting change -- may hand billfold to a clerk to take the amount needed
Planning vacations, trips.
Understanding, remembering written materials.
Buys more with credit card purchases, magazine subscriptions, telephone calls, on TV or mail order products.
Victim of phone or internet scams.
Dialing the phone in an emergency.
Power implements (snow blowers, saws, gas tanks); unsafe with firearms.
4 Decreased time sense - obsessing over appointment times, getting dressed early, worrying about when things will occur.
Loss of reading comprehension, unable to remember what they have read.
Dial the phone
Determine clean versus dirty: stop cleaning; clean obsessively; linens unchanged; stop using the washing machine, and wash clothing by hand.; soiled bathroom; House develops clutter or develop a dusty “no one lives here” look.
Changes in cooking abilities, storing food, stove on
The thermostat settings are either too hot or too cold.
The person begins to withdraw from complex tasks: social or religious organizations; preparing for holidays; service clubs, holding an office in an organization; or participation in a card club.
Loss of the sense of “risk,” knowing that things are dangerous and/or having “close calls.”
Increased irritability, frustration with activities, and self-absorption.
5 Bathing, starting with the person failing to bathe regularly or becoming resistant when bathing is suggested
Grooming –clean their teeth, comb their hair, shave, or apply makeup, and/or clothing is soiled from spilled food.
Selecting clothing - wear the same clothing day after day, becoming angry when change is suggested or the clothing is laundered, change clothing frequently throughout the day , or begin to select odd combinations of clothing.
Dressing – The person may need actual direction in order to get clothing on in the correct manner.
Intermittent difficulty with recognizing friends or family members.
Non-recognition of TV, mirrors, pictures, objects – The person may report extra people or animals in the house
Clings to caregiver, fearful whenever the caregiver leaves, even for a short time.
Repetitive behaviors –Ask the same question repeatedly or endlessly repeat a particular activity.
Ability to hold a conversation is notably poor and understanding decreased
Regular behaviors including one or more of the following:
Pacing – walking back and forth without a real destination.
Wandering – walking without a purpose or goal.
Sleep disturbances – usually waking at night thinking it is morning or waking in the night confused.
Late day confusion or agitation.
Belligerence when asked to bathe
Demanding to leave social events early.
Agitation.
Aggression – usually related to resisting care.
Having illusions of children or adults in the house.
Not recognizing family or home when tired or stressed.
6 Toileting
Walking
Shuffling.
Coasting from object to object.
Difficulty rising from chair.
Feet getting “glued” to the floor.
Falling
Toddler-like emotions.
Eating
Failing to eat unless served.
Eating with fingers.
Easily distracted when eating
May put non-food items in mouth.
Regular non-recognition of family.
Very poor language ability, may not make sense
7 Loss of ability to move about purposefully, i.e. pushing a wheelchair
Loss of regular verbal communication.
Dependence in all activities of daily living.
Must be fed
Loss of recognition of most family members except during moments of clarity.
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : ) 