Introduction to Staging Dementia Utilizing the
GLOBAL DETERIORATION SCALE (GDS)
By Barry Reisberg, M.D. 1982
Sandy Christos, M.S., CCC/SLP
Clinical Specialist, Genesis Rehab Services
Melissa Muir, M.A., CCC/SLP
Clinical Specialist, Genesis Rehab Services
ASHA 2010
Definition and Use
The Global Deterioration Scale is a scale that is used to stage individuals with cognitive impairments consistent
with dementia (including Alzheimer’s disease) according to a 7 point scale. Staging using the GDS helps
families and caregivers understand the cognitive deficits and set realistic goals for living situations and therapy,
as well as to maintain independence and improve quality of life for individuals with dementia.
Stage 1: No Cognitive Decline
Independent Community Living
Stage 2: Very Mild Cognitive Decline
Independent Community Living
Stage 3: Mild Cognitive Decline
Independent Community Living
Stage 4: Moderate Cognitive Decline
ALF/Adult Day Care or Other Supervision
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Looks “normal”
Has difficulty with complex tasks (finances, shopping,)
Requires daily support
Decreased sense of time
Difficulty with cleaning and cooking
Withdrawal from complex tasks
May repeat themselves
Increased irritability and self absorption
Loss of sense of humor
Rigid
Requires repetition
Memory decreasing
Denies problems
May be depressed
Caregiver Approaches:
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Encourage client to set simple goals by reviewing beginning, middle and end of an activity. Demonstrate
steps
Invite to activities in advance and at onset
Know that the client may be rigid in thinking so base change on relationships – be a friend
Encourage client to ask for assistance when solving problems
Help orient to day and date by using external memory cues (calendar, date book)
Help client recognize cues in environment, i.e. way finding materials
Expect misinterpretation – avoid reasoning: reassure instead
Establish a structured schedule and ADL routine
Keep communication meaningful to client
Stage 5: Moderately Severe Cognitive Decline
Appropriate for SCU, SNF or ALF
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Can look “unfinished”
Needs help to choose clothing (may wear same clothes all the time)
Needs prompting to bathe
Needs help with grooming
Withdrawal from activities
No initiation
Sensitivity to noise
Decreased visual perceptual abilities – tunnel vision, 14” in front of them
Clings to familiar people and places/hates to be alone
Hates change
Decreased communication abilities
May have delusions
Perceives he/she is 20 to 40 years old
Cognitive abilities (processing, decision-making, judgment, etc.) similar to those of an 8 year old to
adolescent
May feel physically cold
Caregiver Approaches
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24 hours care
Assess environment for hazards
Make activities failure proof
Allow additional time to perform tasks
Expect inattention to quality
Adapt activities for poor attention and direction following
Simplify communication – introduce yourself, use nouns, eliminate abstract words, use familiar objects
Structure hydration and approaches for mean intake
Match activities that interest client and match their cognitive skills
Avoid correcting – reassure
Choose clothing for client
Stage 6: Severe Cognitive Decline
Appropriate for SCU, SNF or ALF
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Looks disheveled
Needs help putting on clothing
Requires assistance bathing; may have a fear of bathing
Has decreased ability to use the toilet or is incontinent
Falling more frequently, shuffling gait, deceased posture
Eating with fingers
Difficulty transferring or standing up
Wandering and rummaging
Cognitive abilities (processing, decision-making, judgment, etc.) similar to those of a 2 to 5 year old
Experiencing cold or pain can facilitate hostility
Hard time sitting for meals
May disrobe; won’t wear glasses, shoes, dentures, hearing aids
Decreased communication – yes/no answers/gestures
Shuffling gait
Caregiver approaches:
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Anticipate all needs
Assure consistent caregivers
Understand childhood or traumatic events
Team up with a stage 5 buddy
Determine sleeping patterns
Find effective ways to redirect
Focus on safety issues with mobility, fall prevention and positioning needs
Closely monitor weight and watch for dysphagia issues
Provide props that support identity – items with highly tactile stimulation
Establish an ADL routine, break down the tasks, focus on approach to facilitate comprehension and
reduce resistance
Establish best method of communication – mirroring, props, non-verbal cues
Stage 7: Very Severe Cognitive Decline
SNF or Hospice Care
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Global Deterioration Scale, Reisberg, 1982. Reisberg, B., Ferris, S.H., de Leon, M.J., and Crook, T., American Journal of
Psychiatry, 139:1136-1139, 1982. http://web.missouri.edu/~proste/tool/cog/Global-Deterioration-Scale.pdf
Brief Cognitive Rating Scale (BCRS) http://www.zarcrom.com/users/alzheimers/4-cp8a.html
Functional Assessment Staging of Alzheimer's Disease (FAST) http://www.acsu.buffalo.edu/~drstall/fast.html