Please click on one of the subjects below for more more information about that subject. General Information The Three Major Stages of Alzheimer's Disease? The Clinical Dementia Rating Scale The Functional Assessment Scale [FAST] GENERAL INFORMATION     A variety of scales and rating systems have been devised to describe the stages of alzheimer's disease. We will discuss some of the major rating scales here, but remember, that every patient is different. Some patients have different symptom clusters. Still, some patients decline more rapidly than others. Thus, not all patients can be classified neatly into one stage or another with absolute certainty. THE THREE MAJOR STAGES OF ALZHEIMER'S DISEASE     The first stage is the early or mild stage. Onset of the disease occurs at this stage and it may be four or more years until a diagnosis of alzheimer's disease is established. Changes in memory, thinking, and behavior are usually gradual at this stage. Many persons appear almost normal. However, the affected patient usually knows that he or she has problems with memory and thinking. Often, patients try to compensate for problems and hide their illness from other family members. Denial may be a problem. Patients usually are still able to work and drive a car successfully at this stage. The initial symptom seen in more than 60% of patients prior to diagnosis is memory loss. Later on in this stage, memory problems can lead to problems at work ,where co-workers may notice subtle changes in the patient's job performance. During the early stage, patients become careless in their appearance. They begin to lose interest in hobbies and friends.They become apathetic. Some people become depressed, angry, and frustrated , probably because they cannot remember or do things the way they used to. There are not many physical changes in the affected person at the mild stage. Motor movements, such as walking, may begin to slow. Some patients begin to show weight loss, despite eating normally. Still other patients become hyperphagic, and eat more food than normal. The second or moderate stage of alzheimer's disease is the longest of all the stages. This stage may last from 3 to 10 years. Symptoms of the disease become so apparent at this stage, that diagnosis is usually made at this stage. Problems with short term memory become especially severe. In addition, patients lose their ability to concentrate and think. They forget appointments. They may have problems telling the time from a clock, balancing checkbooks, counting money,or be unable to do grocery shopping. At this stage, patients become agitated and frustrated. Some patients wander. Others get day and night confused,and,thus , sleep during the day and wander at night(This is referred to as sundown syndrome). Patients become increasingly forgetful of personal hygiene,such as bathing and brushing teeth. Patients develop hallucinations and delusions at this stage. Some patients forget where they put things and claim that others have stolen their lost items. Some patients lose the ability to recognize friends, family, or self at this stage. On a "good" day, they may recognize you, but on a "bad" day, they may not know you at all. Some patients become unable to recognize who they are in a mirror. Patients lose the ability to drive early in this stage. However, many continue to drive and they have increasing numbers of motor vehicle crashes, since they cannot recognize common signs ,such as stop signs. Many patients cannot find their way home, even if walking. Toward the end of this stage, declines in thinking, memory, and activities of daily living(such as dressing,bathing,walking) become greatly impaired. The third or severe stage may last one to three years. In this stage, patients become severely-dependent upon others to help them. They lose the ability to speak and to recognize friends and family. In this stage,many patients become very inactive. They don't walk, talk, or move. There is little emotional expression. Many become bedridden. Weight loss is quite common. Patients become incontinent and need total care for even simple needs. Many patients develop skin ulcers because they are immobile, bedridden, and malnourished. Patients become very prone to falls and infection. Hip fractures are a frequent complication of falls. Most patients die from sepsis or pneumonia. THE CLINICAL DEMENTIA RATING SCALE     Washington University, St. Louis, has developed a Clinical Dementia Rating Scale. The scale is used by researchers conducting studies and is useful as a guide to plan care for patients. Specially-trained nurses, doctors,and psychologists interview family and patient and then provide ratings to different categories of behavior and thought. Finally, using an algorithm, a final Clinical Dementia Rating is assessed. Six categories are tested: memory, orientation, judgement, commununity affairs, home and hobbies, and personal care. A five point scale is used to rate each category: 0 is normal, 0.5 is questionable impairment , 1 is mild impairment, 2 is moderate impairment, and 3 is severe impairment. THE FUNCTIONAL ASSESSMENT STAGING SCALE [FAST]     Barry Reisberg,M.D. and associates at the New York University Medical Center Aging and Dementia Research Center developed this scale which charts the decline of people with alzheimer's disease. The FAST scale has seven stages: 1 which is normal adult,2 which is normal older adult, 3 which is early alzheimer's disease, 4 which is mild alzheimer's disease, 5 which is moderate alzheimer's disease, 6 which is moderately severe alzheimer's disease, and 7 which is severe alzheimer's disease. FAST stage 1 is the normal adult with no cognitive decline. FAST stage 2 is the normal older adult with very mild memory loss. Stage 3 is early alzheimer's disease. Here memory loss becomes apparent to co-workers and family. The patient may be unable to remember names of persons just introduced to them. Stage 4 is mild alzheimer's disease. Persons in this stage may have difficulty with finances, counting money, and travel to new locations. Memory loss increases. The person's knowledge of current and recent events decreases. Stage 5 is moderate alzheimer's disease. In this stage, the person needs more help to survive. They do not need assistance with toileting or eating, but do need help choosing clothing. The person displays increased difficulty with serial subtraction. The patient may not know the date and year or where they live. However, they do know who they are and the names of their family and friends. Stage 6 is moderately severe alzheimer's disease. The person may begin to forget the names of family members or friends. The person requires more assistance with activities of daily living, such as bathing, toileting, and eating. Patients in this stage may develop delusions, hallucinations, or obsessions. Patients show increased anxiety and may become violent. The person in this stage begins to sleep during the day and stay awake at night. Stage 6 is severe alzheimer's disease. In this stage, all speech is lost. Patients lose urinary and bowel control. They lose the ability to walk. Most become bedridden and die of sepsis or pneumonia.