TABLE 31-3

STAGES OF ALZHEIMERS DISEASE

STAGE Mild (MMSE* score = 20-30)

DURATION (YEARS) CHANGES 2-3 Decreased short-term memory Word- and name-nding difculties Decision-making, concentration, reasoning, and judgment problems Difculty performing usual activities Denial Getting lost Repetitive questioning Apraxia, agnosia, aphasia with poor comprehension, disorientation, blunting of affect, misidentication, sleep disturbance, delusions, needs assistance with activities of daily living Redirectable, extreme emotional lability, self-absorption, supervision with meals, wandering, urinary incontinence, requires supervision Gait disturbance, unable to feed self, double incontinence, bowel impaction, bed bound, difculty swallowing, fetal position; requires 24-hour supervision, close observation, or both

Moderate (MMSE score = 10-19)

3-4

Severe (MMSE score = 0-9)

5-10

*MMSE, Mini-mental state examination. Modied from Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12, 189.