June 10, 2023

I thought I'd include a bit about the stages that are commonly referred to for Alzheimer's, and where John falls these days. One common scale is the Global Deterioration Scale. The stages are: 1. No deficit. 2. Complaints of being forgetful. 3. Earliest clear deficits. Mild cognitive impairment. 4. Clear deficits on clinical exam. Moderate cognitive impairment. Trouble with travel and finances. 5. Can no longer survive independently in the community. Moderately severe cognitive impairment. Requires cuing for activitites of daily living (ADLs). 6. Largely unable to verblaize recent events in their life. Severe cognitive impairment. May forget name of spouse. Incontinence develops as the stage progresses. Requires increasing assistance with ADLs. Increased behavioral problems (agitation, delusions). 7.Few intelligible words or no verbal abilities. Very severe cognitive impairment. Loses ability to walk as the stage evolves. Another scale is the Functional Assessment Staging Test (FAST). The stages are: (expected duration in parentheses) 1. Normal aging - no deficits. 2. Possible mild cognitive impairment. 3. Mild cognitive impairment. (7 yrs) 4. Mild dementia (2 yrs) 5. Moderate dementia (18 mos) 6. Moderately Severe Dementia 6a. Needs help dressing (5 mos) 6b. Needs help bathing (5 mos) 6c. Needs help toileting (5 mos) 6d. Urinary incontinence (4 mos) 6e. Fecal incontinence (10 mos) 7. Severe Dementia 7a. Speaks 5-6 words during the day(12 mos) 7b. Speaks only 1 word clearly (18 mos) 7c. Can no longer walk (12 mos) 7d. Can no longer sit up (12 mos) 7e. Can no longer smile (18 mos) 7f. Can no longer hold up head (12+ mos) John is in stage 6c. He needs help toileting but is resistive to help. His vocabulary continues to slip, and he oftens makes sounds instead of words. I hear myself complaining that he isn't listening, all the while knowing he's listening but doesn't understand the simple things I'm saying. The expected duration of stage 7 is very depressing. I don't want to watch him suffer. I hope and pray that he doesn't languish that long.