Below, I have enclosed a general guideline describing the 7 stages of Alzheimer's Disease. I was unable to find one specifically for Down's individuals, but I feel that this will, at least, offer a generalized breakdown of the different stages. Many professionals only use a 3 stage chart, but I have found that by further breaking the stages down, it gives a more precise picture. Furthermore, this is a generalized chart. It is very possible (and even probable) that your loved one will exhibit more than one stage's characteristics at a time.
No cognitive decline.
No subjective complaints of memory deficit. No memory deficit evident on clinical interviews.
Very mild cognitive decline (forgetfulness).
Subjective complaints of memory deficit, most frequently in the 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 regarding symptoms.
Mild cognitive decline (early confusional).
Earliest clear-cut deficits. Manifestations in more than one of the following areas: (a) patient may have gotten lost while traveling to an unfamiliar location; (b) co-workers become aware of patient's relatively low performance; (c) word and name-finding deficit become evident to intimates; (d) patient may read a passage of 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. Denial begins to manifest in patient. Mild to moderate anxiety accompanies symptoms.
Moderate cognitive decline (Late Confusional).
Clear-cut deficit on careful clinical interview. Deficit manifest in the following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of one's personal history; (c) concentration deficit elicited on serial subtractions; (d) Decreased ability to travel, handle finances, etc. Frequently no deficit in the following areas: (a) orientation to time and person; (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 occur.
Moderately severe cognitive decline (Early Dementia).
Patient can no longer survive without some assistance. Patient is unable during interview to recall a major relevent 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. Frquently some disaorientation 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 names and generally know the names of their spouses and children. They require no assistance with toileting and eating, but may have difficulty choosing the proper clothing to wear.
Severe cognitive decline (Middle 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. Retains 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 display ability to familiar locations. Diurnal rhythm frequently disturbed. Almost always recalls own name. Frequently continues to be able to distinguish familiar 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 imposter, 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 agitation, and even and even previously nonexistent violent behavior may occur; (d) cognitive abulia, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action.
Very severe cognitive decline (Late Dementia).
All verbal abilities are lost. Frequently there is no speech at all - only grunting. Incontinent of urine, requires assistance toileting and feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting and head control. The brain appears to no longer be able to tell the body what to do. Generalized and cortical neurologic signs and symptoms are frequently present.
(adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The global deterioration scale for the assessment of primary degenerative dementia. American Journal of Psychiatry, 1982.)
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