Box 2: Global Deterioration Scale*
Stage 1 No subjective memory deficit (no cognitive
impairment); no problems with activities of daily
living
Stage 2 Subjective memory complaints (subjective
cognitive impairment): Complaints of being
forgetful, such as complaints of trouble with
recall of names; complaints of misplacing objects
Stage 3 Earliest clear deficits (mild cognitive
impairment): Difficulties often noted at work;
may have gotten lost; may have misplaced a
valuable object
Stage 4 Clear deficits on clinical examination (moderate
cognitive impairment): Decreased knowledge of
personal and/or current events; often trouble
with travel and finances
Stage 5 Can no longer survive independently in the
community without some assistance (moderately
severe cognitive impairment): Difficulty with
recall of some important personal details
(e.g., address, names of one or more important
schools attended); may require cuing for
activities of daily living
Stage 6 Largely unable to verbalize recent events in
their life (severe cognitive impairment): May
forget name of spouse; incontinence develops as
this stage progresses; requires increasing
assistance with activities of daily living;
increased behavioural problems (e.g., agitation,
delusions)
Stage 7 Few intelligible words or no verbal abilities (very
severe cognitive impairment): Loses the ability
to walk as this stage evolves
*Abridged version © Barry Reisberg MD, 2008. Modified from Reisberg
B, Ferris SH, de Leon MJ, et al. The global deterioration scale for
assessment of primary degenerative dementia. Am J Psychiatry
1982;139:1136-9.