Scala deteriorrii globale (Global deterioration scale, Reisberg, Ferris, De

Leon, 1985)
Dup GLOBAL DETERIORATION SCALE (Reisberg, 1982), Boala Alzheimer are 7
stadii. Stadiile 1 i 2 corespund subiecilor normali, fr risc special de evoluie spre demen.
Subiecii din stadiile 3 si 4 au un viitor nesigur, ins un numr important de subieci din
stadiul 3 vor evolua spre demen. Stadiile de la 5 la 7 corespund unui proces patologic mai
mult sau mai putin avansat.
Itemi:
1 = fr deficit cognitiv (subiect vrstnic normal, peste 65 de ani, definit prin autonomie
complet, absena tulburrii mnezice i cu funcii mnezice normale la examenul clinic).
2 = acuze subiective fr deficit mnezic obiectivabil (suferin pur subiectiv cu diminuarea
performanelor mnezice in viaa cotidian, fr efect asupra autonomiei si fr deficit de
memorie la examinare; probele Rey verbal, Rey figur complex; creion rou, cine
pechinez,frigider).
3 = acuze subiective cu deficit mnezic obiectivabil, fr s ntruneasc criteriile pentru
diagnosticul de demen (dificulti discrete in activitatea profesional, tulburri n vorbire,
tulburri n orientarea spaial, observabile de ctre familie)
4 = demena uoar (scderea capacitii de a cltori, de a face calcule, tulburri ale
memoriei de lucru - amintirea evenimentelor recent trite, tulburri de limbaj)
5 = demena moderat (necesit supraveghere i ajutor n alegerea imbrcminii, dezorientare
temporal i spaiala, scderea capacitii de a-i reaminti numele persoanelor foarte
cunoscute; ex: numele nepoilor, tulburri ale memoriei mai indeprtate)
6 = demena sever (are nevoie de supraveghere i ajutor pentru alimentare i asigurare a
igienei personale; poate apare incontinena; dezorientare in timp i spaiu i posibil
dezorientare,allopsihic)
7 = demena terminal (mutism, amimie, incontinen, rigiditate motorie, tulburri de mers)
Scala global de deteriorare (GDS: Global Deterioration Scale), claseaz
deteriorarea in sapte stadii de gravitate crescanda avand la baza criterii clinice. Este acoperita
o arie vasta de etape de dezintegrare cognitiva, permitand evaluarea usoara a pacientilor.
Scala globala de deteriorare (Reisberg, Ferris, De Leon, 1985, p.18-37):
Stadiul 1 (nici o slabire intelectuala) corespunde stadiului clinic de normalitate: nu exista
plangeri subiective, examenul clinic nu evidentiaza deficit mnezic.
Stadiul 2 (afectare intelectuala foarte usoara) marcheaza debutul alterarii mnezice: subiectul
prezinta o neliniste justificata pentru ca uita unde a pus obiectele familiare si numele vechilor
cunostinte. Examinarea nu gaseste semne obiective. Repercusiunea socioprofesionala este
nula. Acest stadiu este bine corelat cu uitarea benigna a senescenei.
Stadiul 3 (afectare intelectuala usoara) corespunde unui debut al deteriorarii. Sunt prezente
doua semne din sapte:
Pacientul s-a pierdut intr-un mediu non familiar.

Ce zi este astzi? an? lun?

Vi s-a ntmplat n ultima perioad s uitai unde ai pus anumite lucruri?
Ai ntmpinat probleme n ultima perioad n a v achita de sarcinile profesionale?
Cnd cunoatei o persoan vi se ntmpl s-i uitai numele?
n ce privete evenimentele din viaa dumneavoastr, reuii s vi le amintii pe toate?
Cele mai recente?
Dar cele mai ndeprtate?
S-a ntmplat s uitai numele persoanelor apropiate?
S-a ntmplat s pierdei obiecte de valoare n ultima perioad?
V place s cltorii singur?
Dumneavoastr v alegei singur vestimentaia sau altcineva o face?
Suntei capabil s v administrai bugetul propriu?
Randamentul la munca este diminuat.
Are dificultati in a gasi un cuvant sau un nume propriu.
Are dificultati in a retine numele unei persoane care ii este prezentata pentru prima data.
A citit un text dintr-o carte si nu a retinut decat putine lucruri.
A putut sa piarda sau sa rataceasca un obiect de valoare.
Dificultatile de concentrare sunt evidente in timpul evaluarii clinice.
Obiectivarea afectarii functiilor cognitive superioare nu poate fi pusa in evidenta decat cu
ajutorul testelor neuropsihologice.
Performantele socioprofesionale sunt alterate mai cu seama in situatii dificile. Pacientul
prezinta o anxietate moderat, dar raionalizeaz dificultile sale.
Stadiul 4 (afectare intelectuala moderata) indica o deteriorare care poate fi dovedita. Deficitul
intelectual este evident in timpul unui examen riguros:
Pacientul este mai putin la curent cu actualitatea.
Nu-si mai aminteste decat anumite evenimente din viata sa.
Concentrarea este alterata in timpul testelor de scadere in serie.
Pacientul are dificultati in a calatori singur, in a-si administra bugetul
Totusi, nu sunt perturbate:
Orientarea in timp.
Recunoasterea persoanelor si evenimentelor familiare.
Capacitatea de a merge in locuri cunoscute.
Pacientul este incapabil sa execute lucruri complexe incepe sa-si restranga activitatile si evita
situatiile de competitie. Negarea afeciunii devine norma.

Stadiul 5 (afectare intelectuala destul de grava) corespunde unei demente de debut. Subiectul
nu poate sa traiasca fara ajutor. Este incapabil sa-si aminteasca aspecte importante din viata sa
cum ar fi adresa, numarul de telefon, numele nepotilor. Este frecventa dezorientarea temporospatiala. Un subiect cu studii superioare are dificultati mari in a numara de la 40 inapoi din 4
in 4 sau de la 20 inapoi din 2 in 2. Pacientii isi pot aminti inca numele propriu, al partenerului
de viata sau al copiilor. Nu au nevoie de ajutor pentru toaleta sau alimentatie, dar pot avea
dificultati in a-si gasi hainele.
Stadiul 6 (afectare intelectuala grava) corespunde unei demente dovedite. Subiectul poate sa
uite numele sotului (sotiei), de care este dependent pentru a supravietui. Nu are constiinta
mediului inconjurator. Are dificultati in a numara de la 10 la 0, adesea de la 0 la 10. Este
dependent de altii pentru activitatile de zi cu zi. Poate deveni incontinent. Are nevoie de ajutor
pentru a se deplasa dar poate sa parcurga un traseu familial. isi cunoaste numele si poate sa-i
distinga pe apropiati de persoanele straine. Poate sa prezinte modificari in structura de
personalitate sau episoade psihiatrice: halucinatii (isi poate acuza partenerul ca este un
impostor si poate sa vorbeasca de personaje imaginare sau propria imagine in oglinda),
stereotipii psihomotorii, anxietate cu agitatie si agresivitate, apragmatism cu abulie.
Stadiul 7 (afectare intelectuala foarte grava) corespunde unei demente severe, cu pierderea
capacitatii de comunicare, de deplasare si de control sfincterian. Subiectul este total
dependent, tintuit la pat, incontinent si nu emite decat niste mormaituri.
Reisberg B., Ferris S.H., De Leon M.J., Senile dementia of the Alzheimer type: Diagnostic
and differential diagnosis features with special reference to functional assessment staging. In:
J. Traber, W.H. Gisper (eds.) Senile dementia of the Alzheimer type. Springer, Berlin, 1985, p.
18-37.
Level 1
No cognitive decline - (or Normal Adult). No subjective complaints of memory deficit. No
memory deficit evident on clinical interviews.
Level 2
Very mild cognitive decline (forgetfulness or normal older adult). Subjective complaints of
memory deficit, most frequently in the following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well. No objective evidence of memory deficit on
clinical interview. No objective deficits in employment or social situations. Appropriate
concern regarding symptoms.
Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-cut deficits.
Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes 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;
3

(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 become manifest in patient. Mild to moderate
anxiety accompanies symptoms.Deficits noticed in demanding employment situations.
Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut deficit on careful
clinical interview. Deficit manifest in 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 withdrawl from challenging situations
occur.
Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD). Patient can no longer
survive without some assistance. Patient is unable during interview to recall a major relevant
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. Frequently some disorientation 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 own names and generally know their spouse's and children's names. They require no
assistance with toileting and eating, but may have some difficulty choosing the proper
clothing to wear.
Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD). 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. Retain 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 recall their own name. Frequently continue to be
able to distinguish familiar from unfamiliar persons in their environment. Personality and
emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., paatients may accuse their spouse of being an impostor, 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 symptoms, agitation, and even previously nonexistent violent behavior may occur;
4

(d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long
enough to determine a purposeful course of
action.
6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence
Level 7
Very severe cognitive decline (Late Dementia or Severe AD). 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.
7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost