global deterioration scale (GDS)

Introduction

Score:

• no cognitive decline
• very mild cognitive decline
  • subjective complaints of memory deficit, most frequently
    • forgetting where he/she put familiar object
    • forgetting names he/she formerly knew well
  • no objective evidence of memory deficit on clinical interview
  • no objective deficits in employment or social situations
  • appropriate concern with respect to symptomatology
  • prognosis: benign in 95% over a 4 year period
• mild cognitive decline
  • earliest clear cut deficits
  • manifestations in more than 1 of the following areas:
    • getting lost in an unfamiliar location
    • co-workers become aware of patient's poor performance
    • word & name-finding deficits become evident to spouse, family & close friends
    • patient may read a passage or a book & retain very little information
    • diminished ability to remember names when introduced to new people
    • patient may have lost or misplaced an object of value
    • a concentration deficit may be evident on clinical testing
  • prognosis: > 80% show no further decline in 4 years
• moderate cognitive decline
  • clear clut deficit on careful clinical interview
  • deficit manifests in the following areas
    • decreased knowledge of current & recent events
    • may exhibit some deficit in memory of one's personal history
    • concentration deficit on serial subtractions
    • decreased ability to travel, handle finances etc.
  • frequently NO deficits in the following areas
    • orientation to time & person
    • recognition of familiar persons & faces
    • ability to travel to familiar locations
  • inability to perform complex tasks 1]] denial is the dominant defense mechanism
    • flattening of affect & withdrawal from challenging situations occur
  • prognosis at 4 years
    • 25% show no change
    • 25% are worse, but at home
    • 25% are institutionalized
    • 25% are dead
• moderately severe cognitive decline
  • patient can no longer survive without some assistance
    • patient is unable during interview to recall a major relevant aspect of current life (addresses, telephone numbers, names of close family members)
  • frequently some disorientation to time (date, day of week, season) or place
  • an educated person may have difficulty back from 40 by 4's or 30 by 2;s
  • may retain knowledge of many major facts regarding themselves & others
    • they know their own names & generally their spouse's name & the names of their children
  • NO assistance needed for toileting & eating, but may have some difficulty with choosing proper clothing
  • prognosis: most are worse after 4 years
• severe cognitive decline
  • may occasionally forget the name of spouse upon whom they are entirely dependent upon for survival
  • largely unaware of recent events & experiences in their lives
  • some, but sketchy knowledge of remote events
  • generally unaware of their surroundings (year, season etc)
  • may have difficulty counting from ten, backward & sometimes forward
  • will require some assistance with basic activities of daily living (bADL)
  • may occasionally display ability to travel to familiar place
  • diurnal rhythm is frequently disturbed
  • nearly always able to recall their own names
  • frequently able to distinguish familiar from unfamiliar persons
  • personality & emotional changes occur,variable & include
    • delusional behavior
    • obsessive symptoms
    • symptoms of anxiety, agitation & violent behavior
    • cognitive abulia (i.e. loss of will power, because of an inability to think long enough to execute purposeful behavior)
  • prognosis at 4 years
    • 2/3 are institutionalized
    • 1/3 are dead
• very severe cognitive decline
  • non verbal, frequently only grunting
  • incontinent of urine
  • requires assistance toileting & eating
  • loses basic psychomotor skills (ability to walk)
  • generalized & cortical neurologic signs/symptoms are frequently present

More general terms

• numerical rating scale (NRS)