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Stage One: No Impaired Behavior

A patient usually does not exhibit symptoms of memory loss or other cognitive
impairments during stage one of Alzheimer’s disease. The only way the disease
can be detected during this stage is by a positron emission tomography (PET)
scan, which is an imaging test that studies how well the brain is working. As the
disease progresses into other stages, a patient will experience more changes in
their reasoning or thinking.

Stage Two: Very Mild Impairment

Patients with stage two Alzheimer’s disease still may not show symptoms, or
they may exhibit very mild cognitive impairment. In most cases, memory loss
associated with this stage is difficult to differentiate from the symptoms of
normal aging. A patient with stage two Alzheimer’s disease may still do well on
memory tests, and symptoms are unlikely to be picked up by medical
professionals yet. Stage two is characterized by small changes that do not
interfere with a patient’s ability to live on their own.

Stage Three: Mild Decline

By stage three, a patient’s medical doctors and family members may begin to
notice memory and cognitive impairments. The three most common areas
affected during stage three Alzheimer’s disease are planning and organizing,
finding the right word to describe feelings during a conversation, and
remembering names of new places or people. A patient with stage three may
finally show signs of Alzheimer’s disease on memory and cognitive tests. During
this stage, it is common to lose personal possessions such as keys, money, and
other valuables.

Stage Four: Moderate Impairment

During stage four Alzheimer’s disease, the symptoms that began to arise in
stage three start to get worse. A patient will often forget important details
about themselves, forget what month or time of year it is, have trouble locating
the date on a calendar or perform simple math equations, and can no longer
order from a menu or cook for themselves. It is recommended that patients in
stage four no longer drive and are protected from being taken advantage of

Stage Five: Moderately Severe Impairment

During stage five, patients often experience significant confusion resulting in the
inability to get dressed or recall simple details like their phone number. They
may still maintain a moderate amount of functionality and can usually bathe
and use the restroom by themselves unassisted. They may also still recall the
names of family members and details about their past, such as their youth and
childhood. A person with stage five Alzheimer’s disease may repeat themselves
or ask the same questions over and over again.

Stage Six: Severe Impairment

Stage six Alzheimer’s disease is characterized by confusion or being unaware of

a patient’s surroundings or environment, extreme personality changes and
behavioral problems, the inability to recognize faces except for very close
friends and relatives, loss of bladder and bowel control, and wandering. A
person in stage six will need to be supervised regularly and requires the help of
professional care. He or she will need assistance with going to the bathroom,
bathing, eating and other daily activities.

Stage Seven: Very Severe Decline

The final stage of Alzheimer’s disease may be warranted by the inability to

swallow, the need for assistance in all life activities, and the failure to speak
anything except a few words or phrases. A patient in this stage is considered
near death as Alzheimer’s disease is a terminal illness. The patient is not aware
of their surroundings and can no longer tell when they are hungry or thirsty.
They may require complete assistance with eating, walking, and using the
bathroom. Patients with stage seven may no longer be able to recognize their
loved ones.
A simple personality test could be used to detect the very early signs of
Alzheimer’s, scientists claim.
Symptoms of mild behavioral impairment (MBI) - a condition which
experts believe can predict the onset of dementia - could be diagnosed
through a checklist, experts say.
Mood and behavior changes happen before the typical memory loss
issues of dementia patients and could indicate early stages of the
disease, researchers believe.
And by filling out the questionnaire, doctors would be able to identify if
people are headed in the direction of the devastating brain disease,
according to Canadian experts.
MBI is regarded as a pre-dementia syndrome for patients who still have
their independence and are typically younger than dementia sufferers.
Speaking at the Alzheimer’s Association International Conference in
Toronto, health professionals said the personality changes should be
treated as a main and early indicator of dementia.
They proposed a 35-question checklist for symptoms including repetitive
behaviour, a lack of motivation and anxiety.
Questions include:
 Has the person lost interest in friends, family, or home activities?
 Is the person less affectionate and/or lacking in emotions when compared
to her/his usual self?
 Has the person developed sadness or appear to be in low spirits? Does
she/she have episodes of tearfulness?
 Has the person become more easily frustrated or impatient? Does she/he
have troubles coping with delays, or waiting for events or for their turn?
Participants should only circle 'yes' if their behaviour has been present for
at least six months and is unusual to them.
Severity is then measured on a scale from one to three, with three
being the most dramatic change of symptoms and one the least.
Once all questions have been answered, the scores will be totalled by
health professionals who will then determine how at risk a person is.



This domain describes interest, motivation, and drive

Has the person lost interest in friends, family, or home activities? YES NO 123

Does the person lack curiosity in topics that would usually have attracted her/his interest? YES NO 123

Has the person become less spontaneous and active for example, is she/he less likely to initiate or
YES NO 123
maintain conversation?

Has the person lost the motivation to act on their obligations or interests? YES NO 123

Is the person less affectionate and/or lacking in emotions when compared to her/his usual self? YES NO 123

Does she/he no longer care about anything? YES NO 123

This domain describes mood or anxiety symptoms

Has the person developed sadness or appear to be in low spirits? Does he/she have episodes of
YES NO 123

Has the person become less able to experience pleasure? YES NO 123

Has the person become discouraged about their future or feel that she/he is a failure? YES NO 123

Does the person view herself/himself as a burden to family? YES NO 123

Has the person become more anxious or worried about things that are routine (e.g. events, visits,
YES NO 123

Does the person feel very tense, having developed an inability to relax, or shakiness, or symptoms of
YES NO 123

This domain describes the ability to delay gratification and control behavior, impulses, oral
intake and/or changes in reward

Has the person become agitated, aggressive, irritable, or temperamental? YES NO 123

Has she/he become unreasonably or uncharacteristically argumentative? YES NO 123

Has the person become more impulsive, seeming to act without considering things? YES NO 123

Does the person display sexually disinhibited or intrusive behaviour, such as touching
(themselves/others), hugging, groping, etc., in a manner that is out of character or may cause YES NO 123

Has the person become more easily frustrated or impatient? Does she/he have troubles coping with
YES NO 123
delays, or waiting for events or for their turn?

Does the person display a new recklessness or lack of judgement when driving (e.g. speeding, erratic
YES NO 123
swerving, abrupt lane changes, etc.)?
Has the person become more stubborn or rigid, i.e., uncharacteristically insistent on having their
YES NO 123
way, or unwilling/unable to see/hear other views?

Is there a change in eating behaviors (e.g., overeating, cramming the mouth, insistent on eating only
YES NO 123
specific foods, or eating the food in exactly the same order)?

Does the person no longer find food tasteful or enjoyable? Are they eating less? YES NO 123

Does the person hoard objects when she/he did not do so before? YES NO 123

Has the person developed simple repetitive behaviors or compulsions? YES NO 123

Has the person recently developed trouble regulating smoking, alcohol, drug intake or gambling, or
YES NO 123
started shoplifting?

This domain describes following societal norms and having social graces, tact, and empathy

Has the person become less concerned about how her/his words or actions affect others? Has she/he
YES NO 123
become insensitive to others feelings?

Has the person started talking openly about very personal or private matters not usually discussed in
YES NO 123

Does the person say rude or crude things or make lewd sexual remarks that she/he would not have
YES NO 123
said before?

Does the person seem to lack the social judgement she/he previously had about what to say or how
YES NO 123
to behave in public or private?

Does the person now talk to strangers as if familiar, or intrude on their activities? YES NO 123

This domain describes strongly held beliefs and sensory experiences

Has the person developed beliefs that they are in danger, or that others are planning to harm them or
YES NO 123
steal their belongings?

Has the person developed suspiciousness about the intentions or motives of other people? YES NO 123

Does she/he have unrealistic beliefs about her/his power, wealth or skills? YES NO 123

Does the person describe hearing voices or does she/he talk to imaginary people or spirits? YES NO 123

Does the person report or complain about, or act as if seeing things (e.g. people, animals or insects)
YES NO 123
that are not there, i.e., that are imaginary to others?

Questions are divided into five categories of behavioural symptoms,

including motivation, mood, impulse control, social appropriateness and
The extensive questionnaire has been designed to address a younger,
pre-dementia population and specifically emphasise any changes in
behaviour over six months or more.
Doctors have yet to finalise the scale but lead researcher Zahinoor Ismail,
from the University of Calgary, said he hopes the test could be made into
a tool for caregivers of people with dementia to measure changes over
'We may be able to create or derive a version that can be provided to
family members of older adults to determine the nature and extent of
neuropsychiatric symptoms and to measure changes over time,' he said.
Researchers believe the proposed rating scale could allow for more
accurate estimates towards the prevalence of Alzheimer’s.