Expert: Mary Gordon - 11/25/2009

Question
Hi Mary,

My 73yr old mother has had dementia/alzheimers for about 6 years now. She's in a full time care facility now. She must be in the later stages since she has limited vocabulary. Now is seems she grunts and moans but she will have a few words pop out every once in awhile. She's even been know to sing along to a song on the radio. She has her days where she'll be able to feed herself but other days not. She's still mobile somewhat except she needs a wheel chair at times. They are giving her multiple medications a month. I'm trying to get a handle on what level of Alz she might be in at this time? Late Stage 6 or early State 7?  

Answer
Hi Keith,

As you probably know - the FAST (Functional Assessment STaging) scale is actually a continuum - so it would be rare for a person to fit neatly into a stage. Usually it's fuzzy around the edges, so many people will straddle more than one stage.

Here are the descriptors for the last two stages

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 orient 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., patients 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;
(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   

From what you are describing, it sounds like she is early Stage 7. S

Hope this helps.

Mary G.