Table 1.

Staging of advanced dementia

SCALE	SEVERITY LEVEL	CHARACTERISTICS
Clinical Dementia Rating (CDR; Hughes et al., 1982)	CDR 3: Severe	Severe memory loss; only fragments remain. Orientation to person only. Unable to make judgments or solve problems. No significant function in home outside of own room. Requires much help with personal care; often incontinent.
Functional Assessment of Alzheimer Disease (FAST; Sclan and Reisberg, 1992)	Stage 6: Moderately Severe	Requires physical assistance in putting on clothes properly. Requires assistance in bathing properly. Requires assistance with mechanics of toileting. Urinary incontinence. Fecal incontinence.
	Stage 7: Severe	Speech limited to about six words in the course of an average day. Intelligible vocabulary generally limited to a single word in the course of an average day. Ambulatory ability lost. Ability to sit up lost. Ability to smile lost. Ability to hold head up lost.
Global Deterioration Scale (GDS; Reisberg et al., 1982)	Stage 5: Moderately Severe	Patients can no longer survive without assistance. They cannot recall major relevant aspects of current lives. May be disoriented to time or place. They require no assistance with toileting or eating but may require help choosing proper clothing and dressing.
	Stage 6: Severe	Largely unaware of all recent events and experiences. Retain some knowledge of past lives. Unaware of surroundings. Require substantial assistance with ADLs. May be incontinent. Frequently exhibit neuropsychiatric symptoms.
	Stage 7: Very Severe	All verbal abilities are lost. Incontinent of urine. Requires assistance in toileting and in eating. Loss of psychomotor skills. Generalized cortical and focal neurologic signs and symptoms are frequently present.
International Classification of Diseases (ICD-10; World Health Organization, 2007)	Severe	The degree of memory loss is characterized by the complete inability to retain new information. Only fragments of previously learned information remain. The individual fails to recognize even close relatives. The decline in other cognitive abilities is characterized by an absence, or virtual absence, of intelligible ideation.
Mini-mental State Examination (MMSE)	Moderately severe*	Score range is 11–17 *Tombaugh and McIntyre (1992)
Folstein et al. (1975)	Severe	Score range is 0–10
Severe Impairment Rating Scale (SIRS) Rabins and Steele (1996)	Very Severe	Determines severity level for individuals who score less than 6 on the MMSE.