Table 1.

Dementia Disability Rating

	IMPAIRMENT
	None (0)	Slight (1)	Mild (2)	Moderate (3)	Severe (4)
Awareness & Orientation	Fully oriented to time, space, location and/or context	Modest/occasional disorientation to time, space, location and/or context	Significant disorientation to time space, location and/or context. Regularly reliant on cues	Marked disorientation to time, space, location and/or context. Generally needs active guidance	Complete disorientation to time, space, location and context; needs constant guidance; may be oriented to self
Speech & communication	Normal speech fluency, and no impairment in comprehension or pragmatics (i.e., exchange)	Detectable abnormality of speech fluency, comprehendsion, or pragmatics, but no difficulty conversing	Obvious impairment of fluency, comprehension or pragmatics, but with effort and/or assistance is able to converse	Marked impairments, cannot converse, usually can provide responses and make simple requests or comments	Little or no communication; generally not able to provide responses, or to make requests or comments
Self care & home maintenance	Normal, does not need any help with home maintenance and self-care tasks	Slight difficulty with home/self-care tasks; may need occasional reminders	Often needs reminders and prompting for home/self-care tasks; needs supervision with complex or multistep tasks	Needs supervision and practical assistance with most home/self-care tasks	Complete dependence on others for self-care
Life skills & problem-solving	No difficulty with home or work skills, routines, or transactions, or in solving everyday problems	Modest/occasion al difficulty with skills, routines, transactions or solving problems, performance is generally adequate	Significant difficulty with skills, routines, transactions or problem-solving; frequent judgment errors; performance is impaired, needs supervision	Marked difficulty; judgment very impaired; able to make simple decisions (e.g. what to wear or to eat) and/or able to do simple tasks (e.g. folding laundry)	Basic skills essentially lost. Cannot do any routines or transactions, or make any judgments; generally requires assistance with basic tasks
Comportment & socialization	Normal attitudes, habits, and social graces; sensitive to others; conforms to social rules and expectations. Maintains normal involvement in family life, and professional and community activities	Modest change in emotional or social involvement; sometimes appears disconnected. Lapses in empathy; Modest/occasional inertia, or transgressions, disinhibited or self-centered acts, or carelessness	Reduced involvement; frequent or moderate inertia; frequent disinhibited, self-centered or careless acts, or transgressions, or lack of empathy. Neglects interests; participation in activities may require coaxing	Little involvement. Everyday comportment is dominated by indifference and/or inertia; or by impusions, intrusive acts, loss of graces, rigid routines or compulsions, etc. Interests abandoned; participation in activities is modest and usually requires direction	Profound loss of involvement; disconnected from immediate environment. Severe disruption of behavior. profound inertia, purpose- lessness, environment dependence or perseverative actions. Little or no interaction with others, cannot participate in activities