I figure before we go too far into this, that I should explain the measuring tool I’ve been using to track Jim’s decline.

This is the scale I use Global Deterioration Scale / Reisberg Scale

The most commonly used scale is often referred to simply as GDS, or by its more formal name, the Reisberg Scale or even but the lengthy name Global Deterioration Scale for Assessment of Primary Degenerative Dementia.

The GDS scale divides the disease process into seven stages based on the amount of cognitive decline in the inflicted senior.

In the below scale, elders in stages 1-3 do not typically exhibit enough symptoms for a dementia diagnosis. By the time a diagnosis has been made, a dementia patient is typically in stage 4 or beyond. Stage 4 is considered “early or mild dementia,” stages 5 and 6 are considered “middle or moderate dementia”, and stage 7 is considered “late or severe dementia”.

Global Deterioration Scale (CGS) / Reisberg Scale
Diagnosis	Stage	Signs and Symptoms	Expected Duration of Stage
No Dementia	Stage 1: No Cognitive Decline	In this stage, the person functions normally, has no memory loss, and is mentally healthy. People with NO dementia would be considered to be in Stage 1.	N/A
No Dementia	Stage 2: Very Mild Cognitive Decline	This stage is used to describe normal forgetfulness associated with aging. For example, forgetting names and where familiar objects were left. Symptoms of dementia are not evident to the individual’s loved ones or their physician.	Unknown
No Dementia	Stage 3: Mild Cognitive Decline	This stage includes increased forgetfulness, slight difficulty concentrating, and decreased work performance. People may get lost more frequently or have difficulty finding the right words. At this stage, a person’s loved ones will begin to notice a cognitive decline.	Average duration of this stage is between 2 years and 7 years.
Early-stage	Stage 4: Moderate Cognitive Decline	This stage includes difficulty concentrating, decreased memory of recent events, and difficulties managing finances or traveling alone to new locations. People have trouble completing complex tasks efficiently or accurately and may be in denial about their symptoms. They may also start withdrawing from family or friends because socialization becomes difficult. At this stage, a physician can detect clear cognitive problems during a patient interview and exam.	Average duration of this stage is 2 years.
Mid-Stage	Stage 5: Moderately Severe Cognitive Decline	People in this stage have major memory deficiencies and need some assistance to complete their daily living activities (dressing, bathing, preparing meals, etc.). Memory loss is more prominent and may include major relevant aspects of current lives. For example, people may not remember their address or phone number and may not know the time or day or where they are.	Average duration of this stage is 1.5 years.
Mid-Stage	Stage 6: Severe Cognitive Decline (Middle Dementia)	People in Stage 6 require extensive assistance to carry out their Activities of Daily Living (ADLs). They start to forget names of close family members and have little memory of recent events. Many people can remember only some details of earlier life. Individuals also have difficulty counting down from 10 and finishing tasks. Incontinence (loss of bladder or bowel control) is a problem in this stage. Ability to speak declines. Personality / emotional changes, such as delusions (believing something to be true that is not), compulsions (repeating a simple behavior, such as cleaning), or anxiety and agitation may occur.	Average duration of this stage is 2.5 years
Late-Stage	Stage 7: Very Severe Cognitive Decline (Late Dementia)	People in this stage have essentially no ability to speak or communicate. They require assistance with most activities (e.g., using the toilet, eating). They often lose psychomotor skills. For example, the ability to walk.	Average duration of this stage is 1.5 to 2.5 years.

This chart gives me a rough timeline as we continue this journey. For me, the planner, this has been the one piece of information that’s helped ease my panic and fear about what is to come.

Side Note – Doctors prefer to use the 3 stage model for Dementia (mild/moderate/severe) but I find the 7 stage model much easier to use in real life. The steps within the model aren’t as drastic a change for one to the next. It gives me better examples to place our progress and to understand what’s next and to prepare for the next stage of decline.

Looking back with the knowledge I have now, Jim was most likely half way through Stage 3 when we met and got married. At that time he was still working at a high functioning complex job. Any missteps were easily explained by the number of balls he was juggling between work, family and starting a new life with me.

He retired in 2016 and I think the sudden lack of stimulation hastened his decline. ‘Use it or lose it’ isn’t just a saying, is a fact when trying to prevent the onset of Dementia. After he started working out at the gym and socializing with people he seemed to level off.

I first recognized things were not just the natural aging process in July 2017. He could still cook multi-step meals but had difficulty grasping our overall financial picture and processing new information if it was at all complicated.

I used the chart to figure out that Jim was starting to show some signs of Stage 4 Dementia. But when I checked again three months later, after our trip to New Brunswick (see this blog entry about our trip) it was clear he was firmly in Stage 4’s grip.

In August 2019, I revisited this scale and was saddened to see that Jim was slipping into stage 5. He rarely cooked and only meals that he could do without using our new stove. He was constantly checking to see what day of the week it was on our dementia clock.

So far, he seems to be sticking to the ‘average’ length of time in each stage as described. It is a double-edged sword. It’s great because I have a timeline to prepare myself and him for what is to come but then, I also have a schedule for his decline.

If I’m not careful, I’ll start over-anticipating and smother him.