4 Dementia Staging Tools for Speech Therapy (Free PDFs!)

Speech therapy plays an important role in managing cognitive-communication and swallowing difficulties in all stages of dementia. 

Dementia staging tools can help you offer better treatment to patients and their care partners.

In this article, you will learn the stages of dementia, 4 dementia staging tools, and speech therapy’s role along the journey.

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What Is Dementia Staging?

Dementia can impact many important functions, including cognition, swallowing, and communication. Symptoms will depend on which parts of the brain are affected and the type of dementia a patient has (Mayo Clinic, 2024).

It’s progressive, which means that the condition gets worse over time. Dementia staging can tell you where the patient is in this progression and where they’ll likely be in the future.

Speech therapy can use standardized dementia staging assessment tools to identify current cognitive-communication abilities. Staging can also determine the progression and prognosis of a patient’s dementia (Rikkert et al., 2011).

Check if your facility offers training on dementia staging tools. There are also online trainings for some of the tools, including the Brief Cognitive Assessment Tool (BCAT®).

The Benefit Of Early Dementia Staging

Whenever possible, identify cognitive-communication deficits early in patients with dementia. Early intervention can help you make decisions that maximize your patient’s quality of life and care.

Early dementia staging can help (you):

  • Guide your speech therapy plan of care based on your patient’s level of need
  • Choose appropriate treatment and strategies
  • Offer functional and meaningful support to the patient with dementia and their carers

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Popular Dementia Staging Tools

We’ll review 4 well-regarded dementia staging tools: the Clinical Dementia Rating Scale, the Global Deterioration Scale, the Functional Assessment Staging tool, and the Arizona Battery For Communication Disorders Of Dementia.

1. Clinical Dementia Rating Scale

The Clinical Dementia Rating Scale (CDR®) was developed in 1979 to stage dementia severity for the Memory and Aging Project. It’s available in over 30 languages.

A 2011 systematic review found the CDR to be the best-evidenced dementia scaling tool (Rikkert et al.)

It assesses 6 domains of cognition, including orientation and memory, and it is scored on a five-point scale:

  • 0 = none
  • 0.5 = questionable or very mild dementia 
  • 1 = mild 
  • 2 = moderate 
  • 3 = severe

You can download the CDR for free on the Washington University Website. Then use an online scoring algorithm for accurate (and easy!) scoring.

clinical dementia rating scale
Screenshot from the Washington University
in St. Louis webpage

The Atherosclerosis Risk Communities Study (ARIC) also offers printable instructions for the Clinical Dementia Rating Scale.

2. Global Deterioration Scale (GDS)

the 7 stages of dementia

The Global Deterioration Scale (GDS), also known as the Reisberg Scale, is a dementia staging tool that is most often used with Alzheimer’s dementia (Reisberg et al., 1982).

It is a seven-stage model that scores cognitive decline from normal aging to severe dementia.

Share and save the infographic above for reference. And for more information, read a summary of the 7 stages and download the Global Deterioration Scale PDF.

3. FAST Dementia Staging: Functional Assessment Staging Tool

The FAST, or “Reisberg FAST”, is another seven-stage dementia staging tool used to identify dementia progression, particularly in Alzheimer’s disease (Sclan & Reisberg, 1992). The FAST is widely used and has notable reliability (Rikkert et al., 2011).

FAST Stages of DementiaCharacteristics
1. Normal AgingNo difficulty.
2. Possible Mild Cognitive Impairment The patient notices difficulties.
3. Mild Cognitive ImpairmentOthers notice difficulties.
Impacts most complex tasks.
4. Mild DementiaInstrumental activities of daily living affected.
5. Moderate DementiaNeeds help choosing the proper clothes to wear.
6. Moderately Severe Dementia Need help with ADLs.
Develops incontinence.
7. Severe DementiaIncreasing loss of speech.
Increasing loss of motor skills.

Here is a link to the Functional Assessment Staging Test PDF.

4. Arizona Battery For Communication Disorders Of Dementia (ABCD)

The ABCD is a standardized cognitive-communication assessment for mild to moderate neurocognitive disorders, including dementia (Armstrong et al., 1996).

The ABCD contains 17 brief subtests that evaluate five domains, including language expression, language comprehension, and different aspects of memory. You can purchase the ABCD on the publisher’s website.

Speech Therapy’s Role In Each Stage Of Dementia

Dementia Staging Tools for Speech Therapy

In speech therapy, we often refer to the stages of dementia as early, middle, and late. Here are the common symptoms of dementia and your role in each of these stages.

Early Stages of Dementia (Mild Dementia) 

In the early stage of dementia, cognitive-communication deficits are often subtle but can still impact daily life and functioning. 

Common signs of early-stage dementia include:

  • Decreased ability to remember and retain new information
  • Mild word-finding difficulties
  • Difficulty following complex conversations
  • Trouble with thought organization, especially when speaking 
  • Mild dysphagia symptoms may emerge (e.g. coughing on thin liquids, prolonged chewing) (Suiter & Gosa, 2019)

What Is Speech Therapy’s Role In Early-Stage Dementia?

Middle Stages of Dementia (Moderate Dementia)

Symptoms of middle-stage dementia may include:

  • Difficulty engaging in conversations
  • Reduced language comprehension
  • Increased difficulty with problem-solving, memory, and reasoning
  • Significant word-finding difficulties
  • Personality changes (Sutin et al., 2023)
  • Increased signs and symptoms of dysphagia (e.g. weight loss, coughing on food and liquids, etc.) (Suiter & Gosa, 2019).

What Is Speech Therapy’s Role In Middle-Stage Dementia?

At the middle stage of dementia, your patient will need increased strategies and support for progressing cognitive and communication challenges.

Late Stages of Dementia (Severe Dementia)

In the late stages of dementia, communication, cognition, and swallowing abilities deteriorate significantly. Symptoms may include:

  • Loss of verbal language (patient may be nonverbal)
  • May only use facial expressions, gestures, or vocalizations to communicate
  • Limited comprehension of spoken language
  • Severely impaired cognition
  • Relying on care partners for activities of daily living
  • Severe dysphagia

What Is Speech Therapy’s Role In Late-Stage Dementia?

Speech Therapy and Dementia Materials

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References

Adult Speech Therapy

Alisha Kleindel is an instructor of speech-language pathology at Midwestern University with over 15 years of full-time speech therapy work experience. Miwa Aparo is a researcher, editor, and occupational therapist. Chung Hwa Brewer is an SLP and instructor at Western Washington University’s Communication Science Disorders program. More about us →