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IDEAL Dementia Severity Scale |
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The IDEAL schedule is a global clinical staging schedule for dementia,
The 7 domains are explored in 10 questions :
The IDEAL schedule can be used to monitor symptom progression, response to treatment and health care needs. |
| You can access the glossary for each item by clicking the "instructions" link in the top right of the screen |
1. Activities of daily living |
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Fully independant
Completely dependent on others
for all activities |
The patient is fully independent, and is able to perform all activities of daily living.
S/he is able to occupy a significant function in the home (e.g. cooking, gardening, shopping, paying of bills),
and is fully able to maintain self-care (e.g. dressing, maintaining of personal hygiene).
The patient is unable to perform any activities of daily living, and is completely dependent on others for all activities.
S/he requires significant help with self-care (e.g. needs help dressing, is unable to maintain personal hygiene),
is unable to occupy a significant function in the home (e.g. is unable to cook or prepare food, unable to pay bills, or to go shopping),
and is unable to work.
2. Physical health |
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No physical illness
or physical illness does not need regular control / treatment Physical illness requires intensive control
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The patient is either a) completely healthy and has no physical illness, disability or complaints,
or b) has a minor physical illness or disability, but one which needs no regular control or treatment.
The patient has a major physical illness or disability, which requires major intervention such as heavy medication, surgery or intensive therapy.
The illness or disability has a significant impact on the patient’s ability to function (e.g. s/he may be unable to move around, or perform usual activities).
3. Cognitive functioning |
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Normal cognition
Severe cognitive impairment
(consider judgment, memory, language, handling visuospatial abilities) |
The patient has normal cognitive functioning for his/her age, including in terms of:
memory (i.e. no or only slight memory loss or forgetfulness),
language (i.e. is able to speak coherently, and read and write to the same standard as usual),
judgment (e.g. is able to make decisions independently),
handling of complex tasks (e.g. is able to handle finances),
and visuospatial tasks (e.g. has no difficulties operating apparatuses as usual).
The patient has a high score on the MMSE, or an equivalent score on a similar mental status examination or neuropsychological test.
The patient is severely impaired in cognitive functioning, displayed by one or more of the following:
severe memory loss (e.g. is unable to remember where s/he was born, or whether s/he is married),
severe impairments in learning, i.e. is unable to acquire and remember new information (e.g. repetitive questions or conversations,
getting lost on familiar routes), severely impaired language, including in speech, reading or writing (e.g. has difficulties thinking of common words when speaking,
has lost the ability to read or write), poor judgment and/or severely impaired reasoning (e.g. poor decision-making ability),
inability to handle complex tasks (e.g. is unable to manage finances),
impaired visuospatial abilities (e.g. is unable to recognize faces or common objects, or to operate simple apparatuses),
impaired problem-solving. The patient has a very low score on the MMSE, or an equivalent score on a similar mental status examination or neuropsychological test.
4. Behavioural and psychological symptoms |
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Normal behaviour and/or mood
Severely disturbed behaviour
and/or mood/severe psychiatric symptoms |
The patient displays no signs of disturbed behaviour or mood.
His/her hobbies and interests are well maintained, and there are no signs of abnormal or socially unacceptable behaviours.
The patient displays no psychiatric symptoms, for example symptoms of depression or anxiety.
The patient is severely disturbed in his/her behaviour, personality, or mood.
For example, s/he may have no interest in previous activities, may display socially unacceptable behaviours,
or compulsive or obsessive behaviours, or be impaired in motivation or initiative;
s/he may display uncharacteristic mood fluctuations such as agitation or agressivity,
or be apathetic or socially withdrawn, or show a loss of empathy.
S/he may display severe psychiatric symptoms, for example severe depression, anxiety or psychosis.
5. Social support |
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Sufficient social support
No or severely insufficient social support
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The patient is embedded in a well-functioning social network.
The patient has sufficiently meaningful relationships with either family members, friends or colleagues,
who regularly provide either emotional, material or care support to the patient according to the needs of the patient.
For example, the patient is in regular contact with several family members, friends or colleagues, who together provide sufficient support to the patient.
The patient is not embedded in a well-functioning social network.
The patient either has no contact with family members, friends or colleagues,
or does not have meaningful relationships with them, i.e. the patient has no family members, friends or colleagues
who provide regular emotional, material or care support.
For example, the patient may be living alone with no support from family members, friends or colleagues.
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Non-professional care dimension 6.1 Time spent on care by non-professional carer
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No non-professional carer
Non-professional carer provides full-time care
(30 hours or more per week) |
The patient has no non-professional carer.
Non-professional carers include only carers who are not employed by the health care system, for example family members of the patient.
The care may be due to the dementia, or some other illness or disability.
The patient has one or more non-professional carers who together provide full-time care to the patient (i.e. at least 30 hours per week in total).
This includes only carers who are not employed by the health care system, for example family members of the patient.
The care may be due to the dementia, or some other illness or disability
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Non-professional care dimension 6.2 Carer distress |
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No carer distress
Severe carer distress
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The patient either a) has no non-professional carer,
or b) has one or more non-professional carers who are coping well and are content with their carer’s role,
and the relationship between the patient and carer(s) is not violent or abusive.
This includes only carers who are not employed by the health care system, for example family members of the patient.
The patient has one or more non-professional carers who are severely distressed and/or not coping with their role as a carer.
For example, the carer(s) may feel very overwhelmed by their role as a carer,
may display depressive symptoms as a result of their role as a carer, the patient may be violent or abusive towards the carer(s) (or vice versa),
or lay or professional support has already had to be installed to support the carer(s).
Carer distress will usually relate to carers of the patient who are not employed by the health care system, for example family members.
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Professional care dimension 7.1 Total number of hours of professional care received
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No professional care received
Full-time
(30 hours or more per week) professional care received |
The patient receives no professional care.
This includes any care for the dementia as well as for non-dementia related care, for example for a physical illness or disability.
The patient receives full-time professional care in total (i.e. at least 30 hours per week).
This includes any care for the dementia as well as for non-dementia related care, for example for a physical illness or disability.
For example, the patient may have a full-time professional carer in his/her home, or may live in a nursing home or hospital.
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Professional care dimension 7.2 Total number of hours of professional care needed
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No professional care needed
Full-time
(30 hours or more per week) professional care needed |
The patient has no need for professional care.
This includes any care for the dementia as well as for non-dementia related care, for example for a physical illness or disability.
The patient requires full-time professional care (i.e. at least 30 hours per week).
This includes any care for the dementia as well as for non-dementia related care, for example for a physical illness or disability.
For example, the patient may need a full-time professional carer in his/her home, or may need to live in a nursing home or hospital.
The item should be rated in the same way, regardless of whether or not this care has already been installed. For example, the same rating would be given if a) the patient needed full-time professional care but was not receiving it yet, or b) the patient was already receiving full-time professional care.
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Professional care dimension 7.3 Type of dementia-related care needed |
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Informal dementia-care only needed
Complete institutionalization
(24 hours a day, 7 days a week) needed for dementia |
The patient requires a) no dementia-related care,
or b) only informal (non-professional) care for the dementia, for example care from the patient’s wife/husband or other family member.
The item should be rated in the same way, regardless of whether or not this care has already been installed.
The patient requires complete institution-based formal care for the dementia, 24 hours a day, 7 days a week – for example in a nursing home or hospital.
The item should be rated in the same way, regardless of whether or not this care has already been installed.
Results |