| Impairment | None (0) | Questionable (0.5) | Mild (1) | Moderate (2) | Severe (3) |
| Memory | No memory loss or slight inconstant forgetfulness | Consistent slight forgetfulness; partial recollection of events | Moderate memory loss; more marked for recent events; defect interferes with everyday activities | Severe memory loss; only highly learned material retained; new material rapidly lost | Severe memory loss; only fragments remain |
| Orientation | Fully oriented | Fully oriented or slight difficulty with time relationships | Moderate difficulty with time relationships; oriented for place at examination; may have geographic disorientation elsewhere | Severe difficulty with time relationships; usually disoriented in time, often to place | Oriented to person only |
| Judgment and problem | Solves everyday problems and handles business and financial affairs well; judgment good in relation to past performance | Slight impairment to solving problems, similarities, differences | Moderate difficulty in handling problems, similarities, differences; social judgment usually maintained | Severely impaired in handling problems, similarities, differences; social judgment usually impaired | Unable to make judgments or solve problems |
| Community affairs | Independent function at usual level in job, shopping, volunteer and social groups | Slight impairment in these activities | Unable to function independently at these activities though may still be engaged in some; appears normal to casual inspection | No pretense of independent function outside of home; appears well enough to be taken to functions outside of family home | No pretense of independent function outside of home; appears too ill to be taken to functions outside a family home |
| Home and hobbies | Life at home, hobbies, intellectual interests well maintained | Life at home, hobbies, intellectual interests slightly impaired | Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned | Only simple chores preserved; very restricted interests, poorly maintained | No significant function in home |
| Personal care | Fully capable of self care | Fully capable of self care | Needs prompting | Requires assistance in dressing, hygiene, keeping of personal effects | Requires much help with personal care; frequent incontinence |
