Rancho Los Amigos Guide to Cognitive Levels

Rancho Los Amigos Guide to Cognitive Levels

A scale widely used to classify a neurological patient's level of cognitive dysfunction according to behavior. This scale provides eight levels with descriptors, progressing from level I (no response) to level VIII (purposeful and appropriate response), as follows:

1. No response: is unresponsive to any stimuli. 2. Generalized response: exhibits limited, inconsistent, nonpurposeful responses, often to pain only. 3. Localized response: displays purposeful responses; may follow simple commands; may focus on presented object. 4. Confused, agitated: demonstrates heightened state of activity; confusion, disorientation; aggressive behavior; inability to perform self-care; unawareness of present events; agitation, which appears as internal confusion. 5. Confused, inappropriate: is nonagitated; appears alert; responds to commands; is distractible; does not concentrate on task; demonstrates agitated responses to external stimuli; is verbally inappropriate; does not learn new information. 6. Confused, appropriate: demonstrates goal-directed behavior, needs cuing; can relearn old skills, such as activities of daily living; displays serious memory problems; exhibits some awareness of self and others. 7. Automatic, appropriate: appears appropriate, oriented; frequently acts robot-like in daily routine; has minimal or no confusion; demonstrates shallow recall; exhibits increased awareness of self, interaction in environment; lacks insight into condition; shows decreased judgment and problem-solving ability; lacks realistic planning for future. 8. Purposeful, appropriate: is alert, oriented; recalls and integrates past events; learns new activities and can continue without supervision; is independent in home and living skills; is capable of driving; demonstrates defects in stress tolerance, judgment, abstract reasoning; possibly functions at reduced levels in society.

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