There are 3 Levels of Cognitive Impairments outlined below. Most with CSS in their day-to-day only experience Level I. For those who overdo it, by the end of the day they may experience Level II. This level is also often experienced when woken up in the middle of the night or first thing in the morning.

Level III is encountered when the individual has forced themselves, or has been forced by others, to go above and beyond overdoing it. While Level I suggests cognitive impairment, Level III suggests cognitive incompetency, with Level II being somewhere in between.

Level I is a relatively safe level to be at when leaving the home by yourself. When at Level II, it is not recommended to be out of the house by yourself for more than short trips. When at Level III, you should be bedridden to avoid accidental injury.

If you leave home at Level I and you notice symptoms from Level II kicking in, you then know you need to start heading home. Otherwise, it’s only a matter of time before things start going downhill and the likelihood of being out of the home at Level III goes up. The sooner you get home, the more likely you are able to do so safely.

Know the symptoms, know the levels, and be mindful of your level at all times.

Levels can change over the course of the day, and over the course of your life. I am a Level III if you wake me up int the middle of the night. A Level II-III in the mornings and late at night. And I’m a Level I-II during the day. Two years ago I was a Level I during the day. This means my challenges are greater now and it’s much easier for me to reach Level III. So, I have to be much more careful to maintain my safely and independence. However, at one point in time I was at Level II-III all day, so, things can change, for the worse, and the better.

Level I

• Difficulty handling finances, balancing checkbook, doing math calculations in your head.
• May pause to find words on the tip of your tongue, the names of object, or the names of people.
• Will notice you are using one word when you meant to say another either just before saying it, or immediately after.
• May struggle to articulate yourself verbally. May excel at written articulation with patience and practice.
• May feel mentally “foggy” and physically fatigued. May trip over words when speaking for a prolong amount of time.
• Can handle complex tasks with or without direction.
• Difficulty focusing and concentrating in active environments. Are somewhat easily distracted.
• May have difficulty listening to others speak and holding a conversation.
• May lose your train of thought mid-sentence, but will pick back up after a pause.
• May struggle to recall information and perform tasks in sequence. All information is recovered, but in random order. May need to keep physical lists to assist in tasks.
• May struggle with short term memory, but long term memory is intact.
• May struggle to recall how to do routine things, or may miss a step.
• May have difficulty reading due to lack of focus and attention.
• May have difficulty distinguishing left from right.
• May say or write words out of order, where you determine what to say, but one word may accidentally end up preceding another when you do not intend this to happen. When writing, letters or words may be written in the incorrect order (dyslexic-like experiences), but you will be able to notice the error. Amy be prone to misspelling, but can correct the error.
• May need to pause when seeing someone before you recognize you know them. May see someone you recognize, but may pause to remember who they are or where you know them from.
• Judgement in general is not impaired as long as you pace yourself.
• May have difficulty making decisions.
• May have difficulty integrating information like putting ideas together to form a complete picture or concept. Critical and creative thinking may be challenging.

Level II

• Have to automate bill pay and finance management. Unable to do math calculations in head. Will struggle to do math calculations by hand – or unable to do math calculations without a calculator.
• Cannot find the correct word and will often substitute with another word. May need to keep a digital thesaurus on your computer/phone. May not be able to recall the name of an object and will have to describe it. May not remember the name of a person.
• May use the wrong word without noticing, but once pointed out by others, you understand the error. Will be prone to misspelling words and may not be able to notice the error, or may notice the error, but will be unable to figure out the correct spelling.
• May not be able to articulate yourself or explain even basic things verbally. May still do well articulating through written expression and explanation.
• May feel mildly “drunk or high” mentally, physically, and emotionally. May be prone to easily crying or shouting in anger. May have trouble walking straight, bump into things. Speech may be slurred and slowed.
• Can handle complex tasks with direction, or simple tasks without direction.
• May struggle to focus and concentrate even in ideal environments. Are very easily distracted.
• May zone in and out while others speak, often asking for the speaker to repeat what they said (often the beginning, middle or end of a story). May not be able to hold conversations for long due to lack of attention and struggling to think of things to say and questions to ask.
• May lose your train of thought mid-sentence and are unable to recall where you left off or what you were talking about without assistance from others.
• Short term memory is compromised. Cannot hold images in your head. May be able to recall words and images if you stop to focus while seeing or hearing them, but otherwise may not be able to recall.
• Cannot recall information and perform tasks in sequence. All information is recovered (minutes, days, weeks), but in random order. Will need to keep physical lists and take notes to assist in tasks and recall in general. May even forget occasionally to do routine things like bathing.
• Will struggle to do routine things and will likely miss several steps unless they are listed and followed.
• May have difficulty reading due to difficulty with attention, focus, and recalling the meanings of words.
• Will struggle with identifying left and right. May remember something put on the right when it was put on the left.
• May say or write words or whole sentences out of order, where you determine what to say, but one word may accidentally end up preceding another when you do not intend this to happen. You may start telling the middle or end of a story rather than the beginning. When writing, letters or words may be written in the incorrect order (dyslexic-like experiences), and you may not be able to notice the error.
• May look right at someone you know and not recognize you know them until you are spoken to. May see someone you recognize, but may not be able to remember who they are or where you know them from. Faces are typically blurred until you intentionally focus on a face. It may take them seeing a new person several times before you remember and can recognize their face.
• Judgement can be impaired even when you pace yourself.
• May need to take a prolong amount of time to make decisions.
• Will have difficulty integrating information like putting ideas together to form a complete picture or concept. Critical and creative thinking may be highly challenging.

Level III

• Have to have a payee due to inability to manage money. Inability to make sense of calculations.
• Cannot find the words necessary. Vocabulary is highly limited. May skip words entirely in sentences without noticing.
• Will use the wrong words occasionally without noticing, and may not be able to see the error once pointed out by others. Words and meanings are often blurred, mixed, and confused.
• Cannot articulate yourself verbally or in writing. Unable to organize thoughts, words, and may experience aphasic-like experiences. May be entirely incapable of verbal communication to any extent. Can still take direction from others, and may articulate through hand gestures and body language.
• May feel highly “drunk or high” or compare competency to that of a small child. May be prone to panic attacks, accidental injury, may stagger when walking, and are a fall risk. May get frustrated and throw or hit things.
• Unable to handle simple tasks even with step-by-step direction.
• Cannot concentrate or hold focus. Is in a constant state of distraction and disorientation. May exhibit symptoms of mild to moderate delirium. May not be able to recall critical information, even personal details.
• May be confused how to use common objects, may not remember the names of others, and may not respond to their own name. May not recognize the faces of people they know well.
• May get lost in their own neighborhood, forget to look both ways before crossing the street, may grab a hot pot with bare hands, may not be able to watch a movie or television due to not being able to understand what is going on.
• May not be able to remember what happened minutes before. May not be able to recall any events that occurred at this level once they have reverted back to an earlier level.
• Unable to do routine things. Muscle memory still applies, and subconscious reactions are still present. However, anything else has to be taken step-by-step and relearned in the moment.
• Cannot read. May experience aphasic-like experiences. Language may seem foreign, or words read are not absorbed. Sentences read even aloud may not have meaning.
• Direction must be ushered physically. Left and right may not be understood.
• Judgement and critical thinking is impaired. Unable to make decisions on your own.