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22 Your Loved One%u2019s SymptomsPAIN ASSESSMENT IN ADVANCED DEMENTIA (PAINAD) SCALECRITERIABreathing(independentof vocalization)Normal Occasional labored breathing,short period of hyperventilationNoisy labored breathing. Longperiod of hyperventilation.Cheyne-stokes respirationsNone Occasional moan or groan. Lowlevel of speech with a negative ordisapproving qualityRepeated troubled calling out.Loud moaning or groaning. CryingSmiling orinexpressiveSad, frightened, frown Facial grimacingRelaxed Tense, distressed pacing.FidgetingRigid. Fists clenched. Knees pulledup. Pulling or pushing away.Striking outNo need to consoleDistracted or reassured by voiceor touchUnable to console, distract orreassureNegativeVocalizationFacialExpressionBody LanguageConsolabilitySCORE 0 SCORE 1 SCORE 2Change in behavior patternsSpecific body movements:tense posture, rigidity, draws up legsFrowningFidgetyLack of appetiteRestlessnessClenching JawsMoaningAggressivenessChange in behavior patternsSpecific body movements:tense posture, rigidity, draws up legsFrowningFidgetyLack of appetiteChange in behavior patternsSpecific body movements: tense posture, rigidity, draws up legsFrowningFidgetyLack of appetiteRestlessnessClenching JawsMoaningAggressivenessGlaringGrasping/AgitationPerspiringTearingIncreased BP/PulseChange in behavior patternsSpecific body movements:tense posture, rigidity, draws up legsFrowningFidgetyLack of appetiteRestlessnessClenching JawsMoaningAggressivenessGlaringGrasping/AgitationPerspiringTearingIncreased BP/PulseCrying/ScreamingThrashingNo Pain Discomfort Painful (NonDistractable) VeryPainfulWorst Possible Pain