Comparison between neuropsychological evaluation instruments for severe dementia

Abstract

-Objective: To study the correlation between two tools for cognitive evaluation, Mini-Mental State Examination-severe (MMSE-s) and Severe Impairment Battery (SIB), and the Bristol Daily Activities Functional Scale. Method: 50 patients from the Behavioral Neurology Section -EPM-UNIFESP -were evaluated. Mean age was 76.8±7.9 (range 57 to 95); 32% were males; mean education was 5.0±2.3 years (range 4 to 15); mean disease duration was 3.9±1.5 years (range 2 to 10). Results: Preliminary results in a small sample drawn from the study group do indicate a difference between the three cognitive scales. SIB and MMSE-s had a better correlation with functional score than MMSE, and MMSE-s had a correlation slightly better than SIB. Conclusion: These data indicate that it is possible to follow dementia patients up to severe stage as long as adequate instruments are used, and that there may be differences between scales with regard to sensitivity.KEY WORDS: cognitive tests, daily activities functional scale, dementia. AD is the most common dementing disorder in the elderly population. Typically this disorder has a insidious onset, with progressive decline of memory, followed by other cognitive areas, such as executive function, language, and praxis 2 . It is estimated that in the United States only more than four million elderly have dementia at a severe stage and another one and half million dementia at mild or moderate stage. It is expected that the population with dementia in that country will rise to nine million by 2030 3 . Investigations in São Paulo state hinterland showed the same trend 4 , with an estimated 750 thousands to one million Brazilians with dementia. The realization of the huge dimension of AD has brought a lot of interest in treating and following these patients as they progress to more advanced disease stages. Many scales have been developed for the evaluation of pre-clinical, mild and moderate stages 5 , but the same is not true for the evaluation of patients in more severe stage, for whom relatively few investigations have been undertaken 6 . Comparação de instrumentos de avaliação neuropsicológica para a demência grave RESUMO -The evaluation of cognitive abilities in these patients would fill several clinical and research needs, like the identification of less affected cognitive areas, which could in turn be used by health professionals

Is there correlation between cognition and functionality in severe dementia? The value of a performance-based ecological assessment for Alzheimer’s disease

“…All patients met Diagnostic and Statistical Manual of Mental Disorders -DSM-IV 2 diagnostic criteria for probable AD. For inclusion in the study protocol, each patient should score between five and fifteen points (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) We excluded patients who did not spend time with the same caregiver at least four daily hours for at least four days per week, patients who had any uncorrected visual or auditory deficits that could affect their evaluation (inadequate or unsuited prostheses), and patients with history of cerebrovascular diseases (ischemic or hemorrhagic strokes) in the 12 months preceding the neuropsychological assessment.…”

“…For specific cognitive evaluation, we employed the Severe Mini-Mental State Examination -MMSEsev 11,12 . The MMSEsev is based on the original version of the MMSE 8 , but with simpler questions, including self-recognition, orientation, responding to simple commands, constructive skills, semantic verbal fluency, and memory.…”

Correlation and adaptation among functional and cognitive instruments for staging and monitoring Alzheimer?s disease in advanced stages

“…As pointed before 21 , methods for intervention could improve quality of life for both patient and family, bringing information on cognition and functionality still preserved that are not assessed due to inadequate methods of evaluation.…”

Confirmatory factor analysis of the general activities of daily living scale: further evidences of internal validity

“…This probably occurred due to the low variance of the measure, since our sample only included patients with moderate or milder dementia, and this activity is usually impaired in advanced stages of dementia. 7 Therefore, GADL is a brief, easy to use, and wellvalidated measure of functional performance for the assessment of older adults as increasing evidence suggests. Future studies should attempt to replicate these results in other samples, thus heightening the reliability and consistency of GADL for clinical use.…”