Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination

Wajman, José Roberto; Oliveira, Fabricio Ferreira de; Schultz, Rodrigo Rizek; Marin, Sheilla de Medeiros Correia; Bertolucci, Paulo Henrique Ferreira

doi:10.1590/0004-282x20140002

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…In conclusion, the findings of this study suggest that the ecological functional assessment is a well-grounded alternative for objectively following and assessing the functional status of AD patients, beyond the reporting of caregiver. Thus, the incorporation and enforcement of instruments such as the one we have proposed can be of paramount importance for clinical and multidisciplinary teams to better understand the symptoms in these stages of the disease 23 , as well as to propose proper therapeutic alternatives 24 .…”

Section: Discussionmentioning

confidence: 99%

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

Wajman

Oliveira

Marin

et al. 2014

Arq. Neuro-Psiquiatr.

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Objective: Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. Method: A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). Results: Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (r,0.001), according to FAST subdivisions. Conclusion: Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.Keywords: Alzheimer disease, neuropsychology, activities of daily living. RESUMOObjetivo: Além do significativo declínio cognitivo, pacientes em estágios avançados da doença de Alzheimer (DA) também apresentam prejuízo funcional global. Este estudo investigou atividades de vida diária correlacionando teste específico para a demência grave, com escala funcional baseada no desempenho. Método: 95 pacientes com DA foram submetidos a uma bateria neuropsicológica composta por instrumentos de rastreio, a escala Functional Assessment Staging Test (FAST), o Mini-exame do Estado Mental grave (MEEMg) e escala ecológica baseada no desempenho: a Performance Test of Activities of Daily Living (PADL). Resultados: Achados consistentes emergiram da comparação entre os instrumentos. De acordo com as subdivisões da escala FAST, a PADL apresentou significativa correlação estatística com o MEEMg (r,0.001). Conclusão: Na suspeita de relato pouco confiável por parte do cuidador, escalas ecológicas podem ser úteis no estadiamento da doença. Igualmente à cognição, variados graus de funcionalidade estão presentes mesmo em fases avançadas da DA, exigindo avaliação adequada.Palavras-chave: doença de Alzheimer, neuropsicologia, atividades de vida diária.Dementias are a worldwide burden to public health systems. Given the demographic changes with a global aging trend ( faster in developing countries), estimates on the rising prevalence of these disorders are discouraging, considering associated costs in primary, secondary and tertiary levels of care . As suggested by current guidelines 2 , the progressive course of dementia might be classified in three main stages: mild -there is still some aptitude for independent life, despite the impact on instrumental activities of daily living; moderate -the abilities for independent living are limited and supervision is needed in many activities; severerestricted independence for all activities, incl...

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Section: Discussionmentioning

confidence: 99%

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

Wajman

Oliveira

Marin

et al. 2014

Arq. Neuro-Psiquiatr.

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“…After diagnostic confirmation, patients were assessed for: gender, age, schooling, marital status, estimated age of dementia onset, quantification of alcohol use or smoking, and scores on the Neuropsychiatric Inventory (NPI) [5], Mini-Mental State Examination (MMSE) [6], Severe Mini-Mental State Examination (SMMSE) [7], Clinical Dementia Rating (CDR) [8], CDR sum-of-boxes (CDR-SOB), a 15-item Clock Drawing Test (free drawing) (CDT) [9], the Index of Independence in activities of daily living (ADL) [10], Lawton's Scale for Instrumental activities of daily living (IADL) [11], and the Brazilian Version of the Zarit Caregiver Burden Interview (ZCBI) [12]. All evaluations were conducted on weekdays at morning time, by the same examiner (FFO).…”

Section: Methodsmentioning

confidence: 99%

Correlations among cognitive and behavioural assessments in patients with dementia due to Alzheimer's disease

Oliveira

Wajman

Bertolucci

et al. 2015

Clinical Neurology and Neurosurgery

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“…In conclusion, they found the severe MMSE and the SIB more sensitive for the evaluation of severe stage dementia patients than conventional screening scales like MMSE. The study of Sales and coworkers also in Brazil 10 demonstrated the utility and the reliability of the SMMSE for the brief cognitive assessment of patients with advanced dementia who pertained to low educational levels.On this issue of the Arquivos de Neuro-Psiquiatria Wajman et al 11 present the objective cognitive responses in moderate and severe Alzheimer's disease patients by way of the …”

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confidence: 99%

“…On this issue of the Arquivos de Neuro-Psiquiatria Wajman et al 11 present the objective cognitive responses in moderate and severe Alzheimer's disease patients by way of the…”

mentioning

confidence: 99%

“…On this issue of the Arquivos de Neuro-Psiquiatria Wajman et al 11 present the objective cognitive responses in moderate and severe Alzheimer's disease patients by way of the Severe MMSE (SMMSE), correlating with performance in the MMSE, and providing cutoff ranges for accurate assessment and monitoring of these patients. They evaluated, in a cross-sectional design, four hundred outpatients (N=400) with moderate and severe probable Alzheimer's Disease patients consecutively recruited from the Behavioral Neurology Section of the Universidade Federal de São Paulo, in Sao Paulo, Brazil, between November 2008 and February 2013.…”

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Cognitive assessment in severe dementia and lower levels of education: reducing negligence

Chaves

2014

Arq. Neuro-Psiquiatr.

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Dementia is a devastating age-associated syndrome which is highly prevalent among the elderly, and an increasing problem with regard to public health costs and the use of services. The prevalence of dementia was of 24.3 million in 2001, and the estimate for the worldwide increase of new dementia cases every year is 4.6 million 1 . Furthermore, two thirds of the dementia patients live in low-and middle-income countries placing South America and Brazil at the top of the problem.Because a growing proportion of older adults with dementia (and particularly Alzheimer disease -AD) are surviving to more advanced stages of the illness it is estimated that onethird of dementia patients are in severe stages 2 . Evaluating from other sources of patients, almost half of community-dwelling patients and around 60% of institutionalized residents with dementia are in moderate or severe stages of the disease 3 . Additionally, severe dementia represents a major problem from the point of view of public health because it is always accompanied by marked functional impairment and frequent psychiatric and behavioral problems, often associated with marked loss of autonomy.Despite all these facts much research attempts and clinical attention have been directed towards early diagnosis, mild and prodromal stages of this condition, leaving severe dementia relatively neglected. At any rate, the information on cognition of these patients is still based on a relatively small amount of data compared to those on earlier stages of dementia. A partial explanation of the paucity of data is the floor effect reached by most used tests. Few neuropsychological tests are currently available for this purpose, such as the Test for Severe Impairment . Nonetheless, these instruments require a considerable amount of time and specialized training to administer, consequently they are not practical for brief assessment. The Mini-Mental State Examination (MMSE) is the most widely used tool for brief cognitive assessment, due to its simplicity and reliability 7 . However, this test shows a significant floor effect 8 for patients in more advanced stages of dementia, limiting its use in the evaluation of this specific sub-group. For this reason and based on the MMSE, Harrel and associates in 2000 developed the Severe Mini-Mental State Examination (SMMSE). The SMMSE is a brief assessment that requires minimal training and no special materials.Other important aspect of the investigation of cognitive assessment in severe dementia is that most of the studies with these instruments were developed with patients of high educational level. Studies on impact of low levels of education in severe dementia patients and instruments for the assessment of cognitive abilities in these patients are even fewer. In Brazil, Wajman and Bertolucci 9 have compared the performance in the severe MMSE with a set of instruments as well as age, education, and disease duration in a sample of fifty moderate to severe probable AD patients in moderate. In conclusion, they found the severe MMSE an...

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Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination

Cited by 26 publications

References 22 publications

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

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

Correlations among cognitive and behavioural assessments in patients with dementia due to Alzheimer's disease

Cognitive assessment in severe dementia and lower levels of education: reducing negligence

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