The Mattis Dementia Rating Scale in Nursing Home Octogenarians and Nonagenarians: Effects of Age and Education

Abstract

Despite their increasing representation in the population, little is known about the neuropsychological test performance of the oldest old, particularly those who live in residential settings. Limited published data and clinical experience suggest that this group is more likely to perform in the impaired range on standardized tests when cut-offs developed with younger groups are used. We examined the Dementia Rating Scale (DRS) performance of 82 nondemented nursing home residents, aged 80 to 99, with a mean education level of 11 years. Using published norms and cutoffs, a large percentage of this sample performed in the impaired range, particularly on the initiation and conceptualization subtests and on the total score. Education, but not age, was significantly related to performance in this sample. Percentages of patients misclassified were substantial in all groups, but were higher in those with less than 13 years of education. Using a lower total-score cutoff of 110 reduced the percentage of misclassifications markedly. We recommend the development and use of revised cutoff scores for the evaluation of very elderly nursing home residents.

Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease

“…The results found in this study confirm the influence of the variables age and schooling in the DRS 12,20,24,25 . The Conceptualization subscale, which contains tasks related to abstraction and semantic memory, showed sensitivity both to the variables age and schooling.…”

“…The Construction subscale, considered to have little sensitivity to the effects of age and schooling 24 , appeared to be influenced by low levels of schooling. The tasks in this subscale are the copying of geometrical figures and writing the name, which although relatively easy, become more complex for individuals with very low levels of schooling.…”

“…The Conceptualization subscale, which contains tasks related to abstraction and semantic memory, showed sensitivity both to the variables age and schooling. In a study conducted by Bennett et al 24 , elderly people in their eighties and nineties, without dementia, showed poor performance in tasks involving abstraction and verbal fluency, suggesting that the cognitive decline associated with age is related to symptoms of frontal lobe dysfunction. Our findings suggest that the decline observed by these authors is even more accentuated in patients with AD.…”

“…Thus, the data derived from these studies are not considered representative, which has led researchers to validate the scale in specific populations 12,22,23 . Recent studies have shown the influence of age and schooling on performance in the DRS, suggesting that a single cutoff score is not appropriate for all groups of elderly people 20,[23][24][25] .…”

A escala de avaliação de demência (DRS) no diagnóstico de comprometimento cognitivo leve e doença de Alzheimer

“…A amostra utilizada por Coblentz é considerada muito pequena e tanto o nível socio-econômico como a escolaridade, dos sujeitos da amostra de Montgomery, são muito altos (Spreen e Strauss, 1998 Estudos recentes têm demonstrado a influência da idade e escolaridade no desempenho da DRS sugerindo que uma única nota de corte não é apropriada para todos os grupos de idosos (Bennett et al, 1997, Lucas et al,1998, Bank et al, 2000, Chan et al , 2003, Rilling et al, 2005 Petersen et al (1999Petersen et al ( , 2001, é descrito como um estado cognitivo entre normalidade e demência e o risco de conversão para DA é 12% ao ano (Petersen et al, 2001). Pode ser classificado de acordo com três subtipos: amnéstico, múltiplo domínios e comprometimento de uma única função cognitiva diferente de memória.…”