Severe dementia in the elderly: How to evaluate it?

• Published in: Archives of gerontology and geriatrics 1998, Vol.26, p.57-64
• Main Authors: Caputo, L., Boller, F., Verny, M., Hugonot-Diener, L., Saillon, A., Traykov, L., Jahchan, T., Forette, F., De Ladoucette, O.
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; assessment of dementia in elderly; behavioral rating scales; severe dementia
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/S0167-4943(98)80010-1

The intention was to identify the instruments that can better assess cognitive, behavioral and functional characteristics of patients with severe dementia. Multiple scales were administered in a series of patients with mini mental state examination (MMSE) scores ≦ 10: the activity of daily living (ADL), the clinical dementia rating scale (CDR), the global deterioration scale (GDS), the severe impairment battery (SIB), the hierarchic dementia scale (HDS), the behavioral rating scale for dementia (BRSD), the behavioral pathology in Alzheimer's disease rating scale (BEHAVE-AD). All these scales were applied in their standardized French versions. Two geriatric long-term facilities in the Paris area participated: 12 elderly patients (mean age: 83.8 ± 5.3 years) with a clinical diagnosis of probable or possible Alzheimer's disease (AD) (DSM III-R, NINCDSADRDA) and an MMSE mean score: 4.8 ± 3.3. Functional and behavioral scales were administered by the nurses of long-term facilities, who knew the patients better. As main outcome measures, evaluation of feasibility of cognitive (SIB and HDS) and behavioral (BRSD and BEHAVE-AD) scales and their correlation with MMSE were considered. All the patients were partially or totally dependent on ADL (mean: 1.9 ± 1.1). Scores of GDS and CDR varied from 5 to 7 (mean: 5.8 ±0.8) and from 2 to 4 (mean: 3.1 ± 0.7), respectively. A significant correlation was found between MMSE and scores of SIB (mean: 56.3 ± 29.6, range: 3–86) and HDS (mean: 90.6 ± 43.5, range: 18–148) (r = 0.87 and r = 0.91, respectively; p < 0.0001 for both). HDS, however, required a greater time for administration. We also found a significant negative correlation (r = −0.74, p = 0.005) with BRSD (mean: 82 ± 12.7, range: 48–104), but not with BEHAVE-AD (mean: 9 ± 7, range: 1–24) (r = −0.44, p = 0.16). Although severely-demented patients can be difficult to test, an exhaustive and appropriated assessment of cognitive, behavioral and functional characteristics can and should be accomplished. Preliminary data suggest that SIB and BRSD, together with the well known ADL, GDS and CDR scales, may be proposed as tests for clinical use in severe dementia.