STAGING THE SEVERITY OF DEMENTIA - COMPARISON OF CLINICAL (CDR, DSM-III-R), FUNCTIONAL (ADL, IADL) AND COGNITIVE (MMSE) SCALES

The Helsinki Aging Study is based on a random sample of 795 subjects a ged 75 years (N = 274), 80 years (N = 266) and 85 years (N = 255). Nin ety-three demented patients were found. All were assessed for severity of dementia by Clinical Dementia Rating (CDR) scale by a general prac titioner and according to the DSM-III-R criteria by a neurologist. The Mini-Mental State Examination (MMSE) was carried out by a community n urse and the Index of ADL and the IADL-scale by a close informant. The correlation of the severity of dementia between the DSM-III-R criteri a and the CDR scale was moderate. The overall agreement was 64.5% and the Kappa index 0.56. The CDR scale tended to put patients in milder c ategories than the DSM-III-R criteria. The correlation between the cli nical scales and categorized MMSE was moderate to fair. The overall ag reement between MMSE and DSM-III-R criteria was 64% (Kappa 0.44) and b etween MMSE and CDR scale 55% (Kappa 0.33%). The dispersion of the fun ctional scales (ADL, IADL) was much greater indicating that there were also other factors influencing the functional capacity than the degre e of dementia. Different methods in staging dementia give different re sults thus influencing for instance the results of epidemiological stu dies. Functional scales are needed in clinical practice in addition to the assessment of the severity of dementia. The CDR scale is useful i n assessing the need for support services.