SEVERE DEMENTIA IN THE ELDERLY - HOW TO EVALUATE IT

The intention was to identify the instruments that can better assess c ognitive, behavioral and functional characteristics of patients with s evere dementia. Multiple scales were administered in a series of patie nts with mini mental state examination [MMSE) scores less than or equa l to 10: the activity of daily living [ADL), the clinical dementia rat ing scale (CDR), the global deterioration scale (GDS), the severe impa irment battery (SIB), the hierarchic dementia scale (HDS), the behavio ral rating scale for dementia (BRSD), the behavioral pathology in Alzh eimer's disease rating scale (BEHAVE-AD]. All these scales were applie d in their standardized French versions. Two geriatric long-term facil ities in the Paris area participated: 12 elderly patients (mean age: 8 3.8 +/- 5.3 years] with a clinical diagnosis of probable or possible A lzheimer's disease (AD) [DSM III-R, NINCDS-ADRDA) and an MMSE mean sco re: 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), respe ctively. A significant correlation was found between MMSE and scores o f SIE (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 b oth). HDS, however, required a greater time for administration. We als o 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-demen ted 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 SIE and BRS D, together with the well known ADL, GDS and CDR scales, may be propos ed as tests for clinical use in severe dementia.