We verified the characteristics and usefulness of a slightly modified versi
on of the test for severe impairment (mTSI) on a nursing-home sample of 130
subjects suffering from moderate to end-stage dementia clinical dementia r
ating (CDR) scale, range: 1-4; mini mental state examination (MMSE) range:
0-18. The mTSI and the MMSE could be applied to 87 subjects (66.9 %): unres
ponsiveness and uncooperation were the main reasons for the lack of applica
bility in the remaining subjects. The mTSI and the MMSE scores were differe
nt from 0 in 76/87 (87.4 %) and 59/87 (67.8 %) subjects, respectively; 41 s
ubjects were in CDR stage of 3 or 4: their mTSI and MMSE range was 0-36, an
d 0-5, respectively. The mTSI mean score decreased significantly at each CD
R stage from stage 2 to stage 4, whereas no mean mTSI difference was detect
able at the comparison between CDR stages 1 and 2. The mTSI did not appear
more informative than the original version of the test. The TSI looks promi
sing in the evaluation of the moderate to severe stages of dementia, althou
gh a floor effect remains detectable for the severe to end stages.