Comparison between neuropsychological evaluation instruments for severe dementia

Accuracy of two prognostic indexes to predict mortality in older adults with advanced dementia

Dementia is a cause of disability among older adults. Accessing advanced dementia prognosis is a challenge.

[Use of the Mini-Mental State Examination in research on the elderly in Brazil: a systematic review]

The Mini-Mental State Examination (MMSE) is the most widely used cognitive screening test around the world. In Brazil, different MMSE versions and many cut-off points have been used. A systematic review of papers indexed in Scielo was conducted in order to analyze use of the MMSE in Brazilian empirical studies with elderly people. To search for these texts, the complete name of the instrument and its abbreviation were used. A growth trend in the scientific production during the 1998 to 2013 period was observed. Eleven versions of the MMSE were identified and the Bertolucci et al. version was the most cited. Over half of the studies used schooling as the criteria to establish cut-off points. The studies were predominantly conducted using samples recruited from large cities in the Southeastern region and in the community. Despite the growing trend of research with the elderly using the MMSE, the psychometric properties of this scale of measurement have been the subject of little investigation. Despite the widespread use of the MMSE in Brazil, there is a lack of standardization and evidence of validity for this this scale of measurement.

Clinical evaluation of brief cognitive assessment measures for patients with severe dementia

BACKGROUND

Alzheimer's disease has become an important public health burden for older adults. Clinicians face a challenging task to efficiently evaluate cognition in dementia in clinical settings. We sought to assess the validity and inter-correlations of brief cognitive assessments in a cohort of severely demented patients.

METHODS

In total, 49 individual patients (N = 49) ranging in age from 62 to 97 years old were included in this performance improvement project. Over the course of two-three sessions, five cognitive instruments were administered to each patient: Severe Impairment Battery (SIB), Severe Impairment Battery-8 (SIB-8), Mini Mental State Examination (MMSE), Severe Mini Mental State Examination (sMMSE) and Brief Interview of Mental Status (BIMS). We sought to assess patient factors that might have been barriers to optimal performance on cognitive/functional tests. Researchers assessed her impression of the participants' difficulty comprehending instructions, distractibility, apparent fatigue, and frustration, which were the four barriers rated.

RESULTS

Data were analyzed for 49 patients from the inpatient dementia unit with a total of 51 samples. All of the inter-correlations between the five cognitive instruments had Spearman coefficients of (rs) > 0.7 and were statistically significant with p < 0.001. The SIB-8 and sMMSE were positively correlated with the SIB. The perceived barrier scores ranged from 0- no issue to 1-mild issue on all five cognitive instruments.

CONCLUSION

Brief cognitive tests designed for severe dementia such as the SIB-8 and sMMSE have been evaluated in this project to be shorter in administration duration and highly correlated with gold standard instruments: the SIB and MMSE.

Is there correlation between cognition and functionality in severe dementia? the value of a performance-based ecological assessment for Alzheimer's disease

OBJECTIVE

Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale.

METHOD

A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL).

RESULTS

Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (ρ<0.001), according to FAST subdivisions.

CONCLUSION

Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.

Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination

Cognitive assessment in advanced stages of Alzheimer’s disease (AD) is limited by the imprecision of most instruments. Objective: To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method: Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results: Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). Conclusion: The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.

Brief cognitive assessment of Alzheimer's disease in advanced stages: Proposal for a Brazilian version of the Short Battery for Severe Impairment (SIB-8)

The measurement of cognitive abilities of patients with severe dementia can serve a wide range of methodological and clinical needs.

A useful and brief cognitive assessment for advanced dementia in a population with low levels of education

BACKGROUND/AIMS

Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education.

METHODS

A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed.

RESULTS

Seventy-five patients with a mean of 4.1±3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8±7.0 and 17.8±9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r=0.87; p<0.001). In addition, significant correlations were found between the SMMSE and functional scales (p<0.001). It was observed that educational level did not interact with SMMSE performance.

CONCLUSION

The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.

Cognitive, functional and behavioral assessment: Alzheimer's disease

A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer's disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data.

The Severe Impairment Battery predicts functional abilities in an inpatient geriatric population

There is limited research examining the relationship between cognition in severe dementia and functional skills. The aim of the present study was to examine the relationship between the Severe Impairment Battery (SIB) and functional abilities as measured by the Assessment of Instrumental Function (AIF) in an acute inpatient geriatric psychiatry setting. Analyses showed significant correlation between the SIB and the AIF. Multiple regression demonstrated that SIB scores accounted for 44% of the variance in adaptive functioning. These results replicate some of the prior data examining the relationship between the cognition and functional abilities and extend these findings into the inpatient setting with more severely impaired patients.

Semantic Verbal Fluency test in dementia: Preliminary retrospective analysis

Abstract The Semantic Verbal Fluency (SVF) test entails the generation of words from a given category within a pre-set time of 60 seconds. Objectives: To verify whether socio-demographic and clinical data of individuals with dementia correlate with the performance on the SVF test and to ascertain whether differences among the criteria of number of answers, clusters and data spread over the intervals, predict clinical results. Methods: This was a retrospective study of 49 charts of demented patients classified according to the Clinical Dementia Rating (CDR) scale. We correlated education, age and gender, as well as CDR and Mini-Mental State Exam (MMSE) scores with the number of answers, clustering and switching distributed over four 15-second intervals on the SVF test. Results: The correlation between number of answers and quartiles was weak (r=0.407, p=0.004; r=0.484, p<0.001) but correlation between the number of clusters and responses was strong (r=0.883, p<0.001). The number of items on the SVF was statistically significant with MMSE score (p=0.01) and there was a tendency for significance on the CDR (p=0.06). The results indicated little activity regarding what we propose to call cluster recalling in the two groups. Discussion: The SVF test, using number of items generated, was found to be more effective than classic screening tests in terms of speed and ease of application in patients with CDR 2 and 3.