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P1‐170: Severe Dementia: A Protocol for Clinical Assessment
Author(s) -
Schultz Rodrigo Rizek,
Bertolucci Paulo,
Romio Teresa Cristina,
Tanuri Christiano,
Pereira Fernando
Publication year - 2011
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2011.05.450
Subject(s) - clinical dementia rating , dementia , rating scale , neuropsychology , cognition , neuropsychological assessment , protocol (science) , clinical psychology , psychology , mini–mental state examination , distress , psychiatry , medicine , cognitive impairment , developmental psychology , pathology , disease , alternative medicine
Background: Severe dementia (SD) is relatively neglected, and its prevalence is unclear, but it is estimated that one-third of dementia patients are in the severe stages. There is a lack of assessment tools for cognition with standardized neuropsychological tests and patients are labelled “untestable”. Behavioral symptoms are responsible for most distress that both sufferers and caregivers experience and decline in functional autonomy is a major component. Our aim is to present a pilot study of a protocol to evaluate cognition, behavior and functionality in patients with SD. Methods: 30 subjects with SD were assessed in one year (2010). SD was defined based on scores on global rating scales, observation of subjects’ residual abilities and interview with the patient’s caregiver. According with the literature, we defined SD as a score of 3 or higher in the Clinical Dementia Rating (CDR); or categories 6a to 7f in the Functional Assessment Staging Test (FAST); or a score of 6 or 7 in the Global Deterioration Scale (GDS). The protocol we applied includes the Mini-Mental State Examination (MMSE) and Severe Mini-Mental State Examination (SMMSE) to evaluate cognitive functions; CDR and FASTas two different staging systems; Katz scale for functional assessment; Neuropsychiatric Inventory (NPI) for behavior. A nutritional evaluation was also applied; the Functional Outcome Questionnaire for Aphasia (FOQ-A) and a Brazilian version of the Southampton Assessment of Mobility (SAM-BR). Our intention with this study is to evaluate the performance in different types of dementia and make correlations to determine the best tools for followup. Results: Our results showed that most of patients were AD’s women with apathy or agitation/aggression as more frequently behavior disturbs. SMMSE was better than MMSE to evaluate cognition in this population. Conclusions: In severe cognitive impairment, differential diagnosis is often difficult. A complete multidisciplinary group is essential to make it possible. Without a good multidisciplinary group and a comprehensive non-pharmacological intervention it is not possible to treat patients in this stage. With our extend protocol we expect to study all these functions and make a correct disease and problems diagnosis to improve treatment and follow-up.