engleski

Clinical diagnosis of Alzheimer's disease : importance of rating instruments

Alzheimer's Disease (AD) is the most common disease leading to demen¬tia and it affects approximately 4 to 8% of the population aged above 65 years. Since severe disturbance in cholinergic neurotransmission appears to be an early event in AD and there is a correlation between the losses of cholinergic neurons in basal forebrain and impaired memory function, treatment at¬tempts are focused on replacement of the neurotransmitter acetylcholine. The assessment of cognitive impairment is necessary for the initial diagnosis of de¬mentia. 45 The most often used instrument in the assessment of cognitive impair¬ment is the Mini Mental State Examination (MMSE). It takes 5-10 minutes to complete the test ; maximum score is 30. The Alzheimer Disease Assessment Scale (ADAS) also measures cognitive functioning, memory, concentration, mood, and behavioral disturbances. It consists of 21 items ; it takes approxi¬mately 45 minutes tq administer. The Severe Impairment Battery (SIB), Gresham Ward Questionnaire and Multidimensional Observation Scale for Elderly Subjects (MOSES) are used to assess cognitive impairment in severely demented patients. MOSES and Neuropsychiatric Inventory (NPI) are used in the assessment of psychosocial functioning. The purpose of the Co- hen-Mansfield Agitation Inventory (CMAI) is to assess the frequency of mani¬festation of agitated behaviors in elderly persons. In the mobility assessment, the examiner administers and scores a series of tests on how well a subject can perform various movements and maneuvers. This assessment has been de¬signed for older persons in order to assess the effectiveness and safety of their mobility during daily activities. Blessed's Dementia Scale is used to obtain heterohistory regarding patient's functioning during the last six months. Modified Hachinsky Ischemic Scale (MHIS) is used to assess the presence of vascular risk factors in patients with ischemia. Clinician's Interview-Based Impression (CIBD is a global change measure, which reflects data gathered from an interview conducted by a skilled and experienced independent rater familiar with the manifestations of dementia and not involved in routine care of the patient. Geriatric Mental State Schedule is a semistructured interview for the assessment of patient's cognitive functioning. Assessment of severity of cognitive impairment can also be performed by the following scales: Cam¬bridge Examination for Mental Disorders of the Elderly (CAMDEX), Crichton Geriatric Behaviour Rating Scale, Clifton Assessment Schedule, Stochton Ge¬riatric Rating Scale, Present Behavioural Examination (PBE), Manchester and Oxford Universities scale for the Psychopathological Assessment of Dementia (MOUSEPAD), Performance Test of Activities of Daily Living (PADL), and Vineland Social Maturity Scale.Neuropsychologic estimation and rating scales are necessary for perform¬ing good clinical practice. Also, rating scales are good indicators of therapy ef¬ficacy. Based on this, decisions on further therapeutic procedures are made.

diagnosis; Alzheimer's disease; rating instruments

Indexed/Abstracted in: Neuroscience Citation Index ; EMBASE/Excerpta Medica