• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Monitoring Dementia Symptoms: Which Scales are Practical for Clinicians?

Monitoring Dementia Symptoms: Which Scales are Practical for Clinicians?

April 1, 2010
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Dhwani Shah, MD
Let’s assume that you have already diagnosed a patient with Alzheimer’s Disease (AD). Your patient has received a full workup to rule out medical causes, and has had a full battery of neuropsychological tests. (See this month’s interview with Dr. Small for guidance on this initial workup.) Let’s further assume that you have started a standard cocktail of whichever cholinesterase inhibitor you prefer, plus memantine (Namenda).

Actually, that was the easy part. Now, you have to figure out if the medications are working. You’re dissatisfied with the old fashioned method of simply asking the patient and the family if there has been any improvement or decline in functioning, because it is too subjective. You’d like to be able to get a number to write in the chart so that you can convincingly demonstrate that treatment is working (or not).

The standard research instrument used for monitoring treatment outcomes in dementia is the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) (Rosen WG et al., Am J Psychiatry 1984;141(11):1356–64). While it is useful in research, the ADASCog takes 30 minutes to administer and is thus too time consuming for the average busy clinician.

Two common alternatives that have been brought over from the bench to the bedside are the Mini Mental State Exam (MMSE) (Folstein MF et al., J Psychiatr Res 1975;12:189–198) and the Clock Drawing Test (Sunderland T et al., J Am Geriatr Soc 1989;37(8):725-729). The MMSE is quick—usually completed in less than 10 minutes—and effective at identifying and monitoring moderate to severe dementia. Studies have documented a typical decline of two to four points over 12 months if dementia is untreated. For patients who have been treated, the decline in scores is generally no more than one point (Winblad B et al., Neurology 2001;57:489–495; Courtney C et al., Lancet 2004;363:2105–2115). Keep in mind, however, that the test is not sensitive for mild cognitive impairment (MCI) or mild AD (Ihl R et al., Psychiatry Res 1992;44:93–106; Tombaugh TN et al., J Am Geriatr Soc 1992;40: 922–935), or for detecting impairment in patients who are well-educated and intelligent (Crum RM et al., JAMA 1993;269:2386–2391).

A relatively new test, called the Mini-Cog (Borson J et al., J Am Geriatr Soc 2003;51(10):1451–1454), is a combination of the MMSE’s three item recall question and the Clock Drawing Test. The Mini-Cog is administered in two steps. First, you ask your patient to repeat and memorize three simple words (the specific words are up to you). Then you give him a paper and pen, and ask him to draw a clock with the hands pointing to “11:10.” Once the clock is drawn, ask him to repeat your three words. The Mini-Cog is faster to administer than the MMSE, and studies have shown no significant differences in sensitivity or specificity between the two.

In measuring cognition on the milder end of the spectrum (MCI and mild AD), a potential alternative to the MMSE and the Mini-Cog is the Montreal Cognitive Assessment (MoCA). The MoCA emphasizes language and executive skills, takes about 10 minutes to conduct, and is very effective for identifying MCI (Nasreddine ZS et al., J Am Geriatr Soc 2005;53:695–699). The MoCA test and instructions are available for free at www.mocatest.org. (For TCPR’s take on the MoCA, see “The MoCA: A Better MMSE?” TCPR May 2008.)

While these instruments are effective in assessing cognition, they neglect some important aspects of treatment outcome in dementia, particularly caregiver burden and quality of life. Caregiver burden refers to the challenges faced by family members of patients with dementia, and can lead to significant problems with burnout and depression in those who care for such patients (Black W et al., Int Psychogeriatr 2004;16(3):295–315). To assess this, we recommend the shortened 7-item Screen For Caregiver Burden available in Appendix 1 at the end of the developer’s article (Hirschman KE et al., J Am Geriatr Soc 2004;52(10):1724–1729).

To assess your patients’ quality of life and functional abilities, we recommend the Quality of Life in Alzheimer’s Disease scale (QOL-AD) (Logsdon RG et al., Psychosomatic Medicine 2002:64:510–519), which takes about 10 minutes to administer and is available online with instructions at http://bit.ly/9RjySn.

TCPR Verdict:

Dementia Scales can help guide our treatment.
General Psychiatry
www.thecarlatreport.com
Issue Date: April 1, 2010
SUBSCRIBE NOW
Table Of Contents
Neuroimaging and Other Diagnostic Tools for Dementia
Can Omega 3s Prevent Psychotic Disorders?
Antidepressants May Not Induce Mania in Bipolar Disorder
D-Amphetamine or Caffeine May be Effective Augmentation of SSRIs for OCD
Medications for Treating Alzheimer’s Dementia
Monitoring Dementia Symptoms: Which Scales are Practical for Clinicians?
DOWNLOAD NOW
Featured Book
  • MFB6eCover.jpg

    Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

    Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto4921771.jpg
    General Psychiatry

    Psychopharm Commandment #6: MAOIs

    MAOIs rank high in efficacy and are pretty well tolerated too, as long as you watch for two critical interactions.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.