Brief Scales Can Measure Dementia, Mental Illness: Each Battery Should Measure Patient's Memory, Executive Function, and Activities of Daily Living

By Ault, Alicia | Clinical Psychiatry News, July 2007 | Go to article overview

Brief Scales Can Measure Dementia, Mental Illness: Each Battery Should Measure Patient's Memory, Executive Function, and Activities of Daily Living


Ault, Alicia, Clinical Psychiatry News


NEW ORLEANS -- The dizzying array of scales available for measuring dementia and mental illness in the elderly can be whittled down to create an essential picture of an individual patient. Most importantly, these scales can be used to establish a baseline to monitor progression or worsening and to meet federal documentation requirements in nursing homes, speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

"You should choose scales that are brief, easy to score and have proven validity and reliability," said Dr. Allan Anderson, director of geriatric psychiatry at Shore Behavioral Health Services, Cambridge, Md.

Scales can enhance clinical practice and measure the effectiveness of psychiatric treatments, Dr. Anderson said.

Deborah Weber helps administer scales to patients at Shore Behavioral Health. Usually, she said, she spends an hour or more with patients and their caregivers. The tests are not used to make a diagnosis, she said.

The Mini-Mental Status Exam is one of the most frequently administered scales at Shore Behavioral Health, Ms. Weber said. Although this is a common exam measuring cognitive ability, it has some limitations. Patients have to be fluent in English, or they may not do well, she said, adding that they also have to be literate. If they can't spell "world" forward, then they won't be able to spell it backward, she notes. The MMSE usually only takes 10 minutes to administer, but, she said, "don't rush the patient--some patients take longer."

Ms. Weber also uses several executive function tests, which occasionally require family or caregiver input. Examples include the Tinker Toy Test, Tower of Hanoi, and Proteus Mazes. Failure doesn't automatically mean dementia, she said, noting that medical illness or other mental disorders can interfere with executive function. Fluency tests--such as asking patients to categorize items--are also good ways to measure executive function, she said.

The clinician-administered CLOX test, developed by Dr. Donald Royall, has rapidly gained followers, Ms. Weber said. It is a good test, but "it's important that you understand the nuances of this scoring," she said.

To measure depression, she uses the Geriatric Depression and the Cornell Scale for Depression in Dementia. Independence can be assessed with the Physical Self-Maintenance Scale or the Functional Activities Questionnaire, which takes only 5-10 minutes to complete, rating the patient's abilities in 10 areas.

Another test she likes is the Dementia Rating Scale II, which is clinician administered and computer scored, measuring competency in attention, initiation/preservation, construction, conceptualization, and memory. However, this test is not sensitive enough to detect mild forms of dementia in people who are intelligent or well educated, Ms. Weber said.

The choice of scales should be based on each patient's specific needs, she said. However, each battery should measure memory, executive function, and activities of daily living, she said. …

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