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-Objective: To study the correlation between two tools for cognitive evaluation, Mini-Mental State Examination-severe (MMSE-s) and Severe Impairment Battery (SIB), and the Bristol Daily Activities Functional Scale. Method: 50 patients from the Behavioral Neurology Section -EPM-UNIFESP -were evaluated. Mean age was 76.8±7.9 (range 57 to 95); 32% were males; mean education was 5.0±2.3 years (range 4 to 15); mean disease duration was 3.9±1.5 years (range 2 to 10). Results: Preliminary results in a small sample drawn from the study group do indicate a difference between the three cognitive scales. SIB and MMSE-s had a better correlation with functional score than MMSE, and MMSE-s had a correlation slightly better than SIB. Conclusion: These data indicate that it is possible to follow dementia patients up to severe stage as long as adequate instruments are used, and that there may be differences between scales with regard to sensitivity.KEY WORDS: cognitive tests, daily activities functional scale, dementia. AD is the most common dementing disorder in the elderly population. Typically this disorder has a insidious onset, with progressive decline of memory, followed by other cognitive areas, such as executive function, language, and praxis 2 . It is estimated that in the United States only more than four million elderly have dementia at a severe stage and another one and half million dementia at mild or moderate stage. It is expected that the population with dementia in that country will rise to nine million by 2030 3 . Investigations in São Paulo state hinterland showed the same trend 4 , with an estimated 750 thousands to one million Brazilians with dementia. The realization of the huge dimension of AD has brought a lot of interest in treating and following these patients as they progress to more advanced disease stages. Many scales have been developed for the evaluation of pre-clinical, mild and moderate stages 5 , but the same is not true for the evaluation of patients in more severe stage, for whom relatively few investigations have been undertaken 6 . Comparação de instrumentos de avaliação neuropsicológica para a demência grave RESUMO -The evaluation of cognitive abilities in these patients would fill several clinical and research needs, like the identification of less affected cognitive areas, which could in turn be used by health professionals

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.

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