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Background/Aims: Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education. Methods: A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed. Results: Seventy-five patients with a mean of 4.1 ± 3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8 ± 7.0 and 17.8 ± 9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r = 0.87; p < 0.001). In addition, significant correlations were found between the SMMSE and functional scales (p < 0.001). It was observed that educational level did not interact with SMMSE performance. Conclusion: The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.

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Background: Frontotemporal dementia (FTD) is a type of dementia causing degeneration in the frontal and temporal lobes. Patients with FTD often show signs or symptoms of environmental dependency. We investigated patterns of television watching in patients with FTD to discern its frequency in patients with FTD, and to possibly find evidence of its relation to other environmental dependency symptoms found in FTD.C Methods: We recruited 40 patients diagnosed with FTD and 48 Alzheimer's disease patients as controls. Patients' caregivers were given a structured interview based on a questionnaire regarding patients' television watching patterns and other behavioral symptoms. Results: More patients with FTD than AD watched more TV compared to before disease onset. Compared to AD patients, FTD patients watched more hours of TV per day, and watched more hours of TV compared to before disease onset. There were more FTD patients who exhibited 'excessive -more than 12 hours/day' TV watching. More than half of the FTD patients showed signs of environmental dependency. Patients with more signs of environmental dependency watched more hours of TV. Conclusions: Thus, frontal lobe damage may cause a release of parietal lobe driven approach behavior such as a grasp reflex or possibly magnetic apraxia or utilization behavior. Environmental dependency has previously been described in FTD but there have not been studies that systematically investigated the frequency of environmental dependency in patients with FTD. The television as an appliance usually sits in a common room of a home and is placed in an area that is easily focused upon. Because of this, in patients prone to environmental dependency the mere presence of the television could act as an external environmental cue.