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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.

Functional performance, visuospatial skills, and behavioral symptoms are helpful for differential diagnoses between LBD and AD. Cerebrovascular risk might be more important for AD pathogenesis, whereas environmental factors might impact development of LBD.

Objective: Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. Method: A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). Results: Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (r,0.001), according to FAST subdivisions. Conclusion: Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.Keywords: Alzheimer disease, neuropsychology, activities of daily living. RESUMOObjetivo: Além do significativo declínio cognitivo, pacientes em estágios avançados da doença de Alzheimer (DA) também apresentam prejuízo funcional global. Este estudo investigou atividades de vida diária correlacionando teste específico para a demência grave, com escala funcional baseada no desempenho. Método: 95 pacientes com DA foram submetidos a uma bateria neuropsicológica composta por instrumentos de rastreio, a escala Functional Assessment Staging Test (FAST), o Mini-exame do Estado Mental grave (MEEMg) e escala ecológica baseada no desempenho: a Performance Test of Activities of Daily Living (PADL). Resultados: Achados consistentes emergiram da comparação entre os instrumentos. De acordo com as subdivisões da escala FAST, a PADL apresentou significativa correlação estatística com o MEEMg (r,0.001). Conclusão: Na suspeita de relato pouco confiável por parte do cuidador, escalas ecológicas podem ser úteis no estadiamento da doença. Igualmente à cognição, variados graus de funcionalidade estão presentes mesmo em fases avançadas da DA, exigindo avaliação adequada.Palavras-chave: doença de Alzheimer, neuropsicologia, atividades de vida diária.Dementias are a worldwide burden to public health systems. Given the demographic changes with a global aging trend ( faster in developing countries), estimates on the rising prevalence of these disorders are discouraging, considering associated costs in primary, secondary and tertiary levels of care . As suggested by current guidelines 2 , the progressive course of dementia might be classified in three main stages: mild -there is still some aptitude for independent life, despite the impact on instrumental activities of daily living; moderate -the abilities for independent living are limited and supervision is needed in many activities; severerestricted independence for all activities, incl...

All variants showed swallowing difficulties and they were more frequent in PPA-S. Further studies with larger samples of patients are needed to better characterize swallowing problems and their consequences in the different variants of PPA.