Baylor Profound Mental Status Examination: A Brief Staging Measure for Profoundly Demented Alzheimer Disease Patients

Development of the Cognitive Test for Severe Dementia

“…Recently, cognitive tests for moderate-to-severe dementia patients, such as the Severe Impairment Battery (SIB), have gradually increased in number, showing clinical utility [10,11]. To our knowledge, the following tests exist for measuring cognitive function in severe dementia: SIB [12], Severe Cognitive Impairment Rating Scale (SCIRS) [13], Test for Severe Impairment (TSI) [14], Severe Mini-Mental State Examination (SMMSE) [15], Hierarchic Dementia Scale [16,17], Modified Ordinal Scales of Psychological Development (M-OSPD) [18], SIB-Short Version (SIB-S) [19], SIB-8 [20], Bedford Alzheimer Nursing Severity Scale (BANS-S) [21], Severe Impairment Rating Scale (SIRS) [22], Severe Cognitive Impairment Profile (SCIP) [23], Baylor Profound Mental State Examination (BPMSE) [24], and the Clinical Evaluation of Moderate-to-Severe Dementia (KUD; Swedish acronym) [25]. …”

“…Dementia patients at the end of the severe stage are difficult to test using measures such as the SIB and SCIRS, as they show floor effects [21,24,25]. These tests differ in administration time, response modality, equipment, rating methods, and so forth.…”

“…Saxton et al [12] indicated that the administration time of tests for severe dementia should be short, and that the tests should not show floor effects. Volicer et al [21] and Doody et al [24] indicated that the SCIP and SIB each take more than 20 min, which is too long for individuals with severe dementia to sustain attention. Regarding response modality, Volicer et al [21] and Doody et al [24] noted that tests should utilize simple verbal responses to assess patients until a profound stage of dementia, but the SIB relies heavily on verbal responses.…”

“…Volicer et al [21] and Doody et al [24] indicated that the SCIP and SIB each take more than 20 min, which is too long for individuals with severe dementia to sustain attention. Regarding response modality, Volicer et al [21] and Doody et al [24] noted that tests should utilize simple verbal responses to assess patients until a profound stage of dementia, but the SIB relies heavily on verbal responses. Regarding the style of assessment, Saxton et al [12] and Ericsson et al [25] indicated that cognitive tests for severe dementia should be performance-based rather than observational, and assess simple reactions, including verbal responses, in order to evaluate the patients' maximum abilities.…”

“…For instance, the SMMSE includes an item asking respondents to spell ‘cat', which would not be appropriate for Japanese people, as spelling accords with pronunciation in Japanese. Regarding the equipment and training for the examiner, Doody et al [24] and Harrell et al [15] indicated that the SIB requires considerable training for the examiner, and that preferable instruments for these tests are items that are widely available (e.g. clock and pencil).…”