Clinical features and assessment of severe dementia. A review¹

Abstract

Sound understanding of the dementia syndrome requires adequate acquaintance with its entire spectrum, from the lightest to the most advanced stages. Most studies of dementia deal with light to moderate stages of the condition, while relatively little attention has been paid to its most severe stages. This review presents a clinical description of patients with severe dementia and of the tests currently available to evaluate their cognitive, behavioural, and functional status. Available instruments such as the Hierarchic Dementia Scale or the Severe Impairment Battery now allow quantification of the cognitive and behavioural status of patients with severe dementia. Experience with severe dementia shows that, far from being in a "vegetative state", as is commonly thought, late-stage patients are in fact quite different from one another and in most cases continue to have an interaction with their environment. This ability to better define the characteristics of patients with severe dementia provides the basis for correlations between clinical data and data derived from neuroimaging, neurochemistry, or neuropathology. It also sets the stage for possible therapeutic trials involving these patients.

Altered Mental Status in Older Emergency Department Patients

“…This is especially the case in patients with endstage dementia, where they can exhibit symptoms of inattention, altered level of consciousness, disorganized thinking, sleep-wake cycle disturbances, and perceptual disturbances in the absence of delirium. 34 When patients with end-stage dementia develop delirium, an acute change in mental status is still observed, and any pre-existing abnormalities in cognition and level of consciousness will likely worsen. For this reason, diagnosing delirium can be extremely challenging in patients with severe dementia and establishing their baseline mental status is critical to the diagnosis.…”

Treatment of Moderate to Severe Alzheimer's Disease: Rationale and Trial Design

“…Cognitive measures such as the MMSE and ADAS-cog are limited by a floor effect, as noted in the previous moderate to severe AD studies. 48 The SIB has demonstrated excellent sensitivity in this population. The SIB appears to be most useful in patients with MMSE <10 and may suffer from a ceiling effect in patients with moderate disease (e.g., MMSE >15).…”

“…48 Since small changes in cognitive function may have questionable clinical relevance at this stage of AD, it is recommended that primary outcome measures include a global rating and either a functional or behavioural measure. Cognitive, functional, behavioural, and measures of caregiver distress are all appropriate secondary measures.…”

Amyloid Hypothesis and Alzheimer's Disease

“…The development of AD is progressive and can sometimes last for over decades. The development of AD can be divided into three stages according to clinical symptoms (Boller et al, 2002). In the mild stage of AD, patients first lose their short-term memory.…”