Review of Alzheimer's disease scales: is there a need for a new multi-domain scale for therapy evaluation in medical practice?

Abstract

IntroductionThe present review of Alzheimer's disease (AD) rating scales aims to outline the need for a new rating scale to be used in routine clinical practice for long-term medical care of AD patients. An ideal scale would be: 1) practical, easy and quick to administer for an experienced clinician; 2) validated for AD; 3) multi-domain: covering the AD-relevant areas of cognition, activities of daily living, behavior, communication/social interaction, and quality of life; 4) applicable to all AD severity stages; 5) able to monitor disease progression; and 6) sensitive to measure therapy effects.MethodsThe National Library of Medicines' MEDLINE database was searched for the years 1981 to September 2008, using a set of keywords aiming to select instruments which cover at least some of the requirements for an ideal practical AD scale for therapy evaluation. Measures for AD staging and screening tests were not considered for review.ResultsOf 1,902 articles resulting from the literature search, 68 relevant AD scales were identified. Most of them were scales that predominantly measure the severity of major dysfunctions in particular AD domains. Only five scales met some of the requirements for a practical multi-domain AD scale, but did not possess all required characteristics.ConclusionsDespite the multitude of AD scales for various purposes, there remains a need for a new multi-domain and easy to administer AD scale for assessment of disease progression and response to therapy in daily medical practice.

On the early diagnosis of Alzheimer's Disease from multimodal signals: A survey

“…Nevertheless, they present some drawbacks. The most important one is that the assessment by means of these tests is lengthy and complicated [49]. Furthermore, they are not suitable for all the patients in all the stages of the dementia.…”

“…Some tests are based on the most basic activities (ADL), like feeding, walking or dressing, while others measure the abilities for more complex tasks, called instrumental activities (IADL) [49]. Examples of IADL are cooking, tasks which involve the use of money, etc.…”

“…Some examples are the MMSE [44] which is the most frequently used test for AD diagnosis, the Severe Cognitive Impairment Scale [45], the Alzheimer's Disease Assessment ScaleCognitive [46] which focuses on attention, orientation, language, executive functioning and memory skills, the Neuropsychological Test Battery [47] which includes treatment effects' measurements, the Blessed Test which assesses memory, attention, concentration, and the ability to complete Activities of Daily Living (ADL) and the Severe Impairment Battery [48] which alternatively focuses on measuring the unaffected cognitive functions [49].…”

“…These tools may help the patient himself and his relatives to take conscience of the real state of the disease. Tests like the Behavioural Pathology in AD Rating Scale (BEHAVE-AD) [232], the Brief Psychiatric Rating Scale [233], the Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for AD [234], Neuropsychiatric Inventory (NPI) [50] and the Dementia Behaviour Disturbance Scale [235] are questionnaires used to measure the behavioural abnormalities that the AD patients can undergo [49].…”

Aging and Functional Complex Activities: Clinical and Social Perspectives

“…In spite of the high development in qualifying scales for functional level in dementia in medical practice progression evaluation turns long and complex because functional evaluation devices are not sensitive enough to measure this effect (Robert et al, 2010). Evidence has increased the use of functional scales to evaluate complex functional status because on clinical assessment it is hard to tell change from expected loss for the age of disease indicators.…”