The Stages of Alzheimer’s Disease: A Reappraisal

Abstract

‘Stages’, as used in clinical practice and research, are defined, their value described, and criteria are proposed for their evaluation. The specific interest is in staging Alzheimer’s disease (AD). Two staging systems, one based on the Global Deterioration Scale (GDS) and one based on the Mini-Mental State Exam (MMSE), are compared in terms of these criteria, as an illustration of the process involved. We propose that there is not one unique staging system, that different staging criteria might be appropriate to different research or clinical needs, depending on which part of the temporal course of the disease is of primary interest, and on whether the focus is on cognitive, functional, neurological, behavioral, economic, or other issues. GDS staging seems a better choice for the later stages of AD when the focus is on functional change. MMSE staging seems a better choice for tracking the earlier stages of AD when the focus is on cognitive change.

Validation of the Addenbrooke’s Cognitive Examination for Detecting Early Alzheimer’s Disease and Mild Vascular Dementia in a German Population

“…However, to ensure that patients with significant functional impairments, who might already have crossed the threshold to moderate dementia, were not included, patients with a score below 15 points on the MMSE were excluded from the study. This score on the MMSE has been found to discriminate mild from moderate dementia [19] . MMSE staging has been proven to be a good choice for tracking the earlier stages of dementia [19] .…”

“…This score on the MMSE has been found to discriminate mild from moderate dementia [19] . MMSE staging has been proven to be a good choice for tracking the earlier stages of dementia [19] .…”

Quality of Life of Patients with Alzheimer’s Disease: Differential Perceptions between Spouse and Adult Child Caregivers

“…This is a brief cognitive assessment tool has scores ranging from 0 to 30, the cutoff point for cognitive impairment being 21/22. Here, it was used to observe the correlation with caregiver burden and to assess the degree of cognitive impairment according to the criteria proposed [26] .…”

Differences in Survival between Patients with Dementia with Lewy Bodies and Patients with Alzheimer's Disease - Measured from a Fixed Cognitive Level

“…Therefore, there needs to be a more reliable way to predict the clinical course and survival than relying on symptom duration. Methodological finesse when staging and predicting the clinical course has been discussed by, for example, Kraemer et al [30]. They present the MMSE [31] as a valid staging system and claim that this staging allows the researcher to focus on more homogenous patient groups to gain greater statistical power and a clearer interpretation of results.…”