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Severe Impairment Battery: A Neuropsychological Test for Severely Demented Patients

Severe Impairment Battery: A Neuropsychological Test for Severely Demented Patients Abstract Objective: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. Design: Case series. Setting: Geriatric long-term facility. Patients: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99±5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71±6.14. Main Outcome Measure: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. Results: The mean score on the SIB was 92.52±31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11,12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. Conclusion: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up. References 1. Folstein MF, Folstein SE, McHugh PR. 'Mini Mental State': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 2. Rosen W, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease . Am J Psychiatry . 1984;141:1356-1364. 3. Davous PLY, Debrand E, Rondot P. A comparative evaluation of the short orientation memory concentration test of cognitive impairment . J Neurol Neurosurg Psychiatry . 1987;50:1312-1317.Crossref 4. Berg L. Clinical Dementia Rating (CDR) . Psychopharmacol Bull . 1988;24:637-639. 5. Becker JT, Huff FJ, Nebes RD, Holland AL, Boller F. Neuropsychological function in Alzheimer's disease: pattern of impairment and rates of progression . Arch Neurol . 1988;45:263-268.Crossref 6. Ritchie K, Ledesert B. The measurement of incapacity in the severely demented elderly: the validation of a behavioural assessment scale . Int J Geriatr Psychiatry . 1991;6:217-226.Crossref 7. Benesch C, McDaniel KD, Hamill RW. The usefulness of the neurologic examination and the Glasgow scale in endstage Alzheimer's disease . Neurology . 1991;41:235. 8. Saxton J, McGonigle-Gibson K, Swihart A, Miller M, Boller F. Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery . Psychol Assess . 1990;2:298-303.Crossref 9. Albert M, Cohen C. The Test for Severe Impairment: an instrument for the assessment of patients with severe cognitive dysfunction . J Am Geriatr Soc . 1992;40:449-453. 10. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition. Washington, DC: American Psychiatric Association; 1987. 11. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease . Neurology . 1984;34:939-944.Crossref 12. Panisset M, Roudier M, Saxton J, Boller F. Validation d'une batterie d'évaluation neuropsychologique pour des patients avec démence sévère . Presse Med . 1992; 21:1271-1274. 13. Feldman D, Hofmann R, Gagnon J, Simpson J. Statview II . Grenoble, France: Abacus Concepts Inc; 1987. 14. Liepmann D. Die linke Hemisphäre und das Handeln . Munchen Med Wschr . 1905;49:2322-2326, 2375-2378. 15. Lhermitte F, Pillon B, Serdaru M. Human autonomy and the frontal lobes . Ann Neurol . 1986;19:326-334.Crossref 16. Wilson RS, Bacon LD, Fox JH, Kaszniak AW. Primary memory and secondary memory in dementia of the Alzheimer type . J Clin Neuropsychol . 1983;5:337-344.Crossref 17. Jorm AF. Controlled and automatic information processing in senile dementia: a review . Psychol Med . 1986;16:77-78.Crossref 18. Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations . Neurology . 1990;40:1225-1230.Crossref 19. Burns A, Jacoby R, Levy R. Progression of cognitive impairment in Alzheimer's disease . J Am Geriatr Soc . 1991;39:39-45. 20. Katzman R, Brown T, Thal LJ, et al. Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease . Ann Neurol . 1988;24:384-389.Crossref 21. Botwinick J, Storandt M, Berg L. A longitudinal, behavioral study of senile dementia of the Alzheimer type . Arch Neurol . 1986;43:1124-1127.Crossref 22. Ortof E, Crystal HA. Rate of progression of Alzheimer's disease . J Am Geriatr Soc . 1989;37:511-514. 23. Dastoor DP, Cole MG. The course of Alzheimer's disease: an uncontrolled longitudinal study . J Clin Exp Gerontol . 1985;7:289-299. 24. Mayeux R. Stern Y, Spanton S. Heterogeneity in dementia of Alzheimer type: evidence of subgroups . Neurology . 1985;35:453-461.Crossref 25. Chui HC, Lee Teng E, Henderson VW, Moy AC. Clinical subtypes of dementia of the Alzheimer type . Neurology . 1985;35:1544-1550.Crossref 26. Boller F, Holland A, Forbes M, Hood P, McGonigle-Gibson K, Becker JT. Predictors of decline in Alzheimer's disease . Cortex . 1991;27:9-17.Crossref 27. Cummings JL, Benson DF. Dementia: A Clinical Approach . Stoneham, Mass: Butterworth Inc; 1983. 28. Luxenberg JS, Haxby JV, Creasy H, Sundaram M, Rapoport SI. Rate of ventricular enlargement in dementia of the Alzheimer type correlates with a rate of neuropsychological deterioration . Neurology . 1987;37:1135-1140.Crossref 29. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;114:797-811.Crossref 30. Pfeiffer E. Short Portable Mental Status Questionnaire for the assessment of organic brain deficit in elderly patients . J Am Geriatr Soc . 1975;23:433-441. 31. Mattis S. Mental status examination for organic mental syndrome in the elderly patients . In: Bellak L, Karasu T, eds. Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians . New York, NY: Grune & Stratton Inc; 1976:77-121. 32. Cole M, Dastoor D. The hierarchic dementia scale . J Clin Exp Gerontol . 1983; 5:219-234. 33. Démonet J, Doyon B, Ousset P, et al. Etalonnage d'une échelle d'évaluation cognitive de structure modulaire et hiérarchisée applicable aux démences . Rev Neurol . 1990;146:490-501. 34. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation memory concentration test of cognitive impairment . Am J Psychiatry . 1983;140:734-739. 35. Reisberg B. Functional Assessment Staging (FAST) . Psychopharmacol Bull . 1988;24:653-659. 36. Lopez O, Boller F, Becker JT, Miller M, Reynolds CF. Alzheimer's disease and depression: neuropsychological impairment and progression of the illness . Am J Psychiatry . 1990;147:855-860. 37. Forette F, Panisset M, Boller F. Clinical trials in cognitive impairment of the elderly . Aging Clin Exp Res . 1992;4:239-250.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Severe Impairment Battery: A Neuropsychological Test for Severely Demented Patients

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1994.00540130067012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. Design: Case series. Setting: Geriatric long-term facility. Patients: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99±5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71±6.14. Main Outcome Measure: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. Results: The mean score on the SIB was 92.52±31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11,12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. Conclusion: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up. References 1. Folstein MF, Folstein SE, McHugh PR. 'Mini Mental State': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 2. Rosen W, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease . Am J Psychiatry . 1984;141:1356-1364. 3. Davous PLY, Debrand E, Rondot P. A comparative evaluation of the short orientation memory concentration test of cognitive impairment . J Neurol Neurosurg Psychiatry . 1987;50:1312-1317.Crossref 4. Berg L. Clinical Dementia Rating (CDR) . Psychopharmacol Bull . 1988;24:637-639. 5. Becker JT, Huff FJ, Nebes RD, Holland AL, Boller F. Neuropsychological function in Alzheimer's disease: pattern of impairment and rates of progression . Arch Neurol . 1988;45:263-268.Crossref 6. Ritchie K, Ledesert B. The measurement of incapacity in the severely demented elderly: the validation of a behavioural assessment scale . Int J Geriatr Psychiatry . 1991;6:217-226.Crossref 7. Benesch C, McDaniel KD, Hamill RW. The usefulness of the neurologic examination and the Glasgow scale in endstage Alzheimer's disease . Neurology . 1991;41:235. 8. Saxton J, McGonigle-Gibson K, Swihart A, Miller M, Boller F. Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery . Psychol Assess . 1990;2:298-303.Crossref 9. Albert M, Cohen C. The Test for Severe Impairment: an instrument for the assessment of patients with severe cognitive dysfunction . J Am Geriatr Soc . 1992;40:449-453. 10. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition. Washington, DC: American Psychiatric Association; 1987. 11. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease . Neurology . 1984;34:939-944.Crossref 12. Panisset M, Roudier M, Saxton J, Boller F. Validation d'une batterie d'évaluation neuropsychologique pour des patients avec démence sévère . Presse Med . 1992; 21:1271-1274. 13. Feldman D, Hofmann R, Gagnon J, Simpson J. Statview II . Grenoble, France: Abacus Concepts Inc; 1987. 14. Liepmann D. Die linke Hemisphäre und das Handeln . Munchen Med Wschr . 1905;49:2322-2326, 2375-2378. 15. Lhermitte F, Pillon B, Serdaru M. Human autonomy and the frontal lobes . Ann Neurol . 1986;19:326-334.Crossref 16. Wilson RS, Bacon LD, Fox JH, Kaszniak AW. Primary memory and secondary memory in dementia of the Alzheimer type . J Clin Neuropsychol . 1983;5:337-344.Crossref 17. Jorm AF. Controlled and automatic information processing in senile dementia: a review . Psychol Med . 1986;16:77-78.Crossref 18. Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations . Neurology . 1990;40:1225-1230.Crossref 19. Burns A, Jacoby R, Levy R. Progression of cognitive impairment in Alzheimer's disease . J Am Geriatr Soc . 1991;39:39-45. 20. Katzman R, Brown T, Thal LJ, et al. Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease . Ann Neurol . 1988;24:384-389.Crossref 21. Botwinick J, Storandt M, Berg L. A longitudinal, behavioral study of senile dementia of the Alzheimer type . Arch Neurol . 1986;43:1124-1127.Crossref 22. Ortof E, Crystal HA. Rate of progression of Alzheimer's disease . J Am Geriatr Soc . 1989;37:511-514. 23. Dastoor DP, Cole MG. The course of Alzheimer's disease: an uncontrolled longitudinal study . J Clin Exp Gerontol . 1985;7:289-299. 24. Mayeux R. Stern Y, Spanton S. Heterogeneity in dementia of Alzheimer type: evidence of subgroups . Neurology . 1985;35:453-461.Crossref 25. Chui HC, Lee Teng E, Henderson VW, Moy AC. Clinical subtypes of dementia of the Alzheimer type . Neurology . 1985;35:1544-1550.Crossref 26. Boller F, Holland A, Forbes M, Hood P, McGonigle-Gibson K, Becker JT. Predictors of decline in Alzheimer's disease . Cortex . 1991;27:9-17.Crossref 27. Cummings JL, Benson DF. Dementia: A Clinical Approach . Stoneham, Mass: Butterworth Inc; 1983. 28. Luxenberg JS, Haxby JV, Creasy H, Sundaram M, Rapoport SI. Rate of ventricular enlargement in dementia of the Alzheimer type correlates with a rate of neuropsychological deterioration . Neurology . 1987;37:1135-1140.Crossref 29. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;114:797-811.Crossref 30. Pfeiffer E. Short Portable Mental Status Questionnaire for the assessment of organic brain deficit in elderly patients . J Am Geriatr Soc . 1975;23:433-441. 31. Mattis S. Mental status examination for organic mental syndrome in the elderly patients . In: Bellak L, Karasu T, eds. Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians . New York, NY: Grune & Stratton Inc; 1976:77-121. 32. Cole M, Dastoor D. The hierarchic dementia scale . J Clin Exp Gerontol . 1983; 5:219-234. 33. Démonet J, Doyon B, Ousset P, et al. Etalonnage d'une échelle d'évaluation cognitive de structure modulaire et hiérarchisée applicable aux démences . Rev Neurol . 1990;146:490-501. 34. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation memory concentration test of cognitive impairment . Am J Psychiatry . 1983;140:734-739. 35. Reisberg B. Functional Assessment Staging (FAST) . Psychopharmacol Bull . 1988;24:653-659. 36. Lopez O, Boller F, Becker JT, Miller M, Reynolds CF. Alzheimer's disease and depression: neuropsychological impairment and progression of the illness . Am J Psychiatry . 1990;147:855-860. 37. Forette F, Panisset M, Boller F. Clinical trials in cognitive impairment of the elderly . Aging Clin Exp Res . 1992;4:239-250.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1994

References