Dementia Rating Scale

Assessment methods that determine mental functioning (attention, orientation, memory, speech, understanding of speech, psychomotor functions) in a simple, practical way are recommended for a rough estimation of the severity of dementia. The best-known instrument is the Mini-Mental State Examination (MMSE. Folstein et al.. 1975), which allows the grading of dementia on a 30-point scale on the basis of a simple 5 10-min examination. Other, rather more involved procedures include the Dementia Rating Scale (DRS) of Mattis (1976) and the Alzheimer Disease Assessment Scale (ADAS) of Rosen et al. (1984). The... 

Dementia Rating Scale (DRS) Structured interview Total scores range from 0-144 (perfect score) 30-40 minutes to administer. Global measure of dementia using 5 subscales attention, initiation and perseveration, construction, conceptualization, memory... 

Confirmation with use of dementia rating scale (e.g., Mini-Mental Status Exam [MMSE] or Blessed Dementia Scale)... 

Dementia sum of boxes), and agitation and hostility/sus-picion (Brief Psychiatric Rating Scale). Other adverse effects in those who took prednisone were reduced bone density and a small rise in intraocular pressure. 

The efficacy and safety of risperidone have been evaluated in 44 patients (25 women and 19 men) with Parkinson s disease (80). There was either complete or near-complete resolution of hallucinations in 23, but an unsatisfactory response (n = 6) or worsening of parkinsonism (n = 6) in 12. Excluding patients with diffuse Lewy body disease, there was no significant worsening of scores on the Unified Parkinson s Disease Rating Scale after either 3 or 6 months of treatment, and the presence of dementia did not predict the response to treatment. 

Prednisone, 10 mg/day for 1 year, has been evaluated in 136 patients with probable Alzheimer s disease in a double-blind, randomized, placebo-controlled trial (196). There were no differences in the primary measures of efficacy (cognitive subscale of the Alzheimer Disease Assessment Scale), but those treated with prednisone had significantly greater memory impairment (Clinical Dementia sum of boxes), and agitation and hostility/suspicion (Brief Psychiatric Rating Scale). Other adverse effects in those who took prednisone were reduced bone density and a small rise in intraocular pressure. 

Neuropsychiatric rating scales provide specific information such as the rate of change and severity of cognitive decline or improvement. They are useful in situations in which repeated measurements of a patient s mental status are needed because they allow the clinician to determine response to an intervention (e.g., medication) in a more systematic manner. In addition, some cognitive function measures are useful screens for Alzheimer s and other dementias, cerebral infarction, and encephalitis or encephalopathies. A number of cognitive... 

The efficacy and tolerability of risperidone, yokukansan and fluvoxamine for the treatment of behavioural and psychological symptoms of dementia was studied in a blinded, randomised trial [239 ]. Compared with the other treatments, risperidone was significantly associated with constipation, muscle rigidity and extrapyramidal symptoms (based on extrapyramidal rating-scale scores) no significant changes in BP or heart rate were observed with any of the treatments. 

Acetyl-i-carnitine (4) is marketed in Italy for dementia as of this writing it is also in Phase III clinical trials in the United States and Europe. In a double-blind, placebo-controUed clinical trial over a one-year period involving 130 patients with clinically diagnosed AD, a slower rate of deterioration in 13 of the 14 outcome measures was observed in the dmg-treated group (28). Earfler smaller scale pilot studies in demented patients had also shown some improvement of various behavioral and cognitive functions (29). 

I Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia (MOUSEPAD) semistractured interview of psychopathological and behavionral changes. Rates freqnency only. 

The Indianapolis-Ibadan Dementia Project also demonstrated the reverse side of the coin, and this too was passed off with little comment the mortality rate in the African cohort was nearly double that of the American cohort, despite their better cardiovascular health. What they died of is not stated. I imagine many must have died from infections or cancers. Studies in Tanzania, where malaria is also endemic, showed that the death rate fell substantially in regions where malaria had been controlled by draining swamps. The scale of this effect was larger than could be attributed directly to malaria, and prompted research into the hidden morbidity of malaria. This research has confirmed the suspicions immuno-suppression in areas where malaria is endemic perpetuates opportunistic infections, leading to the spread of diseases such as tuberculosis. In addition, cancers such as Burkitt s lymphoma (a malignant cancer of B cells) are common and linked with malarial immunosuppression, probably... 

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