Semin Speech Lang 2001; 22(4): 275-290
DOI: 10.1055/s-2001-17426
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Comprehensive Assessment for Dementia: A Necessity for Differential Diagnosis and Management

Cheryl K. Tomoeda
  • National Center for Neurogenic Communication Disorders, University of Arizona, Tucson, Arizona
Further Information

Publication History

Publication Date:
27 September 2001 (online)

ABSTRACT

A fundamental purpose of comprehensive assessment is to identify impaired and spared abilities of the individual with Alzheimer's disease (AD). In the hands of a skilled professional, the results of a comprehensive assessment provide the basis for the design of meaningful care plans, document the need for appropriate services, and result in optimal patient care. To obtain valid test results, clinicians must be able to recognize and, when possible, control the influence of age-associated variables on test performance. Also, clinicians must be knowledgeable about the many purposes of assessment and consider them when selecting appropriate test instruments. Standardized tests are now available that have been designed specifically to assess communicative and cognitive function in persons with dementia of varying severity. In this article, four standardized tests are described, with particular focus on the information they provide about impaired and spared abilities. Measures that have been found to be useful in screening for the presence of dementia also are discussed.

REFERENCES

  • 1 National Institute on Aging Task Force. Senility reconsidered: treatment possibilities for mental impairment in the elderly.  JAMA . 1980;  244 259-263
  • 2 McKeith I G, Perry R H, Fairbairn A F, Jabeen S, Perry E K. Operational criteria for senile dementia of Lewy body type (SDLT).  Psychol Med . 1992;  22 911-922
  • 3 Perry R H, Irving D, Blessed G, Perry E K, Fairbairn A F. Clinically and pathologically distinct form of dementia in the elderly.  Lancet . 1989;  i 166
  • 4 Tomlinson B E, Blessed G, Roth M. Observations on the brains of demented people.  J Neurol Sci . 1970;  11 205-242
  • 5 Román G C, Tatemichi T K, Erkinjuntti T. Vascular dementia: diagnostic criteria for research studies.  Neurology . 1993;  43 250-260
  • 6 Mendez M F, Selwood A, Mastri A R, Frey W H. Pick's disease versus Alzheimer's disease.  Neurology . 1993;  43 289-292
  • 7 McKeith I G, Glasko D, Kosaka K. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB).  Neurology . 1996;  47 1113-1124
  • 8 Kramarow E, Lentzner H, Rooks R, Weeks J, Saydah S. Health and Aging Chartbook.  Health, United States, 1999. Hyattsville, MD: National Center for Health Statistics; 1999
  • 9 Lindenberger U, Baltes P B. Sensory functioning and intelligence in old age: cross-sectional results from the Berlin Aging Study.  Psychol Aging . 1994;  9 339-355
  • 10 Uhlmann R F, Larson E B, Koepsell T D. Hearing impairment and cognitive decline in senile dementia of the Alzheimer's type.  J Am Geriatr Soc . 1986;  34 207-210
  • 11 Uhlmann R F, Larson E B, Rees T S, Koepsell T D, Duckert L G. Relationship of hearing impairment to dementia and cognitive dysfunction in older adults.  JAMA . 1989;  261 1916-1919
  • 12 Peters C A, Potter J F, Scholer S G. Hearing impairment as a predictor of cognitive decline in dementia.  J Am Geriatr Soc . 1988;  36 981-986
  • 13 Feller B A. Prevalence of Selected Impairments.  United States, 1977. Hyattsville, MD: National Center for Health Statistics; 1981
  • 14 Adams P R, Marano M A. Current estimates from the National Health Interview Survey, 1994; National Center for Health Statistics.  Vital Health Stat 10 . 1995;  193 83-84
  • 15 Ries P W. Prevalence and characteristics of persons with hearing trouble: United States, 1990-1991; National Center for Health Statistics.  Vital Health Stat 10 . 1994;  193 1-75
  • 16 Jerger J, Chmiel R, Wilson N, Luchi R. Hearing impairment in older adults: new concepts.  J Am Geriatr Soc . 1995;  43 124-132
  • 17 Schow R, Nerbonne M. Hearing levels among elderly nursing home residents.  J Speech Hear Disord . 1980;  45 124-132
  • 18 Campbell V A, Crews J E, Moriarty D G, Zack M M, Blackman D K. Surveillance for sensory impairment, activity limitation, and health related quality of life among older adults-United States, 1993-1997. In: Centers for Disease Control and Prevention Surveillance Summaries 48(SS08) Atlanta, GA: Centers for Disease Control and Prevention; 1999
  • 19 Voeks S, Gallager C, Langer E, Drinka P. Hearing loss in the nursing home: an institutional issue.  J Am Geriatr Soc . 1990;  38 141-145
  • 20 American Speech-Language-Hearing Association. Guidelines for Audiologic Screening Rockville, MD: American Speech-Language-Hearing Association; 1997
  • 21 Shultz D, Mowry R B. Older adults in long-term care facilities. In: Kricos PB, Lesner SA, eds. Hearing Care for the Older Adult: Audiologic Rehabilitation Boston, MA: Butterworths-Heinemann 1995: 167-184
  • 22 Witte K, Beachler C, Garstecki D, Weinstein B. Hearing Care in Nursing Homes: Primer for Speech-Language Pathologists. Short course presented at the American Speech-Language-Hearing Association Convention, Washington, DC; 2000
  • 23 Johnson D J. Mental status and aging: cognition and affect. In: Shadden BB, Toner MA, eds. Aging and Communication Austin, TX: Pro-Ed 1997: 67-95
  • 24 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry . 1967;  23 56-62
  • 25 Hamilton M. Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol . 1970;  6 278-296
  • 26 Beck A T, Ward C H, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.  Arch Gen Psychiatry . 1961;  4 561-571
  • 27 Zung W WK. A self-rating depression scale.  Arch Gen Psychiatry . 1965;  1 63-70
  • 28 Zung W WK. The depression status inventory: an adjunct to the self-rating depression scale.  J Clin Psychol . 1972;  28 539-543
  • 29 Sunderland T, Alterman I S, Yount D. A new scale for the assessment of depressed mood in demented patients.  Am J Psychiatry . 1988;  145 955-959
  • 30 Alexopoulus G S, Abrams R C, Young R C, Shamoian C A. Cornell scale for depression in dementia.  Biol Psychiatry . 1988;  23 271-284
  • 31 Wells C E. Pseudodementia.  Am J Psychiatry . 1979;  136 895-900
  • 32 Bayles K A. Cognitive impairment in the adult. In: Yoder DE, Kent RD, eds. Decision making in speech language pathology Philadelphia: B.C. Decker 1988: 36-37
  • 33 Bayles K A, Tomoeda C K. The ABCs of Dementia.  Austin, TX: Pro-Ed; 1995
  • 34 Morris J N, Hawes C, Fries B E. Designing the national resident assessment instrument for nursing homes.  Gerontologist . 1990;  30 293-302
  • 35 Hopper T, Bayles K A, Harris F P, Holland A. The relation of minimum data set ratings to scores on measures of communication and hearing among nursing home residents with dementia.  Am J Speech Lang Pathol (in press).
  • 36 Glickstein J K, Neustadt G K. Reimbursable Geriatric Service Delivery.  Gaithersburg, MD: Aspen Publishers; 1995
  • 37 Neustadt G K. Alphabet soup, post-acute care, and the speech-language pathologist: surviving the current crisis.  ASHA Special Interest Division 2 Neurophysiology and Neurogenic Speech and Language Disorders Newsletter . 1999;  9 14-20
  • 38 Bayles K A, Tomoeda C K, Trosset M W. Relation of linguistic communication abilities of Alzheimer's patients to stage of disease.  Brain Lang . 1992;  42 454-472
  • 39 Bayles K A, Tomoeda C K, Trosset M W. Alzheimer's disease: effects on language.  Dev Neuropsychol . 1993;  9 131-160
  • 40 Bayles K A, Tomoeda C K. Arizona Battery for Communication Disorders of Dementia.  Austin, TX: Pro-Ed; 1993
  • 41 Moorhouse B, Douglas J, Panaccio J, Steel G. Use of the Arizona Battery for Communication Disorders of Dementia in an Australian context.  Asia Pac J Speech Lang Hear . 1999;  4 93-107
  • 42 Armstrong L, Bayles K A, Borthwick S E, Tomoeda C K. Using the Arizona Battery for Communication Disorders of Dementia in the U.K  European J Disord Commun . 1996;  31 171-180
  • 43 Folstein M F, Folstein S E, McHugh P R. ``Mini-mental state'': a practical method for grading the mental state of patients for the clinician.  J Psychiatr Res . 1975;  12 189-198
  • 44 Reisberg B, Ferris S H, de Leon J M, Crook T. The global deterioration scale (GDS): an instrument for the assessment of primary degenerative dementia (PDD).  Am J Psychiatry . 1982;  139 1136-1139
  • 45 Wechsler D. Wechsler Adult Intelligence Scale-Revised. New York: The Psychological Corporation; 1981 . 
  • 46 Perez F I, Rivera V M, Meyer J S. Analysis of intellectual and cognitive performance in patients with multi-infarct dementia, vertebrobasilar insufficiency with dementia, and Alzheimer's disease.  J Neurol Neurosurg Psychiatry . 1995;  38 533-540
  • 47 Hart R P, Kwentus J A, Wade J B, Taylor J R. Modified Wisconsin card sorting test in elderly normal, depressed and demented patients.  Clin Neuropsychol . 1988;  2 49-52
  • 48 Jenkins R L, Parsons O A. Cognitive deficits in male alcoholics as measured by a modified Wisconsin card sorting test.  Alcohol Technical Reports . 1978;  7 76-83
  • 49 Bayles K A, Trosset M W, Tomoeda C K, Montgomery E B, Wilson J. Generative naming in Parkinson's disease patients.  J Clin Exper Neuropsychol . 1993;  15 547-562
  • 50 Tomoeda C K, Bayles K A. Longitudinal effects of Alzheimer's disease on discourse production.  Alzheimer Dis Assoc Disord . 1993;  7 223-236
  • 51 Bayles K A, Tomoeda C K, Wood J A, Cruz R F, McGeagh A. Comparison of the sensitivity of the ABCD and other measures to Alzheimer's dementia.  J Med Speech Lang Pathol . 1996;  4 183-194
  • 52 Sonies B C. Scales of Adult Independence, Language and Recall.  Austin, TX: Pro-Ed; 1997
  • 53 Bayles K A, Tomoeda C K. Functional Linguistic Communication Inventory.  Austin, TX: Pro-Ed; 1994
  • 54 Saxton J, McGonigle K L, Swihart A A, Boller F. The Severe Impairment Battery.  Suffolk, England: Thames Valley Test Company; 1993
  • 55 Saxton J, McGonigle-Gibson K L, Swihart A A, Miller V J, Boller F. Assessment of the severely-impaired patient: description and validation of a new neuropsychological test battery.  Psychological Assessment . 1990;  2 298-303
  • 56 Mattis S. DRS: Dementia Rating Scale Professional Manual.  New York: Psychological Assessment; 1988
  • 57 Craik F IM. Age-related chances in human memory. In: Park DC, Schwarz N, eds. Cognitive Aging: A Primer Philadelphia: Psychology Press; 2000: 75-92
  • 58 Knopman D S, Ryberg S A. A verbal memory test with high predictive accuracy for dementia of the Alzheimer type.  Arch Neurol . 1989;  46 141-145
  • 59 Grober E, Buschke H. Genuine memory deficits in dementia.  Dev Neuropsychol . 1987;  3 13-36
  • 60 Welsh K, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures.  Arch Neurol . 1991;  48 278-281
  • 61 Solomon P R, Hirschoff A, Kelly B. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease.  Arch Neurol . 1998;  55 349-355
  • 62 Bayles K A, Tomoeda C K. Recent Memory Screening Test.  Austin, TX: Pro-Ed; 1998
  • 63 Tombaugh T N, McIntyre N J. The Mini-Mental State Examination: a comprehensive review.  J Am Geriatr Soc . 1992;  40 922-935
  • 64 Reisberg B, Ferris S H, Franssen E, Kluger A, Borenstein J. Age-associated memory impairment: the clinical syndrome.  Dev Neuropsychol . 1986;  2 401-412
  • 65 Bleecker M L, Bolla-Wilson K, Kawas C, Agnew J. Age-specific norms for the Mini-Mental State Exam.  Neurology . 1988;  38 1565-1568
  • 66 Murden R A, McRae T D, Kaner S, Bucknam M E. Mini-Mental State Exam scores vary with education in blacks and whites.  J Am Geriatric Soc . 1991;  39 149-155
  • 67 Burnam M A, Karno M, Hough R L, Escobar J I, Forsythe A B. The Spanish Diagnostic Interview schedule: reliability and comparison with clinical diagnosis.  Arch Gen Psychiatry . 1983;  40 1189-1196
  • 68 Holzer C E, Tischler G L, Leaf P J, Myers J K. An epidemiologic assessment of cognitive impairment in a community population.  Res Commun Ment Health . 1983;  4 3-32
  • 69 Uhlmann R F, Larson E B. Effects of education on the Mini-Mental State Examination as a screening test for dementia.  J Am Geriatr Soc . 1991;  39 876-880
  • 70 Crum R M, Anthony J C, Bassett S S, Folstein M F. Population-based norms for the Mini-Mental State Examination by age and educational level.  JAMA . 1993;  269 2386-2391
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