06 - 6. Scales used in old age psychiatry

6. Scales used in old age psychiatry

© SPMM Course 6. Scales used in old age psychiatry

 The Geriatric Mental State Schedule (GMSS) is a widely used instrument for measuring a variety of psychopathology in community surveys of the elderly. AGECAT is a computerised algorithm based on GMSS.  The Mini-Mental State Examination (MMSE) is a popular cognitive screening instrument for the elderly. It takes 10 minutes to administer by a trained interviewer. A cut-off score of 23 for the presence of cognitive impairment has been suggested. Educational status affects MMSE scores. MMSE does not pick frontal lobe deficits, a major drawback of using it as a screening instrument for dementias. It is also claimed to have only moderate to minimal sensitivity to change in mild cognitive impairment states.  Abbreviated Mental Test Score is a brief 10-point questionnaire to assess memory and orientation in 3 minutes (Hodkinson, 1972). Its origins can be traced back to the Blessed Dementia Scale. A cut-off score of 7/8 out of 10 is suggested to suspect cognitive impairment in the elderly.  The Alzheimer's Disease Assessment Scale (ADAS) is a standardised assessment of cognitive function, and non-cognitive features that take 45 minutes to be administered by a trained professional. The cognitive section is termed ADAS-Cog. It is the gold standard for measuring the change in cognitive function in anti-dementia drug trials. A fall of about 10% per year is expected (deemed average) in Alzheimer's disease.  The BEHAVE—AD is a clinician-administered scale to document behavioural symptoms in patients with Alzheimer's disease. It covers paranoid and delusional ideation; hallucinations; activity disturbances; aggression; diurnal variation; mood; and anxieties and phobias.  The Neuropsychiatric Inventory (NPI) can be used to record severity of associated behavioural symptoms of dementia over ten domains: (delusions; hallucinations; dysphoria; anxiety; agitation/aggression; euphoria; disinhibition; irritability/lability; apathy; and aberrant motor behaviour). It is scored from 1 to 144. The severity and frequency of behavioural symptoms are independently assessed.  MOUSEPAD stands for Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia. It is administered to carers by an experienced clinician for the measurement of behavioural and psychiatric symptoms of dementia (BPSD).  Clifton assessment procedure for the elderly - CAPE (Pattie & Gilleard, 1979) is intended to assess the level of disability and estimate need for care in the elderly. It consists of a short cognitive scale and a behavioural rating scale. The latter has four sub-scales: physical disability, apathy, communication difficulties and social disturbance. It is quick and easy to administer.

© SPMM Course  Bristol Activities of Daily Living Scale assesses 20 daily living abilities in patients with dementia. It is a caregiver-rated scale designed for community use by trained health professionals.