|
ALISTAIR BURNS, BRIAN LAWLOR, and
SARAH CRAIG
Rating scales in old age psychiatry
Br. J. Psychiatry, Feb 2002; 180: 161 - 167. [Abstract]
[Full
text] [PDF]
DEPRESSION
Geriatric Depression
Scale
The Geriatric Depression Scale (GDS) is a self-report scale
designed to be simple to administer and not to require
the skills of a trained interviewer (Yesavage
et al, 1983). Each of the 30 questions
has a yes/no answer, with the scoring dependent
on the answer given. A sensitivity of 84% and specificity
of 95% have been documented with a cut-off score of 11/12;
a cut-off of 14/15 decreased the sensitivity
rate to 80% but increased specificity to 100%.
A 15-item version of the GDS has been devised
by Shiekh & Yesavage (1986), and is
probably the most common version currently used. The shortened
version has a cut-off score of 6/7 and correlates
significantly with the parent scale. Logistic
regression analysis has been used to derive a
four-item version which has a specificity of 88% with
a cut-off of 1/2, and sensitivity of 93% with a cut-off
of 0/1 (Katona, 1994). For the assessment
of depression in older people, it is the scale
against which others should be rated.
Brief Assessment
Schedule Depression Cards
The Brief Assessment Schedule Depression Cards (BASDEC)
system is based on the Brief Assessment Schedule
with the novel development that, because of the
difficulties of questions being overheard on
geriatric wards, patients choose answers from a deck of
cards (Adshead et al, 1992).
The scale is administered by an interviewer and
takes 2-8 minutes to complete. The pack is made
up of 19 cards with enlarged black print on a white background
and are presented one at a time. Both the GDS and
the BASDEC performed identically well in the
original study with a sensitivity of 71% and
negative predictive value of 86% against a psychiatric
diagnosis, using a BASDEC cut-off score of 6/7.
Cornell Scale for
Depression in Dementia
The Cornell Scale (Alexopoulos et al,
1988) is specifically for the assessment
of depression in dementia and is administered
by a clinician. It takes 20 minutes with the carer and 10
minutes with the patient.
It differs from other depression
scales in the method of administration rather than in analysis
of any different symptom profile seen in depression
with dementia compared with depression alone
(Purandara et al, 2001). The 19-item scale is rated
on a three-point score of ‘absent’, ‘mild or
intermittent’ and ‘severe’ symptoms, with a note
when the score is unevaluable. A score of 8 or
more suggests significant depressive symptoms.
It is the best scale available to assess mood in the presence
of cognitive impairment.
Geriatric Mental
State Schedule
The Geriatric Mental State Schedule (GMSS) is one of the
most widely used instruments for measuring a
wide range of psychopathology in older people
in all settings, but most importantly in community
surveys (Copeland et al, 1976).
Literature on the GMSS is extensive, and a number
of different factors can be derived from the
results. There is a computerised algorithm of proven
reliability and validity, AGECAT, which provides standardised
diagnoses. The GMSS can be administered via a laptop
computer, has been translated into a number of different
languages, has to be administered by a trained
interviewer, and takes about 45 minutes to deliver.
The use of the GMSS is limited to research, where
it represents the gold standard.
Centre for Epidemiological
Studies — Depression scale
The Centre for Epidemiological Studies — Depression (CES—D)
scale is a self-administered scale, taking 5 minutes to
complete. Originally developed for a general
population study (Radloff, 1977),
the instrument has been found to be particularly useful
in older people. The scale consists of 20 items and
the scoring range is from 0 to 60. A cut-off
score of 16 has been suggested to differentiate
patients with mild depression from normal subjects,
with a score of 23 and over indicating significant depression.
Hamilton Rating Scale
for Depression
The Hamilton Rating Scale for Depression (Hamilton,
1960) is the gold standard of observer-rated
depression rating scales. It is a semi-structured
interview, requires training to complete, and
takes 20-30 minutes to administer. It is used to assess
in all age groups, both for clinical and research
purposes, the severity of depression rather than
as a diagnostic tool. A cut-off score of 10/11
is generally regarded as appropriate for the
diagnosis of depression.
Montgomery— sberg
Depression Rating Scale
The Montgomery—sberg
Depression Rating Scale (MADRS) is administered by a trained
interviewer, takes 20 minutes to complete and
was designed as a measure of change in studies
of the treatment of depression (Montgomery
&
sberg,
1979). It was developed by taking items from
a longer scale. It is widely used in treatment trials,
in both young and older patients. Specific instructions
are given regarding the ratings and there is
a comparative lack of emphasis on somatic symptoms,
making it useful for the assessment of depression
in people with physical illness. Cut-off scores
have been suggested by Snaith et al (1986):
0-6 indicates the absence of depression (or recovery in
the setting of a clinical trial); 7-19, mild
depression; 20-34, moderate depression; and 35
and above, severe depression.
DEMENTIA: COGNITIVE
IMPAIRMENT
Mini-Mental State
Examination
The Mini-Mental State Examination (MMSE) is a rating of
cognitive function and takes 10 minutes to administer
by a trained interviewer (Folstein et
al, 1975). It is the most widely used measure
of cognitive function, and users need some training
and familiarisation with the instrument. Much
has been written about the MMSE and amendments
have been suggested such as the Standardised Mini-Mental
State Examination (Molloy et al,
1991) and the Modified Mini-Mental State
(Teng et al, 1987). The original
validity and reliability of the MMSE were based
on 206 patients with a variety of psychiatric
disorders, the scale successfully separating those with
dementia, depression, or a combination of the
two. Details of extensive subsequent validity
and reliability studies are described by Tombaugh
& McIntyre (1992). A cut-off score
of 23 for the presence of cognitive impairment
has been suggested, with variations depending
on lack of education.
Mental Test Score
and Abbreviated Mental Test Score
The Mental Test Score (MTS) and its abbreviated version
are brief questionnaires to assess the degree
of cognitive function, particularly memory and
orientation; the MTS takes 10 minutes to administer,
and the abbreviated form 3 minutes (Hodkinson,
1972). The MTS was developed from the Blessed
Dementia Scale and was used in a study of over
700 patients carried out under the auspices of
the Royal College of Physicians in the 1970s.
A score of 25 and above (out of 34) is within normal range.
From it, the Abbreviated Mental Test Score (AMTS)
was developed, scored out of 9 or 10 (depending
on whether the optional recognition questionnaire
is completed). A cut-off score of 7/8 out of 10
(or 6/7 out of 9) is suggested to discriminate between
cognitive impairment and normality. Qureshi &
Hodkinson (1974) further
validated the shorter questionnaire.
Clock drawing test
The clock drawing test takes only 2 minutes to administer
and reflects frontal and temporoparietal functioning
(Brodaty & Moore, 1997;
Shulman et al, 1986). The main
advantages are its simplicity of administration
and the non-threatening nature of the task. The
patient is asked to draw a clock face marking the hours
and then draw the hands to indicate a particular
time (e.g. 10 minutes to 2). Standardised methods
of scoring have been described with sensitivities
of up to 86% and specificity of up to 96% compared
with diagnosis using the MMSE. This test is particularly
useful in the general practice setting.
Seven-minute neurocognitive
screening battery
The 7-minute neurocognitive screening battery is a test
for cognitive impairment which aims to distinguish
patients with dementia and normal controls (Solomon
et al, 1998). It takes a mean of 7
minutes 42 seconds (range 6-11 minutes) to administer
by a trained interviewer. The 7-minute screen consists
of four tests representing four cognitive areas
affected in Alzheimer's disease: memory, verbal fluency,
visuoconstruction and orientation for time. The
screening instrument was designed so that it
could be rapidly administered by a technician, requiring
no clinical judgement or training. It distinguishes
patients with early Alzheimer's disease from
those with normal ageing. It is a relatively
new instrument and its exact use has still to
be established.
Alzheimer's Disease
Assessment Scale
The Alzheimer's Disease Assessment Scale (ADAS) takes 45
minutes administered by a trained observer and is a standardised
assessment of cognitive function and non-cognitive
features (Rosen et al,
1984). The cognitive section of the scale (ADAS-Cog)
is the gold standard for measuring change in
cognitive function in drug trials. Deterioration
of about 10% per year in cognitive tests in patients
with Alzheimer's disease is regarded as average.
The cognitive domains include components of memory,
language and praxis, while the non-cognitive
features include mood state and behavioural changes.
There are 11 main sections testing cognitive
function and 10 assessing non-cognitive features.
GLOBAL ASSESSMENTS
Clinical Dementia
Rating
The Clinical Dementia Rating (CDR) scale
is used as a global measure of dementia (Hughes
et al, 1982; Berg, 1984)
and is usually completed by a clinician in the
setting of detailed knowledge of the individual
patient. Much of the information will therefore
already have been gathered, either as part of
normal clinical practice or as part of a research study.
If a specific interview is carried out, about
40 minutes is needed to gather the relevant information.
The CDR has become one of the
main methods by which the degree of dementia is quantified
into stages. Six domains are assessed: memory; orientation;
judgement and problem-solving; community affairs;
home and hobbies; and personal care. Ratings
are 0 for healthy people, 0.5 for questionable
dementia and 1, 2 and 3 for mild, moderate and
severe dementia as defined in the CDR scale.
Clinicians' Global
Impression of Change
The Clinicians' Global Impression of Change scale is administered
by a trained rater and takes 10-40 minutes (Guy,
1976). The ratings depend on the ability
of the clinician to detect change, and any change
that is clinically detectable is significant.
By definition, these measures are global ratings of a patient's
clinical condition, and inevitably draw information
from a wide variety of sources. The scale has
been used extensively in clinical trials of antidementia
drugs where a global assessment of the degree of dementia
is required, and can usefully assess change from
a specified baseline (Knopman et al,
1994; Schneider & Olin, 1996).
BEHAVIOURAL AND PSYCHOLOGICAL
SYMPTOMS
Neuropsychiatric
Inventory
The Neuropsychiatric Inventory (NPI) evaluates a wider range
of psychopathology than comparable instruments (Cummings
et al, 1994). It may help distinguish
between different causes of dementia, records
severity and frequency separately, and takes
10 minutes to administer. The NPI assesses ten domains:
delusions; hallucinations; dysphoria; anxiety; agitation/aggression;
euphoria; disinhibition; irritability/lability; apathy;
and aberrant motor behaviour. A screening strategy
is used to cut down the length of time the instrument
takes to administer, but obviously it takes longer
if replies are positive. It is scored from 1 to 144 and
severity and frequency are independently assessed.
The NPI has been translated into a number of languages
and it is now used widely in drug trials.
BEHAVE—AD
The BEHAVE—AD (Reisberg et al, 1987)
takes 20 minutes to administer by a clinician
and was designed particularly to be useful in
prospective studies of behavioural symptoms and
in pharmacological trials to document behavioural symptoms
in patients with Alzheimer's disease. The BEHAVE—AD
is the original behaviour rating scale in Alzheimer's
disease. It is in two parts: the first part concentrates
on symptomatology, and the second requires a
global rating of the symptoms, on a four-point
scale of severity. The domains covered are paranoid
and delusional ideation; hallucinations; activity
disturbances; aggression; diurnal variation; mood; and anxieties
and phobias.
MOUSEPAD
The Manchester and Oxford Universities Scale for the Psychopathological
Assessment of Dementia (MOUSEPAD) is administered to carers
by an experienced clinician, and takes 15-30 minutes,
most items being given a three-point severity
score (Allen et al, 1996). The
main indication for use of the scale is the measurement
of psychiatric symptoms and behavioural changes in patients
with dementia.
The MOUSEPAD is based on
the longer Present Behavioural Examination (Hope
& Fairburn, 1992), and was developed as a shorter
instrument and one with an equal emphasis on psychiatric
symptomatology and behavioural changes.
Cohen-Mansfield Agitation
Inventory
The seven-point rating system of the Cohen-Mansfield Agitation
Inventory (CMAI) assesses 29 different agitated behaviours
in patients with cognitive impairment (Cohen-Mansfield,
1989). It takes 10-15 minutes and is carried
out by carers. Training is essential. The agitated
behaviours include wandering, aggression, inappropriate
vocalisation, hoarding items, sexual disinhibition
and negativism, and are rated on a seven-point scale
of frequency. The CMAI is useful for the assessment
of agitation in residents of nursing and residential
homes.
Revised Memory and
Behaviour Problems Checklist
The Revised Memory and Behaviour Problems Checklist assesses
behavioural problems in dementia, taken from caregiver
reports (Teri et al, 1992).
It is a 24-item list that provides one total
score and three subscores for memory-related problems,
depression and disruptive behaviours, assessing both
the frequency of the behaviour and the caregiver's
reaction.
ACTIVITIES OF DAILY
LIVING
Bristol Activities
of Daily Living Scale
The Bristol Activities of Daily Living Scale was designed
specifically for use in patients with dementia
(Bucks et al, 1996). The
scale assesses 20 daily living abilities. Face validity
was measured by way of carer agreement that the
items were important, construct validity was confirmed by
principal components analysis and concurrent
validity by assessment with observed performance,
and there is good test—retest reliability. Three phases
in the design of the scale are described, and researchers
designing their own scale should read the account
of this development, which is a model of clarity.
Alzheimer's Disease
Functional Assessment and Change Scale
The Alzheimer's Disease Functional Assessment and Change
Scale (ADFACS) is used for the assessment of
activities of daily living in patients with Alzheimer's
disease with particular reference to outcomes
in clinical trials (Galasko et al,
1997). It is informant-based and takes 20
minutes. The scale has been used in drug trials,
and consists of ten items for instrumental activities of
daily living: ability to use the telephone; performing
household tasks; using household appliances; handling
money; shopping; preparing food; ability to get
around both inside and outside the home; pursuing
hobbies and leisure activities; handling personal
mail; and grasping situations or explanations.
These are rated from no impairment to severe impairment.
Basic activities of daily
living are assessed on a six-point scale (an
additional rating, very severe impairment, is included).
These are: toileting, dressing, personal hygiene and
grooming, physical ambulation and bathing. The
scale was developed from 45 activities of daily
living items, with the chosen items having been
shown to be sensitive to change over 12 months,
to correlate with the MMSE and to have good test—retest
reliability (Galasko et al,
1997).
Interview for Deterioration
in Daily Living Activities in Dementia
The Interview for Deterioration in Daily Living Activities
in Dementia (IDDD) assesses activities of daily
living, taking 15 minutes to administer with
a caregiver (Teunisse et al, 1991).
The scale covers 33 self-care activities such as washing,
dressing and eating, as well as more complex activities
such as shopping, writing and answering the telephone,
tasks performed equally by men and women (earlier
scales of activities of daily living tended to
rely more heavily on female-dominated and less
complex tasks). Both the initiative to perform activities
and the performance itself are evaluated.
Disability Assessment
for Dementia
The Disability Assessment for Dementia (DAD) scale (Gelinas
et al, 1999) is rated by a trained
observer and takes 20 minutes. It is a new functional
scale specifically developed for patients with
Alzheimer's disease and assesses basic and instrumental
activities of daily living.
GLOBAL MEASURES OF
PSYCHIATRIC SYMPTOMATOLOGY
Psychogeriatric Assessment
Scale
The Psychogeriatric Assessment Scale (PAS) provides an assessment
of the clinical changes of dementia and depression
(Jorm et al, 1995).
The package is easy to administer and score, and
can be used by lay interviewers. It is intended for
use both in research and service evaluation,
taking about 10 minutes to administer by a trained
lay interviewer or clinician. There are three
scales derived from an interview with the subject (cognitive
impairment, depression, stroke) and three derived
from an interview with an informant (cognitive decline,
behavioural change, stroke).
Brief Psychiatric
Rating Scale
The Brief Psychiatric Rating Scale (BPRS) takes about 20
minutes and is administered by a trained interviewer.
The BPRS is a 16-item, seven-point ordered category
rating scale which has been developed through
previous versions (Overall & Gorham, 1962).
The domains assessed are somatic concern; anxiety;
emotional withdrawal; conceptual disorganisation;
guilt feelings; tension; mannerisms and posturing; grandiosity;
depressive mood; hostility; suspiciousness; hallucinatory
behaviour; motor retardation; uncooperativeness;
unusual thought content; and blunted affect.
The questions are completed in 2-3 minutes following the
interview.
Health of the Nation
Outcome Scales 65+
The Health of the Nation Outcome Scales 65+ (HoNOS 65+)
are an adaptation of the equivalent scale for
younger people (Burns et al,
1999a). It is a 12-item score dealing with the
following aspects of the mental state and living situation:
aggression; self-harm; drug and alcohol use;
cognitive problems; physical illness and disability;
hallucinations and delusions; depression; other
symptoms; relationships; activities of daily living;
residential environment; and daytime activities.
Its main use is in the provision
of the global assessment of a patient. Its administration
takes about 10 minutes and requires some training.
The HoNOS 65+ is becoming a useful tool in defining
the characteristics of populations of older people
with mental health problems.
Cambridge Mental
Disorders of the Elderly Examination
The Cambridge Mental Disorders of the Elderly Examination
(CAMDEX) is a structured instrument made up of
eight sections — an interview with the subject,
a cognitive section (the CAMCOG), the interviewer's
observations of the subject, a physical examination,
results of investigations, a note of medication, any
additional information and an interview with
an informant (Roth et al,
1986). The resulting information provides a formal
diagnosis in a number of categories: four types
of dementia, delirium, depression, anxiety, paranoid
disorder, and other psychiatric disorders. Interrater
reliability is excellent and a cut-off score
of 79/80 gives a 92% sensitivity and 96% specificity in
relation to a diagnosis of dementia. The CAMDEX has been
used extensively in research studies.
CARER BURDEN AND
QUALITY OF LIFE
General Health Questionnaire
The General Health Questionnaire (GHQ) is a self-administered
screening test used for detecting psychiatric disorders
in community settings and non-psychiatric clinical
settings (Goldberg & Williams, 1988).
A number of versions are available; the
commonly used 12-item one takes 5 minutes. It is not normally
used as a screening measure in older people, but has
been used as a measure of psychological distress
and psychiatric morbidity in carers of patients
with dementia (Marriott et al, 2000)
and seems to be sensitive to change in that situation.
Quality of Life in
Alzheimer's Disease Patient and Caregiver Report
The Quality of Life in Alzheimer's Disease Patient and Caregiver
Report (QoL—AD) is used for the assessment of quality
of life in dementia and is taken from self and caregiver
reports (Logsdon et al, 1999).
This 13-item assessment relates to the domains
of mood, physical health, memory, relationships, self-esteem
and current situation. Each is marked on a four-point
scale.
OTHER SCALES
Confusion Assessment
Method
The Confusion Assessment Method (CAM) instrument (Inouye
et al, 1990) consists of nine operationalised
criteria from DSM—III—R (American Psychiatric
Association, 1987) including the four cardinal
features of delirium: acute onset and fluctuation,
inattention, disorganised thinking and altered level
of consciousness. Both the first and second features,
and either the third or fourth feature, are required for
the diagnosis. The results have been validated
against psychiatric diagnosis and found to be
valid.
Cognitive Failures
Questionnaire
The Cognitive Failures Questionnaire (CFQ) is used as a
measure of self-reported failures in perception,
memory and motor function (Broadbent
et al, 1982) and takes about 10 minutes to complete.
This questionnaire may be of use in screening different
memory complaints in a population or clinical
sample. Its use has not been validated against
the presence or absence of dementia, but it gives
a useful overview of which aspects of memory loss
are giving rise to problems.
REFERENCES
Adshead, F., Day Cody, D. & Pitt, B.
(1992) BASDEC: a novel screening instrument for depression
in elderly medical inpatients. BMJ, 305, 397.[Medline]
Alexopoulos, G., Abrams, R., Young,
R., et al (1988) Cornell Scale for Depression
in dementia. Biological Psychiatry, 23, 271-284.[Medline]
Allen, N. H., Gordon, S., Hope, T.,
et al (1996) Manchester and Oxford Universities
Scale for the Psychopathological Assessment of Dementia
(MOUSEPAD). British Journal of Psychiatry, 169,
293-307.[Abstract]
American Psychiatric Association (1987)
Diagnostic and Statistical Manual of Mental Disorders
(3rd edn, revised) (DSM—III—R). Washington, DC: APA.
Berg, L. (1984) Clinical dementia
rating (letter). British Journal of Psychiatry,
145, 339.[Medline]
Broadbent, D. E., Cooper, P. F., FitzGerald,
P., et al (1982) Cognitive Failures Questionnaire
(CFQ) and its correlates. British Journal of Clinical
Psychology, 21, 1-16.[Medline]
Brodaty, H. & Moore, C. M. (1997)
The Clock Drawing Test for Dementia of the Alzheimer's Type:
a comparison of three scoring methods in a memory disorders
clinic. International Journal of Geriatric Psychiatry,
12, 619-627.[Cross Reference][Medline]
Bucks, R. S., Ashworth, D. I., Wilcock,
G. K., et al (1996) Assessment of activities
of daily living in dementia: development of the Bristol
Activities of Daily Living scales. Age and Ageing,
25, 113-120.[Abstract]
Burns, A., Beevor, A., Lelliott, P.,
et al (1999a) Health of the Nation Outcome
Scales for elderly people (HoNOS 65+). Glossary for HoNOS
65+ score sheet. British Journal of Psychiatry,
174, 435-438.[Medline]
Burns, A., Lawlor, B. & Craig, S. (1999b)
Assessment Scales in Old Age Psychiatry. London:
Martin Dunitz.
Cohen-Mansfield, J., Marx, M. & Rosenthal,
A. (1989) A description of agitation in a nursing home.
Journal of Gerontology, 44, M77-M84.[Medline]
Copeland, J., Kelleher, M., Kellet,
J., et al (1976) A semi-structured clinical interview
for the assessment of diagnosis of mental state in the elderly:
geriatric mental state schedule. I Development and reliability.
Psychological Medicine, 6, 439-449.[Medline]
Cummings, J. L., Mega, M., Gray, K.,
et al (1994) The Neuropsychiatric Inventory:
comprehensive assessment of psychopathology in dementia.
Neurology, 44, 2308-2314.[Abstract]
Folkman, S. & Lazarus, R. (1980)
An analysis of coping in a middle aged community sample.
Journal of Health and Social Behaviour, 21,
219-239.
Folstein, M., Folstein, S. & McHugh,
P. (1975) Mini mental state: a practical method for
grading the cognitive state of patients for the clinician.
Journal of Psychiatric Research, 12, 189-198.[Cross Reference][Medline]
Galasko, D., Bennett, D., Sano, M.,
et al (1997) An inventory to assess activities
of daily living for clinical trials in Alzheimer's disease.
The Alzheimer's disease co-operative study. Alzheimer's
Disease and Associated Disorders, 11 (suppl.
2), S33-39.
Gelinas, I., Gauthier, L. & McIntyre,
M. (1999) Development of a functional measure for persons
with Alzheimer's disease: the Disability Assessment for
Dementia. American Journal of Occupational Therapy,
53, 471-481.[Medline]
Goldberg, D. P. & Williams, P. (1988)
A User's Guide to the General Health Questionnaire.
Windsor: NFER-Nelson.
Guy, W. (ed.) (1976) Clinical Global
Impressions. In ECDEU Assessment Manual for Psychopharmacology,
pp. 218-222. Revised DHEW Pub. (ADM). Rockville, MD: National
Institute for Mental Health.
Hamilton, M. (1960) A rating scale
for depression. Journal of Neurology, Neurosurgery and
Psychiatry, 23, 56-62.
Hodkinson, H. (1972) Evaluation
of a mental test score for assessment of mental impairment
in the elderly. Age and Ageing, 1, 233-238.[Medline]
Hope, R. A. & Fairburn, C. G. (1992)
The Present Behavioural Examination (PBE): the development
of an interview to measure the current behavioural abnormalities.
Psychological Medicine, 22, 223-230.[Medline]
Hughes, C. P., Berg, L., Danziger, W.
L., et al (1982) A new clinical scale for the
staging of dementia. British Journal of Psychiatry,
140, 566-572.[Abstract]
Inouye, S. K., van Dyck, C. H., Alessi,
C. A., et al (1990) Clarifying confusion: the
Confusion Assessment Method. Annals of Internal Medicine,
113, 941-948.[Medline]
Jorm, A., MacKinnon, A., Henderson,
A. S., et al (1995) Psychogeriatric Assessment
Scales. A multidimensional alternative to categorical diagnosis
of dementia and depression in the elderly. Psychological
Medicine, 25, 447-460.[Medline]
Katona, C. (1994) Depression
in Old Age. Chichester: John Wiley & Sons.
Knopman, D., Knapp, M. J., Gracon, S.
I., et al (1994) The Clinician Interview-Based
Impression (CIBI): a clinician's global change rating scale
in Alzheimer's disease. Neurology, 44, 2315-2321.[Abstract]
Logsdon, R. G., Gibbons, I. E., McCurry,
S. M., et al (1999) Quality of life in Alzheimer's
disease: patient and caregiver reports. Journal of Mental
Health and Aging, 5, (1).
Marriott, A., Donaldson, C., Tarrier,
N., et al (2000) Effectiveness of cognitive—behavioural
family intervention in reducing the burden of care in carers
of patients with Alzheimer's disease. British Journal
of Psychiatry, 176, 557-562.[Abstract/Full
Text]
Molloy, D. W., Alemanelin, E. & Robert,
M. (1991) Reliability of a standardized Mini-Mental
State Examination compared with the traditional Mini-Mental
State Examination. American Journal of Psychiatry,
148, 102-105.[Abstract]
Montgomery, S. A. &
sberg,
N. (1979) A new depression scale designed to be sensitive
to change. British Journal of Psychiatry, 134,
382-389.[Abstract]
Overall, J. & Gorham, D. (1962)
The brief psychiatric rating scale. Psychological Reports,
10, 799-812.
Purandare, N., Burns, A., Craig, S.,
et al (2001) Depressive symptoms in patients
with Alzheimer's disease. International Journal of Geriatric
Psychiatry, 16, 960-964.[Cross Reference][Medline]
Qureshi, K. & Hodkinson, M. (1974)
Evaluation of a 10-question mental test of the institutionalized
elderly. Age and Ageing, 3, 152-157.[Medline]
Radloff, L. (1977) The Centre for
Epidemiological Studies—Depression Scale. A self report
depression scale for research in the general population.
Applied Psychological Measurements, 3, 385-401.
Reisberg, B., Borenstein, J., Salob,
S. P., et al (1987) Behavioural symptoms in Alzheimer's
disease: phenomenology and treatment. Journal of Clinical
Psychiatry, 48 (suppl. 5), 9-15.[Medline]
Rosen, W., Mohs, R. & Davis, K. L. (1984)
A new rating scale for Alzheimer's disease. American
Journal of Psychiatry, 141, 1356-1364.[Abstract]
Roth, M., Tym, E., Mountjoy, C. Q.,
et al (1986) CAMDEX: a standardised instrument
for the diagnosis of mental disorder in the elderly with
special reference to the early detection of dementia.
British Journal of Psychiatry, 149, 698-709.[Abstract]
Schneider, L. S. & Olin, J. T. (1996)
Clinical global impressions in Alzheimer's clinical trials.
International Psychogeriatrics, 8, 277-288.[Medline]
Shiekh, J. & Yesavage, J. (1986)
Geriatric Depression Scale; recent findings in development
of a shorter version. In Clinical Gerontology: A Guide
to Assessment and Intervention (ed. J. Brink). New York:
Howarth Press.
Shulman, K., Shedletsky, R. & Silver,
I. (1986) The challenge of time: clock drawing and cognitive
function in the elderly. International Journal of Geriatric
Psychiatry, 1, 135-140.
Snaith, R. P., Harrop, F. M., Newby,
D. A., et al (1986) Grade scores of the Montgomery—Asberg
Depression and the Clinical Anxiety Scales. British Journal
of Psychiatry, 148, 599-601.[Medline]
Solomon, P. R., Hirschoff, A., Kelly,
B., et al (1998) A 7-minute neurocognitive screening
battery highly sensitive to Alzheimer's disease. Archives
of Neurology, 55, 349-355.[Abstract/Free
Full Text]
Teng, E. L., Chang Chui, H., Schneider,
L. S., et al (1987) Alzheimer's dementia: performance
on the Mini-Mental State Examination. Journal of Consulting
and Clinical Psychology, 55, 96-100.[Cross Reference][Medline]
Teri, L., Truax, P., Logsdon, R.,
et al (1992) Assessment of behavioural problems
in dementia: the revised memory and behaviour problems checklist.
Psychology and Ageing, 7, 622-631.[Cross Reference]
Teunisse, S., Derix, M. M. & van Crevel,
H. (1991) Assessing the severity of dementia. Archives
of Neurology, 48, 274-277.[Abstract]
Tombaugh, T. N. & McIntyre, N. J. (1992)
The minimental state examination: a comprehensive review.
American Journal of Geriatric Psychiatry, 40,
922-935.
Yesavage, J., Brink, T., Rose, T.,
et al (1983) Development and validation of a
geriatric depression screening scale. Journal of Psychiatric
Research, 17, 37-49.
|
