Dementia Rating Scale Subscales Research Articles

Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy

This article reports the severity and profile of neuropsychological impairment on a prevalent cohort of patients with a clinical diagnosis of either multiple system atrophy (n=372) or progressive supranuclear palsy (n=311) from the Neuroprotection and Natural History in Parkinson Plus Syndromes cohort. The Dementia Rating Scale and Frontal Assessment Battery were used to assess global cognition and executive dysfunction. For the Dementia Rating Scale impairment was observed in approximately 57% of the progressive supranuclear palsy group and 20% of the multiple system atrophy group. In the former, impairment in a single cognitive domain was observed in 40%, with the same number showing impairment in multiple domains, while in the latter the figures were 28.6 and 13.5%, respectively. On the Frontal Assessment Battery, impairment was observed in 62.0% of patients with progressive supranuclear palsy and 31.8% of those with multiple system atrophy. Although the progressive supranuclear palsy group performed worse overall, the cognitive profiles of the two groups on the Dementia Rating Scale subscales were identical, with the main impairment of the Initiation and Perseveration subscale. The impaired patients in the two groups were largely indistinguishable, qualitatively and quantitatively. Impairment was associated with greater age and clinical disability in both groups and was evident even in the early stages (22% in multiple system atrophy and 50% in progressive supranuclear palsy). Where a pathological diagnosis was available, the original clinical diagnosis was confirmed in the majority of cases, including those with significant cognitive impairment. The rate of impairment in those with a confirmed pathological diagnosis was comparable to that of the sample as a whole. These results demonstrate, in the largest prospectively recruited cohort of patients with progressive supranuclear palsy and multiple system atrophy studied to date, the existence of a cognitive profile similar to that previously reported in idiopathic Parkinson's disease. The results indicate a high level of cognitive impairment associated with progressive supranuclear palsy, but also point to comparable dysfunction in a substantial proportion of the patients with multiple system atrophy. Significant cognitive impairment appears consistent with a diagnosis of multiple system atrophy, even early in the disease, with important implications for diagnosis, research and management.

Assessment of Medication Management Ability in Middle-Aged and Older Adults With Bipolar Disorder

Medication nonadherence is a key clinical concern in bipolar disorder (BD) across the life span. Cognitive deficits in older adults with BD may hinder medication management ability, which, in turn, may lead to nonadherence. Using an innovative performance-based measure of medication management ability, the Medication Management Ability Assessment (MMAA), we compared performance of 29 middle-aged older community-dwelling outpatients with BD who were clinically stable (mean age, 61 years; SD, 11 years; range, 45-86 years) with those of 59 normal control subjects (NCs) and 219 outpatients with schizophrenia. The MMAA is a role-play task that simulates a medication regimen likely to be encountered by older adults. Within the BD group, we examined the relationships of MMAA scores to demographic, psychiatric symptoms severity, and the Mattis Dementia Rating Scale (DRS) scores. The BD group made 2.8 times the errors on the MMAA than NCs (BD group, 6.2; SD, 5.5 vs NCs, 2.2; SD, 2.5) and did not significantly differ from the Schizophrenia group in errors on the MMAA. Errors in the BD group were more likely to be taking in too few medications as taking in too many. Within the BD group, a significant correlation was seen between MMAA scores and the DRS Total score, but not with age, education, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, number of psychiatric medications, or medical conditions. Among DRS subscales, the Memory Subscale correlated most strongly with MMAA errors. This small cross-sectional study suggests that deficits in medication management ability may be present in later-life BD. Neurocognitive deficits may be important in understanding problems with unintentional nonadherence.

Cognitive improvement after treatment of depressive symptoms in the acute phase of stroke

The outcome of antidepressant treatment for depressive symptoms and cognitive impairment at the acute phase of stroke is controversial. We investigated 93 patients, treating with citalopram 36 with severe depressive symptoms (HAM-D: Hamilton Depression Rating Scale >18), whilst 19 patients with mild depressive symptoms, and 38 non-depressed patients, remained untreated. At baseline (two weeks after stroke), patients with severe depressive symptoms had lower scores in total Dementia Rating Scale (DRS) and in the attention and memory DRS subscales, than the non-depressed patients (p<0.001). At the end of the three-month follow-up period, these differences had disappeared, but patients initially with mild depressive symptoms had higher HAM-D scores than the non-depressed patients (p=0.015), and lower scores in DRS attention and memory subscales (p<0.01), than the patients treated with citalopram. Treatment was associated with improved mood, memory and attention, and a placebo-controlled study on the treatment of mild depressive symptoms is warranted.

Sensitivity of the Dementia Rating Scale in Vascular Dementia: Comparison between Two Sets of Criteria to Define Cognitive Impairment

Background: The Dementia Rating Scale (DRS) is a common measure of cognitive function, but its sensitivity to identify deficits across cognitive domains in vascular dementia (VaD) remains unclear. Methods: We compared the sensitivity and specificity of two recommended cutoff scores of the DRS. Thirty-eight patients diagnosed with VaD participated in the current study. Results: The original recommendations resulted in poor sensitivity for the DRS total score and attention, construction, and memory subscales. The more recent recommendations greatly improved the sensitivity of the subscales and the total DRS score, but resulted in decreased specificity. Correlations between the specific DRS subscales and criterion measures of cognitive function revealed good convergent and divergent validity for most subscales. Conclusions: The DRS is a valid measure of cognitive dysfunction in VaD, but clinicians should consider using the more recent recommendations developed for AD to determine impaired performances in VaD.

Subscale validity of the Mattis Dementia Rating Scale

The Mattis Dementia Rating Scale (DRS), a widely used dementia screening instrument, generates five subscale scores in the areas of Attention (ATT), Initiation-Perseveration (IP), Construction (CN), Conceptualization (CON), and Memory (MEM). The present study sought to determine the criterion validity of the DRS subscales in a sample of 50 patients with Alzheimer's disease (25 with mild and 25 with moderate dementia). Subject performance on the five DRS subscales was correlated with performance on five well-validated neuropsychological criterion measures using Pearson r and stepwise regression. On a univariate level, each DRS subscale correlated most strongly with its assigned neuropsychological criterion measure. On a multivariate level, each DRS subscale emerged as the Step 1 predictor of its assigned criterion measure, with the exception of DRS CN, which was the Step 2 predictor. The results suggested that overall the DRS subscales are valid measures of their respective constructs and have value for both clinical and research purposes in mild and moderate dementia.

Psychometric Properties of the Mattis Dementia Rating Scale

This study investigated the psychometric properties of the Mattis Dementia Rating Scale (DRS), including its internal consistency, sensitivity to age and education effects, pattern of change scores, convergent validity and predictive utility. Age and education effects and stability were assessed in a sample of 280 cognitively normal persons over age 55. All other features were assessed in a sample of 274 persons with cognitive impairment, including 221 newly diagnosed dementia patients and 53 patients with mild cognitive impairment. Both samples were drawn from the Mayo Clinic Alzheimer's Disease Patient Registry. Within the normal sample, Pearson correlation coefficients for DRS Total score with age, education and intelligence were all significant, p < .0001; MAYO Full Scale IQ (FSIQ) shared approximately 20% variance with DRS Total score. Internal consistency was greater than .7 for Construction, Conceptualization, Memory, and Total score, greater than .65 for Attention and less than .5 for Initiation and Perseveration. DRS subscale scores for Memory, Attention, and Conceptualization were significantly correlated with appropriate indices from the WAIS-R or Wechsler Memory Scale-Revised, as assessed in the Mayo Older Americans Normative Studies, providing convergent validity for these DRS scales. Importantly, proportional hazards modeling revealed initial DRS Total score to be a significant predictor of longitudinal institutionalization and mortality outcomes.

The ability of the Dementia Rating Scale to predict everyday functioning

The Dementia Rating Scale (DRS) is a brief neuropsychological assessment battery designed to assess five areas of cognitive functioning in the elderly. The relationship between DRS performance and everyday functioning was examined for 50 psychogeriatric patients. Everyday functioning was assessed with a standardized performance measure examining self-care, safety, money management, cooking, medication administration, and community utilization. Regression analyses were conducted for each of the six functional domains. In addition, correlations between the DRS subscales and the functional areas were computed. Results revealed significant predictive relationships (p <.01) between performance on the DRS and most functional domains. The multiple Rs ranged from .52–.70, accounting for 27% to 49% of the variance. The Initiation/Perseveration subscale was most heavily weighted in each analysis. Significant correlations were obtained between subdomains of cognition and most functional areas. The findings provide evidence of relationships between DRS performance and functional ability.

The ability of the Dementia Rating Scale to predict everyday functioning

The Dementia Rating Scale (DRS) is a brief neuropsychological assessment battery designed to assess five areas of cognitive functioning in the elderly. The relationship between DRS performance and everyday functioning was examined for 50 psychogeriatric patients. Everyday functioning was assessed with a standardized performance measure examining self-care, safety, money management, cooking, medication administration, and community utilization. Regression analyses were conducted for each of the six functional domains. In addition, correlations between the DRS subscales and the functional areas were computed. Results revealed significant predictive relationships (p <.01) between performance on the DRS and most functional domains. The multiple Rs ranged from .52 - .70, accounting for 27% to 49% of the variance. The Initiation/Perseveration subscale was most heavily weighted in each analysis. Significant correlations were obtained between subdomains of cognition and most functional areas. The findings provide evidence of relationships between DRS performance and functional ability.

The clinical utility of the Dementia Rating Scale for assessing Alzheimer patients

Community residing patients with mild ( n = 18) or moderately severe ( n = 16) Alzheimer's disease and controls ( n = 23) were given Mattis' Dementia Rating Scale (DRS) and a brief measure of confrontation naming selected from the Boston Naming Test (BNT). The DRS was shown to be a reliable and clinically useful measure of mental status in patients with Alzheimer's disease. The DRS subscales and the BNT had excellent internal consistency reliabilities and the total DRS score (TDRS) was shown to be generally unrelated to gender and education. Among the dementia patients, performance on the TDRS was significantly associated with functional competence. The two dementia samples had similar profiles on the DRS and BNT, with the mild subjects performing significantly better than the moderately severe subjects on each measure. Extending the range of DRS subscales would improve this measure's utility as an evaluation instrument.