Physical decline and behavioural disturbance in advancing dementia often precipitates hospital or nursing home admission.1 The coexistence of behavioural or psychological symptoms and physical illness requires timely input from a number of professionals in both the health and social services.
Numerous rating scales are available to assess different aspects of dementia, including cognition, psychopathology, quality-of-life, and caregiver burden.
Montreal Cognitive Assessment
The Montreal Cognitive Assessment (MOCA)2 is a 30-item instrument that assesses a broad range of cognitive domains, including visuospatial reasoning and executive function and can be administered within 10 minutes. The MOCA is more effective at differentiating between mild cognitive impairment and early Alzheimer’s disease than the Mini-Mental State Examination (MMSE).2 In addition, the MMSE does not test for frontal lobe (executive) functions. Follow-up assessments can be used to track progress.
Brief Psychiatric Rating Scale
The Brief Psychiatric Rating Scale (BPRS)3 was initially developed to assess symptom domains in schizophrenia, but has also been used in a number of different settings, including Alzheimer’s disease clinical trials.4 The BPRS assesses 24 symptoms covering a range of affective, psychotic, and behavioural disturbances. The instrument can be administered in 10 minutes. The BPRS can be used to assess phenomenological changes in psychopathology as the disease progresses. It is important to note that depressive or anxiety symptoms can lower scores on cognitive testing.
Screen for Caregiver Burden
The Screen for Caregiver Burden (SCB)5 is a short self-report questionnaire that can be administered while carers are waiting to be seen. This scale assesses the occurrence of distress associated with common care experiences and can be used to target social service interventions.
Table 1 shows a package of psychometric tests that can be used by the busy GP to identify behavioural and psychological symptoms in patients with dementia.
Table 1.
Suggested psychiatric assessment for patients with dementia in the community
| Domain | Instrument | Reporting | Items, n | Administration time, minutes |
|---|---|---|---|---|
| Cognition | Montreal Cognitive Assessment (MOCA) | Clinician assessment | 30 | 10 |
| Psychopathology | Brief Psychiatric Rating Scale (BPRS) | Clinician assessment | 24 | 10 |
| Caregiver burden | Screen for Caregiver Burden (SCB) | Self-report questionnaire | 25 | 10 |
REFERENCES
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