Academic literature on the topic 'Clinical Dementia Rating scale'

Reliable measurement of student capability for a skill allows educators to verify student mastery. A major part of a physician's ability to gather information involves patient interviewing, and instruction of this skill is a substantial portion of a medical curriculum. Since 1974, the University of Arizona College of Medicine has employed patient-instructors (PIs), lay persons who function in the roles of patient and teacher for training of interview skills in the Preparation for Clinical Medicine (PCM) program. PIs provide "real" patient-interview experiences and immediate feedback to the students. The PCM program currently has four topic areas: Adult, Pediatric, Geriatric, and Psychiatric. The Arizona Clinical Interview Rating (ACIR) Scale was developed in 1976 to measure the technical performance aspects of interviewing. This study was undertaken to determine reliability of the ACIR. Implication of the results are discussed and suggestions made for the continued application of the ACIR Scale. (Abstract shortened with permission of author.)

Made available in DSpace on 2015-07-22T20:50:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25<br>Introdução: A incidência de demência é o maior problema de saúde pública em populações envelhecidas, particularmente em países em desenvolvimento, nos quais a população idosa tem envelhecido explosivamente. Identificar grupos de risco é de vital importância para implementar promoção de saúde. A Clinical Dementia Rating (CDR) é uma escala válida para classificar a gravidade de casos de demência (leve, moderada e grave) e também é capaz de identificar casos questionáveis (0,5), ou seja, indivíduos que apresentam alteração no seu desempenho cognitivo, mas ainda não preenchem critérios para demência. Há muitas evidências que este grupo tem taxa de conversão para demência mais alta que o grupo de idosos normais. Objetivos: Verificar a taxa de conversão para demência em uma coorte de idosos (70+) vivendo em São Paulo, na comunidade, com CDR de 0 ou de 0,5 e identificar fatores associados. Metodologia: Uma amostra com 156 membros da coorte (n=440) incluiu todos os idosos com um Mini-Mental State Examination (MMSE) abaixo ou igual a 26 pontos e uma amostra daqueles com MMSE acima de 26, todos clinicamente avaliados para demência incluindo uma bateria neuropsicológica (BNP) na linha de base. A versão portuguesa do CDR (validada pelos autores) foi aplicada nos parentes ou cuidadores dos selecionados. Após recusas e mortes, 95 idosos foram reavaliados em um intervalo de dois anos e seis meses, em média. A taxa de conversão foi analisada segundo as características demográficas, saúde mental, independência em atividades de vida diária (AVDS), presença de fatores de risco cardiovascular, desempenho na BNP e classificação CDR inicial, usando o método de regressão de Poisson, tanto nas análises univariadas como na multivariada com o logaritmo natural do tempo de exposição como uma variável offset. O valor de significância considerado foi 0,05. Resultados: Dos 95 idosos reavaliados, 15 já eram dementados na linha de base e não foram incluídos nesta análise. Dos oitenta que nos ficaram para estudar, a maioria era do sexo feminino (72%) e a média de idade era 80,7 anos. 20% eram analfabetos, enquanto 21% possuíam oito ou mais anos de escolaridade. Dentre esses 80 em risco de conversão para demência, 50% tinham CDR 0 e 50% CDR 0,5. Destes últimos, 70% apresentaram a somatória de boxes do CDR menor ou igual a 1 e 30% com esta somatória maior que 1. A taxa de conversão para demência no período foi de 91,3/1000 pessoas-ano e não houve significância entre taxa de conversão e idade ou baixa escolaridade ou gênero, assim como com rastreamento de saúde mental positivo, com dependência nas atividades de vida diária, presença de risco cardiovascular ou BNP alterada no início do seguimento. Houve uma taxa de conversão maior entre aqueles com CDR 0,5 e mais importante naqueles cuja somatória de escores boxes foi mais alta que 1 na avaliação inicial, com risco de 5,69 vezes maior destes em relação ao CDR 0. Na análise multivariada, o CDR 0,5 e a somatória de boxes mais elevada foram as variáveis que se associaram à taxa de conversão para demência de forma independente. Discussão: A taxa de conversão para demência foi alta, como esperado para uma coorte com idade avançada. Essa taxa de conversão, no período observado, foi mais alta entre aqueles com CDR=0,5, e mais alta ainda se a somatória de escores boxes fosse maior, sendo estas as únicas variáveis independentes relacionadas à conversão para demência. Cabe, pois, recomendar o CDR na prática clínica para acompanhar idosos a fim de identificar um grupo de maior risco para demência.<br>Introduction: Incidence of dementia is a major public health problem in aging populations, particularly in developing countries where the elderly population has grown explosively. Identification of risk groups is vital to implement health promotion. The Clinical Dementia Rating (CDR) is a valid scale to classify the severity of dementia cases (mild, moderate, severe), also enabling the identification of borderline cases, when the subject has no longer a normal cognitive status for his age, but hasn’t met criteria for dementia yet. There are many evidences that this group has a significantly higher rate of conversion to dementia than the normal group. Objective: This study aims to verify the conversion rate to dementia in a cohort of elderly (70+) living in São Paulo, a large urban center in Brazil, particularly among borderline cases with a CDR=0.5, and to identify associated factors. Methodology: A sample with 156 members of the cohort (n=440) included all the elderly with a MMSE below 26 and a sample of those with a MMSE equal or above 26, all clinically evaluated for dementia including a Neuropsychological Battery (NPB) at baseline. A Portuguese version of CDR (previously validated by authors) was applied to the closest relative or carer. After refusals and deaths, 95 elderly were re-evaluated after an average 2.6-years interval. The cumulative conversion rate of dementia was compared among demographic characteristics, mental health, Activities of Daily Living (ADL), vascular risk factors, NPB performance and initial classification of CDR, using Poisson Regression methods in both the univariate analysis and the multivariate analysis, with natural logarithm of exposure time as an offset variable. The value of significance accepted was 0.05. Results: 95 elderly were re-evaluated, but 15 were demented at baseline and not included in the present analysis. The majority of those studied (n=80) was women (72%), the average age was 80.7 years, and 20% were illiterate, while 21% had 8 or more years of education. Among those at risk of converting to dementia, 50% had a CDR 0 at baseline and 50% a CDR 0.5 - 70% with sum of boxes scores equals 1 or below, and 30% with sum of boxes scores greater than 1. The conversion rate of dementia in the period was 91.3/1000 person-years and there were no significant differences between the rates of conversion according to age, years of education, gender, mental health, altered NPB, presence of vascular risk factors and degree of independence in the ADL, at baseline. There was a significantly higher incidence rate among those with a CDR 0.5, and most importantly among those with a sum of the boxes scores greater than 1 at baseline, with a relative risk of 5.69 higher compared to CDR 0. In the multivariate analysis, the CDR 0.5 and the sum of the highest boxes scores were the only variables that were independently associated with a higher conversion rate to dementia. Discussion: The conversion rate to dementia was high, as expected given the cohort’s advanced age. The conversion rate to dementia, in the period observed, was higher among those with CDR=0.5 and higher if the sum of the boxes scores was above one. Those were the only variables independently associated to conversion. Hence, the CDR must be recommended in the clinical practice with elderly to identify those at a greater risk of dementia.<br>TEDE<br>BV UNIFESP: Teses e dissertações

Broadband behavior rating scales are commonly used in schools to gain data to help make critical decisions about a student’s educational programming and whether he or she is eligible to receive special education services. Several broadband behavior rating scales are beginning to include a scale that assesses executive functioning. This study investigated how scores from an executive functioning scale on a broadband behavior rating scale (Conners 3, Conners, 2008) compared to an established scale that only measures executive functioning (Behavior Rating Inventory of Executive Function [BRIEF], Gioia, Isquith, Guy, & Kenworthy, 2000). Teachers completed both scales at the same point in time on students receiving academic interventions or special education services. Results indicated that the Conners 3 executive functioning scale primarily measures one scale on the BRIEF related to planning and organization skills. These results suggest that those using the Conners 3 executive functioning scale should be aware of the limited range of skills assessed and that they should be cautious in their interpretation of the scale when evaluating a student’s executive functioning skills.

Executive functioning is an umbrella term used to describe abilities that include self-monitoring, goal-setting, planning, organization, attention, and working memory. Broadband behavior rating scales are commonly used by school psychologists and the instruments often now include an executive functioning scale. It is unknown, however, how these scales, based on a few items, compare to more extensive rating scales that solely measure executive functioning. The current study examined the overall consistency between the executive functioning scale on one broadband instrument to another instrument that assesses multiple areas of executive functioning by having teachers complete both instruments at the same point in time. The comparisons revealed statistically significant correlations, but significantly different mean scores between the executive functioning CAB-T score and the overall BRIEF score. Furthermore, classification consistency (i.e., scores from the two scales are both in the average range or clinically significant range) only occurred approximately two-thirds of the time. Thus, concerns were raised about the use of the scale from the broadband instrument as a general measure of executive functioning.

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2011-2012<br>Dans les dernières années, les recherches scientifiques portant sur le vieillissement neuropsychologique ont mis en évidence la présence de déficits cognitifs bien avant que le diagnostic clinique de la démence ne puisse être porté. La condition des Troubles Cognitifs Légers (TCL) constituerait ainsi une phase intermédiaire entre le vieillissement normal et le vieillissement pathologique. L'intérêt de la reconnaissance précoce des TCL réside en grande partie dans la possibilité d'offrir différents types de traitement potentiellement susceptibles de ralentir l'évolution vers la démence. Considérant le nombre croissant de personnes atteintes de dysfonctions cognitives variées, jumelé au peu de ressources disponibles pour les évaluer, avoir accès à un outil de dépistage cognitif efficace, capable de contribuer également au diagnostic différentiel à un stade débutant de la maladie, constituerait un atout de taille. La présente thèse doctorale s'inscrit dans cette volonté de plus en plus pressante de détecter précocement les désordres cognitifs associés au vieillissement, et plus spécifiquement par le biais de la Mattis Dementia Rating Scale (MDRS-2). Elle se divise en cinq chapitres, chacun tentant de répondre à un objectif particulier. Le chapitre I introduit brièvement les notions cliniques pertinentes et certains tests de dépistages cognitifs déjà répandus pour le diagnostic de la démence. Ensuite, le chapitre II fait état d'une revue systématique de l'utilité clinique de ces derniers en lien avec la détection des TCL comme phase pré-clinique de la maladie d'Alzheimer (MA). Des données rétrospectives portant sur la MDRS-2 y sont également présentées. Le chapitre III présente, sous forme d'article scientifique, les résultats obtenus quant à la validité clinique de la MDRS-2 pour la détection des TCL et de la démence associée à la maladie de Parkinson (D-MP). Quant au chapitre IV, il réfère à un autre article scientifique rapportant les résultats sur la capacité de la MDRS-2 à contribuer au diagnostic différentiel des phases pré-cliniques de la MA et de la D-MP. Finalement, le cinquième et dernier chapitre du présent ouvrage se veut une discussion générale et critique de l'ensemble des résultats et connaissances acquises au cours de la réalisation de cette thèse doctorale, tout en proposant des perspectives de recherches futures.

Base teórica: Apesar de o escore da soma das caixas da escala de avaliação clínica da demência (CDR-SB) ser amplamente utilizado, sua aplicabilidade na avaliação do estadiamento da gravidade da demência e sua acurária para detectar as categorias diagnósticas não foram normatizadas em várias partes do mundo, inclusive no Brasil. Objetivo: O objetivo deste estudo foi avaliar a validade diagnóstica de CDR-SB na detecção e no estadiamento do comprometimento cognitivo e da demência em uma amostra de pacientes brasileiros com comprometimento cognitivo leve amnéstico (CCL amnéstico), doença de Alzheimer (DA) e demência vascular (DV). Métodos: Os dados foram obtidos a partir do banco de dados do ambulatório de demência do Hospital de Clínicas de Porto Alegre (HCPA) e incluíram 407 participantes com idade superior a 50 anos (115 controles saudáveis, 41 pacientes com CCL amnéstico, 165 pacientes com DA e 86 pacientes com DV ou demência mista). Curvas ROC foram geradas para detectar os melhores pontos de cortes de CDR-SB. A escolaridade média foi 4 anos. Resultados: Um ponto de corte de CDR-SB ≥0,5 permite identificar corretamente indivíduos com CCL amnéstico de controles normais (sensibilidade de 100% e especificidade de 98,3%). Um ponto de corte ≥4,5 identifica corretamente os pacientes com CCL amnéstico dos pacientes com demência, todos juntos ou separadamente (DA e DV) (sensibilidade de 96,4% e especificidade de 100%) em 96,9% dos indivíduos. Os melhores intervalos de CDR-SB correspondentes aos escores globais de CDR foram de 0,5 a 4,0 para um escore global de 0,5; 4,5 a 8,0 para um escore global de 1,0; 8,5 a 14,0 para um escore global de 2,0; e 14,5 a 18,0 para um escore global de 3,0. Quando aplicados à amostra de validação, os escores variaram de 0,87 a 0,97. Conclusão: O escore CDR-SB apresentou boa validade clínica para detectar e classificar a gravidade de prejuízos cognitivos na população brasileira.<br>Background: The Clinical Dementia Rating Scale sum of the boxes (CDR-SB) score has been widely used its utility in staging dementia severity and accuracy to detect diagnostic categories in sociodemographic and cultural diverse regions of the world remains untested. Objective: The aim of this study was to evaluate the CDR-SB diagnostic validity in detecting and staging cognitive impairment/dementia in a sample of Brazilian patients with amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD), and vascular dementia (VD). Methods: Data were obtained from the Dementia Clinic of Hospital de Clínicas de Porto Alegre (HCPA) database and included 407 participants (115 healthy controls, 41 aMCI, 165 AD and, 86 VD). Receiver operating characteristic curves were generated to detect best CDR-SB cutoffs. Average education was 4 years. Results: A CDR-SB cutoff ≥0.5 was obtained to correctly identify aMCI from normal controls (sensitivity of 100% and specificity of 98.3%). The cutoff ≥4.5 correctly identified aMCI from dementia patients altogether or separately (AD and VD) (sensitivity of 96.4% and specificity of 100%) in 96.9% of the individuals. Optimal ranges of CDR-SB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 8.0 for a global score of 1.0, 8.5 to 14.0 for a global score of 2.0, and 14.5 to 18.0 for a global score of 3.0. When applied to the validation sample, scores ranged from 0.87 to 0.97. Conclusion: The CDR-SB showed good clinical validity to detect and classify severity of cognitive impairment a Brazilian population.