Diagnostik der Demenzen: Standardisierte Untersuchungsinstrumente im Überblick

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die bei steigender Prävalenz zunehmende Bedeutung demenzieller Erkrankungen schlägt sich auch in den Bemühungen nieder, deren Symptomatik mittels standardisierter Untersuchungen zu erfassen. Um der in den vergangenen Jahren vielfach erweiterten Palette an Instrumenten gerecht zu werden, sind hier über 50 ältere und neuere Verfahren berücksichtigt, die zur Erfassung der Demenz entwickelt wurden. Die Einteilung dieser Skalen, welche im Einzelnen beschrieben und insbesondere im Hinblick auf Validitäts- und Reliabilitäts- sowie zeitökonomische Kriterien bewertet wurden, erfolgte nach ihrem jeweils wichtigsten Bestimmungstyp. Dazu wurden sieben Gruppierungen gewählt, deren Funktion im Hinblick auf den Verwendungsschwerpunkt dieses Skalentyps erläutert wird. Abschließend wird eine Orientierungshilfe zur Auswahl von Testinstrumenten bei spezifischen Fragestellungen der Alzheimer Demenz und ein Ausblick über die absehbare Entwicklung neuer standardisierter Erhebungsverfahren gegeben.

Abstract

The symptoms of dementia refer to a decline in intellectual abilities and to an impairment of general and instrumental activities of daily living (ADL). Beside cognitive decline and loss of ADL's the diagnosis of dementia requires the documentation of changes in social adaptation, psychopathology and behaviour. There are a large number of scales used in the assessment of the various manifestations of the disease. Some scales focus on a particular aspect of the symptomatology, others prefer a comprehensive approach in the detection of dementia symptoms. We present a list of assessment procedures and scales which seem appropriate to detect different aspects of dementia and which are widely accepted in the scientific community. We describe these scales in detail including their methodology and source of informations, psychometric properties regarding validity and reliability as well as time taken to complete the scales. Our synopsis may serve as an orientation mark in the selection of adequate instruments for the assessment of different symptom domains during the process of diagnosis, the observation of the course of dementia and the efficacy of treatment interventions.

Literatur

• 1 Stieglitz R D. Klinische Selbst- und Fremdbeurteilungsverfahren.  Diagnostica. 1988;  34 28-57
  PubMedGoogle Scholar
• 2 Burns A, Lawlor B, Craig S. Assessment scales in old age psychiatry. London: Martin Duniz 1999
  Google Scholar
• 3 Copeland J R, Kelleher M J, Kellet J M. et al . A semistructered clinical interview for the assessment of diagnosis and mental state in the elderly: The Geriatric Mental State Schedule.  Psychol Med. 1976;  6 439-449
  PubMedGoogle Scholar
• 4 Copeland J R, Dewey M E, Griffiths-Jones H M. A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT.  Psychol Med. 1986;  16 89-99
  PubMedGoogle Scholar
• 5 Wing J K, Cooper J E, Sartorius N. The measurement and classification of psychiatric symptoms: an instruction manual for the PSE and catego program. New York: Cambridge University Press 1974
  Google Scholar
• 6 Spitzer R L, Endicott J, Fleiss J L, Cohen J. Psychiatric status schedule: a technique for evaluating psychopathology and impairment in role functioning.  Arch Gen Psychiatry. 1970;  23 41-55
  PubMedGoogle Scholar
• 7 Helmchen H. The Berlin Aging Study (Berliner Altersstudie, BASE): recent psychiatric findings. In: Stefanis C, Hippius H (Ed.). Neuropsychiatry in Old Age Seite 83 - 85 Seattle: Hogrefe & Huber 1996
  Google Scholar
• 8 Roth M, Tyrn E, Mountjoy C Q. et al . CAMDEX. A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia.  Br J Psychiatry. 1986;  149 698-709
  PubMedGoogle Scholar
• 9 Zaudig M, Hiller W. SIDAM - Handbuch. Bern: Huber 1996
  Google Scholar
• 10 Gurland B J, Kuriansky J B, Sharpe L. et al . The Comprehensive Assessment and Referral Evaluation (CARE)-Rationale, development and reliability.  Int J Aging Hum Dev. 1977;  8 9-42
  PubMedGoogle Scholar
• 11 Gutzmann H, Kühl K P, Göhringer K. Das AGP-System. Manual zur Dokumentation gerontopsychiatrischer Befunde. 2. Auflage. Göttingen: Hogrefe 2000
  Google Scholar
• 12 Christensen H, Cullen J S, Henderson A S. et al . The Canberra Interview for the Elderly: a new field instrument for the diagnosis of dementia and depression by ICD-10 and DSM-III-R.  Acta Psychiatr Scand. 1992;  85 105-113
  PubMedGoogle Scholar
• 13 Blessed G, Tomlinson B, Roth M. The association between measures of dementia and of senile change in the cerebral grey matter of elderly subjects.  Br J Psychiatry. 1968;  114 797-811
  PubMedGoogle Scholar
• 14 Gottfries C G, Brane G, Gullberg B, Steen G. A new rating scale for dementia syndromes.  Arch of Gerontol Geriatr. 1982;  1 311-330
  PubMedGoogle Scholar
• 15 Spiegel R, Brunner Ch, Ermini-Fünfschilling D. et al . A new behavioral assessment scale for geriatric out- and inpatients: The NOSGER.  J Am Geriatr Soc. 1991;  39 339-347
  PubMedGoogle Scholar
• 16 Jorm A F, Scott R, Jacomb P A. Assessment of cognitive decline in dementia by informant questionnaire.  Int J Geriatr Psychiatry. 1989;  4 35-39
  PubMedGoogle Scholar
• 17 Jorm A F. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCO-DE): Development and cross-validation.  Psychol Med. 1994;  24 145-153
  PubMedGoogle Scholar
• 18 Jorm A F, Jacomb P A. An Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Soziodemographic correlates, reliability, validity and some norms.  Psychol Med. 1996;  19 1015-1022
  PubMedGoogle Scholar
• 19 Shader R I, Harmatz J S, Salzman C. A new scale for clinical assessment in geriatric populations: Sandoz Clinical Assessment - Geriatric (SCAG).  J Am Geriatr Soc. 1974;  22 107-113
  PubMedGoogle Scholar
• 20 Pelletier F L, Hopkins R W, Hamilton P F. The Kingston Dementia Rating Scale.  Int J Geriatr Psychiatry. 1991;  6 227-233
  PubMedGoogle Scholar
• 21 Oswald W, Fleischmann U. Nürnberger-Alters-Inventar NAI. Göttingen: Hogrefe 1995
  Google Scholar
• 22 Kawas K, Segal J, Stewart W F. et al . A validation study of the Dementia Questionnaire.  Arch Neurol. 1994;  51 901-906
  PubMedGoogle Scholar
• 23 Ritchie R, Ledesert B. The measurement of incapacity in the severly demented elderly: the validation of a behavioural assessment scale.  Int J Geriatr Psychiatry. 1991;  6 217-226
  PubMedGoogle Scholar
• 24 Helmes E, Csapo K G, Short J A. Standardization and validation of the Multidimensional Observation Scale for Elderly Subjects (MOSES).  J Gerontol. 1987;  42 395-405
  PubMedGoogle Scholar
• 25 Panisset M, Roudier M, Saxton J, Boller F. Severe Impairment Battery. A neuropsychological test for severely demented patients.  Arch Neurol. 1994;  51 41-45
  PubMedGoogle Scholar
• 26 Hughes C P, Berg l, Danziger W L. et al . A new clinical scale for the staging of dementia.  Br J Psychiatry. 1982;  140 566-572
  CrossrefPubMedGoogle Scholar
• 27 Burke W, Miller J P, Rubin E, Morris J C, Coben L A, Duchek J, Wittels I G, Berg L. Reliability of the Washington University clinical dementia rating.  Arch Neurol. 1988;  45 31-32
  PubMedGoogle Scholar
• 28 Berg L, Miller J P, Storandt M, Duchek J, Morris J C, Rubin E H, Burke W J, Cohen L A. Mild senile dementia of the Alzheimer type: 2. Longitudinal assessment.  Ann Neurol. 1988;  23 497-484
  PubMedGoogle Scholar
• 29 Reisberg B, Sclan S, Franssen E. et al . Dementia staging in chronic care populations.  Alzheimer Dis Assoc Disord. 1994;  8 Suppl 1 188-205
  PubMedGoogle Scholar
• 30 Morris J, McKeel D, Fulling K, Torack R M, Berg L. Validation of clinical diagnostic criteria for Alzheimer's disease.  Ann Neurol. 1988;  24 17-22
  CrossrefPubMedGoogle Scholar
• 31 Reisberg B, Ferris S H, de Leon M J, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia.  Am J Psychiatry. 1982;  139 1136-1139
  CrossrefPubMedGoogle Scholar
• 32 Reisberg B. Functional Assessment Staging (FAST).  Psychopharmacol Bull. 1988;  24 653-659
  PubMedGoogle Scholar
• 33 Ihl R, Frölich L. Die Reisberg-Skalen. Weinheim: Beltz 1991
  Google Scholar
• 34 Cole M G, Dastoor D P, Koszycki D. The Hierarchic Dementia Scale.  J Clin Exper Gerontol. 1983;  5 219-234
  PubMedGoogle Scholar
• 35 Overall J E, Scott J, Rhoades H M. Empirical scaling of the stages of cognitive decline in senile dementia.  J Geriatr Psychiatry Neurol. 1990;  3 212-219
  PubMedGoogle Scholar
• 36 Pfeiffer R I, Kurosaki T T, Harrah C H. et al . Measurement of functional activities in older adults in the community.  J Gerontol. 1982;  37 323-329
  PubMedGoogle Scholar
• 37 Kahn R L, Goldfarb A L, Pollak M, Peck A. Brief objective measures for the determination of mental status in the aged.  Am J Psychiatry. 1960;  117 326-329
  PubMedGoogle Scholar
• 38 Folstein M F, Folstein S E, McHugh P R. „Mini-Mental-State”.  J Psychiatr Res. 1975;  12 189-198
  CrossrefPubMedGoogle Scholar
• 39 Crum R M, Anthony J C, Bassett S S, Folstein M F. Population-based norms for the MMSE by age and educational level.  JAMA. 1993;  269 2386-2391
  CrossrefPubMedGoogle Scholar
• 40 Rapp M A, Rieckmann N, Gutzmann H, Folstein M F. Mikro-Mental-Test. Ein Kurzverfahren zum Demenzscreening.  Nervenarzt. 1973;  73 839-844
  PubMedGoogle Scholar
• 41 Harrell L E, Marson D, Chatterjee A, Parrish J A. The Severe Mini-Mental State Examination: a new neuropsychologic instrument for bedside assessment of severely impaired patients with Alzheimer disease.  Alzheimer Dis Assoc Disord. 2000;  14 168-175
  PubMedGoogle Scholar
• 42 Rosen W G, Mohs R C, Davis K L. A new rating scale for Alzheimer's disease.  Am J Psychiatry. 1984;  141 1356-1364
  CrossrefPubMedGoogle Scholar
• 43 Ihl R, Weyer G. Alzheimer's Disease Assessment Scale (ADAS). Deutsche Bearbeitung. Weinheim: Beltz 1993
  Google Scholar
• 44 Inzitari D, Rossi R, Lamassa M, Mugnai S, Carlucci G, Bianchi C, Amaducci L. Validity of different linguistic versions of the Alzheimer's Disease Assessment Scale in an international multicentre Alzheimer's disease trial.  Dement Geritr Cog Disord. 1999;  10 269-277
  PubMedGoogle Scholar
• 45 Morris J C, Heyman A, Mohs R C. et al . The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Part 1.  Neurology. 1989;  39 1159-1165
  CrossrefPubMedGoogle Scholar
• 46 Welsh K A, Butters N, Hughes J P. et al . Detection and staging of dementia in Alzheimer's disease.  Arch Neurol. 1992;  49 448-452
  CrossrefPubMedGoogle Scholar
• 47 Satzger W, Hampel H, Padberg F, Bürger K, Nolde Th, Ingrassia G, Engel R R. Zur praktischen Anwendung der CERAD-Testbatterie als neuropsychologisches Demenzscreening.  Nervenarzt. 2001;  72 196-203
  CrossrefPubMedGoogle Scholar
• 48 Tuokko H, Kristjansson E, Miller J. Neuropsychological detection of dementia: an overview of the neuropsychological component of the Canadian Study of Health and Aging.  J Clin Exp Neuropsychol. 1995;  17 352-373
  PubMedGoogle Scholar
• 49 Patti A H, Gilleard C J. Manual of the Clifton Assessment Procedures for the Elderly. Sevenoaks: Hodder & Stoughton 1979
  Google Scholar
• 50 Roddenburg M, Hopkins R W, Hamilton P F. et al . The Kingston Standardized Cognitive Assessment.  Int J Geriatr Psychiatry. 1991;  6 867-874
  PubMedGoogle Scholar
• 51 Ritchie K, Allard M, Huppert F A. et al . Computerized cognitive examination of the elderly (ECO): The development of a neuropsychological examination for clinic and population use.  Int J Geriatr Psychiatry. 1993;  8 899-914
  PubMedGoogle Scholar
• 52 Reisberg B, Schneck M K, Ferris S H. et al . The Brief Cognitive Rating Scale (BCRS): Findings in primary dementia.  Psychopharmacol Bull. 1983;  19 47-50
  PubMedGoogle Scholar
• 53 Mattis S. Mental status examination for organic mental syndrom in the elderly patient. In: Bellak L, Karasu TB (Hrsg). Geriatric Psychiatry New York: Grune & Stratton 1976: 77-122
  Google Scholar
• 54 Erzigkeit H. SKT - Ein Kurztest zur Erfassung von Gedächtnis- und Aufmerksamkeitsstörungen. Weinheim: Beltz 1989
  Google Scholar
• 55 Lehfeld H, Erzigkeit H. The SKT - a short cognitive performance test for assessing deficits of memory and attention.  Int Psychogeriatr. 1997;  9 Suppl 1 115-121
  PubMedGoogle Scholar
• 56 Ihl R, Grass-Kapanke B, Lahrem P, Brinkmeyer J, Fischer S, Gaab N, Kaupmannsennecke C. Entwicklung und Validierung eines Tests zur Früherkennung der Demenz mit Depressionsabgrenzung (TFDD).  Fortschr Neurol Psychiatr. 2000;  68 413-422
  Article in Thieme ConnectPubMedGoogle Scholar
• 57 Solomon P R, Hirschhoff A, Kelly B, Relin M, Brush M, DeVeaux R D, Penlebury M D. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease.  Arch Neurol. 1998;  55 349-355
  CrossrefPubMedGoogle Scholar
• 58 Calabrese P, Kessler J. DemTect zur Untersuchung der Demenzdiagnostik. Testvorlage Karlsruhe: Pfizer & Frankfurt: Esai 2000
  Google Scholar
• 59 Kessler J, Denzler P, Markowitsch H J. Demenz-Test (DT). 2. Auflage. Göttingen: Hogrefe 1999
  Google Scholar
• 60 Cummings J, Mega M, Gray K. et al . The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.  Neurology. 1994;  44 2308-2314
  CrossrefPubMedGoogle Scholar
• 61 Tariot P N, Mack J I, Patterson M B. et al . The Behavioral Rating Scale for dementia of the Consortium to Establish a Registry for Alzheimer's Disease.  Am J Psychiatry. 1995;  152 1349-1357
  CrossrefPubMedGoogle Scholar
• 62 Reisberg B, Borenstein J, Saloh S P. et al . Behavioral symptoms in Alzheimer's disease: Phenomenology and treatment.  J Clin Psychiatry. 1987;  48 9-15
  PubMedGoogle Scholar
• 63 Reisberg B, Auer S R, Monteiro I M. Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale.  Int-Psychogeriatr. 1996;  8 Suppl 3301-8; discussion 351 - 354
  PubMedGoogle Scholar
• 64 Monteiro I M, Boksay I, Auer S R, Torossian C, Ferris S H, Reisberg B. Addition of a frequency-weighted score to the Behavioral Pathology in Alzheimer's Disease Rating Scale: the BEHAVE-AD-FW: methology and reliability.  Eur Psychiatry. 2001;  16 (Suppl 1) 5-24
  CrossrefPubMedGoogle Scholar
• 65 Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie .Das AMDP-System. 7 Auflage. Göttingen: Hogrefe 2000
  Google Scholar
• 66 Allen N H, Gordon S, Hope T, Burns A. Manchester and Oxford Universities Scale for the psychopathological assessment of dementia (MOUSEPAD).  Br J Psychiatry. 1996;  169 293-307
  PubMedGoogle Scholar
• 67 Devenand D P, Miller L, Richards M. et al . The Columbia University Scale for Psychopathology in Alzheimer's Disease.  Arch Neurol. 1992;  49 371-376
  PubMedGoogle Scholar
• 68 Lawton M P, Brody E M. Assessment of older people: self maintaining and instrumental activities of daily living.  Gerontologist. 1969;  9 179-186
  CrossrefPubMedGoogle Scholar
• 69 Reisberg B, Finkel S, Overall J. et al . The Alzheimer's disease activities of daily living international scale (ADL-IS).  Int Psychogeriatr. 2001;  13 163-181
  CrossrefPubMedGoogle Scholar
• 70 Hindmarch I, Lehfeld H, Jongh P. Bayer Activities of Daily Living Scale (B-ADL).  Dement Geriatr Cogn Disord. 1998;  9 (Supplement 2) 20-26
  PubMedGoogle Scholar
• 71 Teunisse S, Derix M M, van Crevel H. Assessing the severity of dementia.  Arch Neurol. 1991;  48 274-277
  PubMedGoogle Scholar
• 72 Gauthier S, Bodick N, Erzigkeit E, Feldman H, Geldmacher D S, Huff J, Mohs R, Orgogozo J M, Rogers S. Activities of daily living as an outcome measure in clinical trials of dementia drugs. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines.  Alzheimer Dis Assoc Disord. 1997;  11 Suppl 3 6-7
  PubMedGoogle Scholar
• 73 DeJong R, Osterlund O W, Roy G W. Measurement of quality-of-life changes in patients with Alzheimer's disease.  Clin Ther. 1989;  11 545-554
  PubMedGoogle Scholar
• 74 Gelinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer's disease: The disability assessment for dementia.  Am J Occup Ther. 1999;  53 471-481
  PubMedGoogle Scholar
• 75 Linn M W, Linn B S. The rapid disability rating scale-2.  J Am Geriatr Soc. 1982;  30 378-382
  PubMedGoogle Scholar
• 76 Fillenbaum G G. Multidimensional functional assessment of older adults. The Duke Older Americans and Services Procedure. Hillsdale, NJ: Lawrence Erlbaum Associates 1988
  Google Scholar
• 77 National Institute of Mental Health .12 - CGI. Clinical Global Impression. In: Guy W, Bonato RR (Hrsg). Manual for the ECDEU Assessmant Battery (Seite 12 - 1 - 12 - 6). Maryland: Chevy Chase 1970
  Google Scholar
• 78 Meya U, Raschig A, Siegfried G, Wannemacher W. Primary outcome measures in dementia drug trials. Modified clinical interview-based impression of change.  Int J Met Psychiatr Res. 1994;  4 189-192
  PubMedGoogle Scholar
• 79 Knopman D S, Knapp M J, Gracon S I, Davis C S. The Clinicans Interview-Based Impression (CIBI).  Neurology. 1994;  44 2315-2321
  PubMedGoogle Scholar
• 80 Goldberg D G, Williams P. A Useraposs Guide to the General Health Questionnaire. Winsor: NFER-NELSON 1988
  Google Scholar
• 81 Davis K L, Marin D B, Kane R, Patrick D, Peskind E R, Raskind M A, Puder K L. The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease.  Int J Geriatr Psychiatry. 1997;  12 978-988
  PubMedGoogle Scholar
• 82 Kinney J M, Stephens M A. Caregiving Hassles Scale: assessing the daily hassles of caring for a family member with dementia.  Gerontologist. 1989;  29 328-332
  PubMedGoogle Scholar
• 83 Vitaliano P P, Russo J, Young H M, Becker J, Maiuro R D. The screen for caregiver burden.  Gerontologist. 1991;  31 76-83
  CrossrefPubMedGoogle Scholar
• 84 Zarit S H, Reever K E, Bach-Peterson J. Relatives of the impaired elderly: correlates of feeling of burden.  Gerontologist. 1980;  20 649-655
  CrossrefPubMedGoogle Scholar
• 85 Vitaliano P P, Russo J, Carr J E, Maiuro R D, Becker J. The Ways of Coping Checklist: revision and psychometric properties.  Mult Behav Res. 1985;  20 3-26
  PubMedGoogle Scholar
• 86 Gilleard C J. Living with dementia: community care of elderly mental infirm. Beckenham: Croom Melm 1984
  Google Scholar
• 87 Patel V, Hope R A. A rating scale for aggressive behaviour in the elderly - the RAGE.  Psychol Med. 1992;  22 211-221
  CrossrefPubMedGoogle Scholar
• 88 Ryden M B. Aggressive behavior in persons with dementia who live in the community.  Alzheimer Dis Assoc Disord. 1988;  2 342-355
  CrossrefPubMedGoogle Scholar
• 89 Rosen J, Burgio L, Kollar M, Cain M, Allison M, Fogleman M, Michael M, Zubenko G. The Pittsburgh Agitation Scale: a user-friendly instrument for rating agitation in dementia patients.  Am J Geriatr Psych. 1994;  2 52-59
  PubMedGoogle Scholar
• 90 Cohen-Mansfield J. Agitated behaviors in the elderly.II. Preliminary results in the cognitively deteriorated.  J Am Geriatr Soc. 1986;  34 722-727
  PubMedGoogle Scholar
• 91 Cohen-Mansfield J, Marx M S, Rosenthal A S. A description of agitation in a nursing home.  J Gerontol. 1989;  44 77-84
  PubMedGoogle Scholar
• 92 Mungas D, Weiler P, Franzi C, Henry R. Assessment of disruptive behavior associated with dementia: the Disruptive Behavior Rating Scales.  J Geriatr Psychiatry Neurol. 1989;  2 196-202
  PubMedGoogle Scholar
• 93 Algase D L, Beattie E R, Bogue E L, Yao L. The Algase Wandering Scale: initial psychometrics of a new caregiver reporting tool.  Am J Alzheimer's Dis Other Demen. 2001;  16 141-152
  PubMedGoogle Scholar

Prof. Dr. M. Rösler

Institut für Gerichtliche Psychologie und Psychiatrie · Universität des Saarlandes

66421 Homburg