The Dementia Rating Scale (DRS) in the diagnosis of vascular dementia

Porto, Cláudia Sellitto; Caramelli, Paulo; Nitrini, Ricardo

doi:10.1590/S1980-57642008DN10300010

Abstract

The Dementia Rating Scale (DRS) is considered a very useful instrument to assess patients with dementia. The tasks are grouped into five subscales, each one evaluating different cognitive areas, namely: Attention, Initiation/Perseveration (I/P), Construction, Conceptualization and Memory. Objective: To verify the ability of the DRS in discriminating vascular dementia (VaD) patients from healthy controls and VaD from Alzheimer disease (AD) patients. Methods: The DRS was applied to 68 patients with mild dementia (12 with VaD and 56 with AD) and 60 healthy controls. The clinical diagnosis was made by two neurologists based on the patients´ history, laboratory and neuroimaging results and neuropsychological tests. Results: In the comparison between VaD patients and controls, the subscales I/P, Memory, Conceptualization and Attention were those displaying best discrimination between the two groups. The cutoff <124 yielded 93.3% of sensitivity and 91.7% of specificity for the diagnosis of VaD. Only the I/P subscale differentiated VaD from AD patients. Conclusions: The DRS was found to be a useful instrument to discriminate VaD patients from controls. VaD patients showed worse performance in tasks of executive functions than AD patients. Executive dysfunction, evaluated through the I/P subscale of the DRS, might be useful in differentiating between VaD and AD patients.

Key words:
dementia; neuropsychological tests; cognitive disorders; Alzheimer disease; vascular dementia.

Resumo

A Escala de Avaliação de Demência (Dementia Rating Scale - DRS) é considerada um instrumento de grande valor para avaliação de pacientes com demência. As tarefas estão agrupadas em cinco subescalas, as quais avaliam diferentes domínios cognitivos: Atenção, Iniciativa/Perseveração (I/P), Construção, Conceituação e Memória. Objetivo: Verificar a capacidade da DRS em discriminar pacientes com demência vascular (DV) de controles saudáveis e pacientes com DV de pacientes com doença de Alzheimer (DA). Métodos: A DRS foi administrada a 68 pacientes com demência leve (12 com DV e 56 com DA) e a 60 indivíduos controles saudáveis do ponto de vista cognitivo. Os diagnósticos de DV e de DA foram realizados por dois neurologistas baseando-se na história clínica, em exames laboratoriais e de neuroimagem e em testes neuropsicológicos. Resultados: Na comparação de pacientes com DV e controles, as subescalas I/P, Memória, Conceituação e Atenção foram as que melhor diferenciaram os dois grupos. A nota de corte <124 demonstrou sensibilidade de 93,3% e 91,7% de especificidade para o diagnóstico de DV. Em relação à comparação de pacientes com DV e DA, apenas a subescala I/P apresentou significância estatística na diferenciação dos dois grupos. Conclusões: A DRS mostrou ser um instrumento útil na discriminação entre pacientes com DV e controles. Pacientes com DV demonstraram pior desempenho em tarefas de funções executivas que pacientes com DA. Disfunção executiva, avaliada através das tarefas da subescala I/P, pode ser útil na diferenciação entre pacientes com DV e DA.

Palavras-chave:
demência; testes neuropsicológicos; transtornos cognitivos; doença de Alzheimer; demência vascular.

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References

¹
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB, editors. Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton; 1976:77-121.
²
Mattis S. Dementia Rating Scale. Professional manual. Florida: Psychological Assessment Resources; 1988.
³
Monsch AU, Bondi MW, Salmon DP, et al. Clinical Validity of the Mattis Dementia Rating Scale in Detecting Dementia of the Alzheimer Type. Arch Neurol 1995;52:899-904.
⁴
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Diagnosis of mild dementia in Alzheimer´s disease. Arq Neuropsiquiatr 2003;61:339-345.
⁵
Paolo AM, Trostr AI, Glatt SL, Hubble JP, Koller WCJ. Differentiation of the dementias of Alzheimer's and Parkinson's disease with the dementia rating scale. Geriatr Psychiatry Neurol 1995;8:184-188.
⁶
Paulsen JS, Butters N, Sadek JR, et al. Distinct cognitive profiles of cortical and subcortical dementia in advanced illness. Neurology 1995;45:951-956.
⁷
Kertesz A, Clydesdale S. Neuropsychological deficits in Vascular Dementia vs Alzheimer's Disease. Arch Neurol 1994;51:1226-1231.
⁸
Lukatela K, Cohen R, Kessler H, et al. Dementia Rating Scale Performance: A Comparison of Vascular and Alzheimer's Dementia. J Clin Exper Neuropsych 2000; 22:445-454.
⁹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research. 1975;12:189-198.
¹⁰
Brucki SMD, Nitrini R, Bertolucci PHP, Caramelli P, Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.
¹¹
Nitrini R, Caramelli P, Porto CS, et al. Avaliação cognitiva breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63:27.
¹²
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich; 1987.
¹³
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.
¹⁴
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
¹⁵
Wechsler, D. Test de Inteligencia para adultos (WAIS). Manual. 2nd ed. Buenos Aires: Editorial Paidos; 1993.
¹⁶
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services; 1983.
¹⁷
Raven JC, Raven J, Court JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo;1988.
¹⁸
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.
¹⁹
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. 2nd ed. New York: Oxford University Press; 1998.
²⁰
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of Functional Activities in Older Adults in the Community. J Gerontol 1982;37:323- 329.
²¹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987.
²²
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
²³
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-60.
²⁴
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.
²⁵
Jorm AF. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.
²⁶
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência de idosos. Arq Neuropsiquiatr 2003;61:601-606.
²⁷
Mesulam M-M. Principles of Behavioral and Cognitive Neurology. 2nd ed. New York: Oxford University Press; 2000.
²⁸
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press; 1995.
²⁹
Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ. Subcortical vascular dementia: integrating neuropsychological e neuroradiologic data. Neurology. 2005; 65:376-382.
³⁰
Osterman JM, Scherder EJ. Distinguishing between vascular dementia and Alzheimer´s disease by means of the WAIS: a meta-analysis. J Clin Exp Neuropsychol 2006;28:1158-1175.
³¹
O´Brien JT. Vascular cognitive impairment. Am J Geriatr Psychiatry 2006;14:724-733.
³²
Villardita C. Alzheimer´s disease compared with cerebrovascular dementia. Neuropsychological similarities and differences. Acta Neurol Scand 1993;87:299-308.
³³
Giovanetti T, Lamar M, Cloud BS, Swenson R, Fein D Kaplan E, Libon DJ. Different underlying mechanisms for deficits in concept formation in dementia. Arch Clin Neuropsychol 2001;16:547-560.
³⁴
Inasaridze K, Sikharulizdze G, Malishava T, Zviadadze M. Attentional disorder in vascular dementia. Georgian Med News. 2006;(135):91-95.
³⁵
Desmond DW. The neuropsychology of vascular cognitive impairment: is there a specific cognitive deficit? J Neurol Sci 2004;226:3-7.
³⁶
Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer´s disease and subcortical vascular dementia. J Neurol Neurosurg Psychiatry 2004;75:61-71.

Publication Dates

Publication in this collection
Jul-Sep 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB, editors. Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton; 1976:77-121.

[2] ²
Mattis S. Dementia Rating Scale. Professional manual. Florida: Psychological Assessment Resources; 1988.

[3] ³
Monsch AU, Bondi MW, Salmon DP, et al. Clinical Validity of the Mattis Dementia Rating Scale in Detecting Dementia of the Alzheimer Type. Arch Neurol 1995;52:899-904.

[4] ⁴
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Diagnosis of mild dementia in Alzheimer´s disease. Arq Neuropsiquiatr 2003;61:339-345.

[5] ⁵
Paolo AM, Trostr AI, Glatt SL, Hubble JP, Koller WCJ. Differentiation of the dementias of Alzheimer's and Parkinson's disease with the dementia rating scale. Geriatr Psychiatry Neurol 1995;8:184-188.

[6] ⁶
Paulsen JS, Butters N, Sadek JR, et al. Distinct cognitive profiles of cortical and subcortical dementia in advanced illness. Neurology 1995;45:951-956.

[7] ⁷
Kertesz A, Clydesdale S. Neuropsychological deficits in Vascular Dementia vs Alzheimer's Disease. Arch Neurol 1994;51:1226-1231.

[8] ⁸
Lukatela K, Cohen R, Kessler H, et al. Dementia Rating Scale Performance: A Comparison of Vascular and Alzheimer's Dementia. J Clin Exper Neuropsych 2000; 22:445-454.

[9] ⁹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research. 1975;12:189-198.

[10] ¹⁰
Brucki SMD, Nitrini R, Bertolucci PHP, Caramelli P, Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.

[11] ¹¹
Nitrini R, Caramelli P, Porto CS, et al. Avaliação cognitiva breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63:27.

[12] ¹²
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich; 1987.

[13] ¹³
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.

[14] ¹⁴
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[15] ¹⁵
Wechsler, D. Test de Inteligencia para adultos (WAIS). Manual. 2nd ed. Buenos Aires: Editorial Paidos; 1993.

[16] ¹⁶
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services; 1983.

[17] ¹⁷
Raven JC, Raven J, Court JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo;1988.

[18] ¹⁸
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.

[19] ¹⁹
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. 2nd ed. New York: Oxford University Press; 1998.

[20] ²⁰
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of Functional Activities in Older Adults in the Community. J Gerontol 1982;37:323- 329.

[21] ²¹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987.

[22] ²²
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[23] ²³
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Work Group. Neurology 1993;43:250-60.

[24] ²⁴
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.

[25] ²⁵
Jorm AF. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.

[26] ²⁶
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência de idosos. Arq Neuropsiquiatr 2003;61:601-606.

[27] ²⁷
Mesulam M-M. Principles of Behavioral and Cognitive Neurology. 2nd ed. New York: Oxford University Press; 2000.

[28] ²⁸
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press; 1995.

[29] ²⁹
Price CC, Jefferson AL, Merino JG, Heilman KM, Libon DJ. Subcortical vascular dementia: integrating neuropsychological e neuroradiologic data. Neurology. 2005; 65:376-382.

[30] ³⁰
Osterman JM, Scherder EJ. Distinguishing between vascular dementia and Alzheimer´s disease by means of the WAIS: a meta-analysis. J Clin Exp Neuropsychol 2006;28:1158-1175.

[31] ³¹
O´Brien JT. Vascular cognitive impairment. Am J Geriatr Psychiatry 2006;14:724-733.

[32] ³²
Villardita C. Alzheimer´s disease compared with cerebrovascular dementia. Neuropsychological similarities and differences. Acta Neurol Scand 1993;87:299-308.

[33] ³³
Giovanetti T, Lamar M, Cloud BS, Swenson R, Fein D Kaplan E, Libon DJ. Different underlying mechanisms for deficits in concept formation in dementia. Arch Clin Neuropsychol 2001;16:547-560.

[34] ³⁴
Inasaridze K, Sikharulizdze G, Malishava T, Zviadadze M. Attentional disorder in vascular dementia. Georgian Med News. 2006;(135):91-95.

[35] ³⁵
Desmond DW. The neuropsychology of vascular cognitive impairment: is there a specific cognitive deficit? J Neurol Sci 2004;226:3-7.

[36] ³⁶
Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer´s disease and subcortical vascular dementia. J Neurol Neurosurg Psychiatry 2004;75:61-71.

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