![]() This is directly relevant to the choice of assessment scales to be used in dementia care and research. ![]() Proxies such as family or professional carers need to be consulted at all stages in the care journey, altering the traditional assessment method to a shared patient/carer encounter (for example, the combination of a patient-facing cognitive assessment with a structured or unstructured informant interview in diagnosing dementia). ![]() Dementia may from its earliest stages affect judgement, speech and memory, making patient judgements less reliable. Another aspect of dementia which distinguishes it from other progressive neurological disorders is the increased reliance on others to assess clinical and practical problems. Scales are frequently misunderstood and misused, wasting patients’, carers’ and assessors’ time. The key task in using assessment scales in dementia (as in any field) is clarifying what they are to be used for, and by whom. Importantly, it should be practical to use – in practice, this often depends on it being short (so it can be used in busy clinical practice or as an outcome measure in a trial such that participants are not overburdened by long interviews) and acceptable – so it does not upset, exhaust or embarrass the patient or assessor. The properties of an ideal assessment scale would be that it is valid, that is, it has face validity (experts like clinicians, patients and carers would agree that the questions are relevant and important), that it has construct validity (it measures the construct it was designed to measure), concurrent validity (when used alongside a gold standard assessment like a very well validated scale or an expert clinical assessment, it performs well), that it shows reliability – typically inter-rater reliability (two or more raters using the scale in the same subjects and conditions come up with the same result) and test–retest reliability (the same rater using the scale on another occasion in the same subject comes up with the same result). The purpose of an assessment scale is to increase the precision of a decision by reducing subjectivity and increasing objectivity for example, using a cognitive screening test score to screen for underlying dementia, to distinguish impairment due to dementia from normal age-related cognitive change or to monitor the effects of treatment of dementia in a clinic or controlled trial. Many scales have been devised just in the field of dementia. Ī vast industry in generation, validation and reporting of properties/utility of rating scales in most branches of medicine, including dementia, has emerged. Rating scales are often advocated for use in influential guidelines. Many nonspecialist branches of medicine now operate some system for screening for and diagnosing dementia – for example, primary care, neurology or general hospital inpatient services. Carer burden in terms of physical work, psychological distress and financial obligations is great. The collateral damage in dementia is vast. With global aging of populations, dementia prevalence is rising and is projected to continue to do so for much of the present century. Incidence and prevalence of dementia are strongly age dependent. ![]() The syndrome is caused by many diseases, with Alzheimer’s disease, vascular dementia and dementia with Lewy bodies together accounting for around 90% of cases. Care burden, for family carers as well as state/other care funders, increases as the condition progresses. Many patients show varying levels of behaviour disturbance at some point in the illness. Dementia is a term for a clinical syndrome characterized by progressive acquired global impairments of cognitive skills and ability to function independently.
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