A Comparison of Clinical Methods for Assessing Dementia

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Abstract
General practice physicians and clinical specialists use various methods for assessing dementia, including the Mental State Questionnaire (MSQ), Face-Hand Test (FHT), Dementia Rating Scale (DRS), tests for developmental reflexes and focal neurologic signs, and examination for evidence of clinical depression, stroke, or other physical health problems. In order to determine how these various methods concur, a sample of elderly persons living in the community were evaluated on eight indices. When MSQ scores were used as criteria, the DRS and FHT concurred with classification of impairment in 76 per cent and 45 per cent of cases, respectively. Positive focal signs and developmental reflexes were significantly related to cognitive impairment but were not common features in this sample. Physical health, drug use, and demographic variables did not appear to be related to cognitive function. Although dysphoric mood was related to cognitive impairment, pseudodementia was not identified. After one year the subjects were retested with the MSQ and the DRS; 14 per cent and 20 per cent, respectively, had improved, indicating a lack of predictive validity of these measures. Results are discussed in the context of the utility of clinical methods for screening and staging cognitive impairment, and recommendations are made regarding a standardized battery.