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LETTERS TO THE EDITOR
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 79-80

Quantification of dementia: Are we there yet?


Consultant Psychiatrist and Founder Trustee, Desousa Foundation, Mumbai, Maharashtra, India

Date of Web Publication27-Jun-2018

Correspondence Address:
Avinash De Sousa
Carmel, 18, St. Francis Road, Off S.V. Road, Santacruz West, Mumbai - 400 054, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_24_17

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How to cite this article:
De Sousa A. Quantification of dementia: Are we there yet?. J Geriatr Ment Health 2018;5:79-80

How to cite this URL:
De Sousa A. Quantification of dementia: Are we there yet?. J Geriatr Ment Health [serial online] 2018 [cited 2018 Dec 18];5:79-80. Available from: http://www.jgmh.org/text.asp?2018/5/1/79/235368



Sir,

I am writing this letter to bring out some pertinent clinical points in dementia assessment and quantification. Dementia is a complex neuropsychiatric disorder with multiple cognitive, psychological, behavioral, and neurological manifestations.[1] There is a dire need for a scale that quantifies dementia in a holistic manner. Most scales look at severity in the range of symptom severity and duration of the illness.[2]

Other parameters such as brain tissue loss and brain atrophy have also been posited to rate dementia quantitatively.[3] Various other factors such as social support and financial status are also important determinants of the disorder. There is need to also consider medical comorbidity and caregiver burden. Symptoms too must be rated on the basis of the distress they cause. For example, urinary incontinence and dribbling is a far more distressing symptom for both the patients and caregivers when compared to memory loss and executive function deficits. We need a quantitative scale that looks at all parameters from neurobiology to psychological and psychosocial factors along with radiological assessments. The scale may be multiaxial, and a cultural angle may also be explored. This is due to cultural phenotypes that may be prevalent toward attitudes when dementia develops in old age.[4]

This shall provide a unique and holistic quantification of dementia and may also serve as a yardstick in dementia severity and dementia disability assessment. A probable multiaxial scale may be:

  • Axis 1 – Dementia type and duration (assessed clinically and on history)
  • Axis 2 – Psychological symptoms (clinical and use of rating scales)
  • Axis 3 – Cognitive symptoms (use rating scales)
  • Axis 4 – Neurological signs if any (formal neurological assessment)
  • Axis 5 – Psychosocial factors (history and clinical assessment)
  • Axis 6 – Brain tissue loss and damage (imaging studies and radiology)
  • Axis 7 – Cultural factors (varies from country to country)
  • Axis 8 – Overall scale of deterioration
  • Axis 9 – Caregiver burden assessment
  • Axis 10 – Composite scores from summation of axis 1–9.


There is need to develop standardized culture-specific scales to assess the multiple axes. A scale of this format shall help in a formal and complete assessment of dementia and for certification and quantification.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rao GN, Bharath S. Cost of dementia care in India: Delusion or reality? Indian J Public Health 2013;57:71-7.  Back to cited text no. 1
  [Full text]  
2.
O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, et al. Staging dementia using clinical dementia rating scale sum of boxes scores: A Texas Alzheimer's research consortium study. Arch Neurol 2008;65:1091-5.  Back to cited text no. 2
    
3.
Deramecourt V, Slade JY, Oakley AE, Perry RH, Ince PG, Maurage CA, et al. Staging and natural history of cerebrovascular pathology in dementia. Neurology 2012;78:1043-50.  Back to cited text no. 3
[PUBMED]    
4.
Janevic MR, Connell CM. Racial, ethnic, and cultural differences in the dementia caregiving experience: Recent findings. Gerontologist 2001;41:334-47.  Back to cited text no. 4
[PUBMED]    




 

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