|LETTERS TO THE EDITOR
|Year : 2018 | Volume
| Issue : 1 | Page : 79-80
Quantification of dementia: Are we there yet?
Avinash De Sousa
Consultant Psychiatrist and Founder Trustee, Desousa Foundation, Mumbai, Maharashtra, India
|Date of Web Publication||27-Jun-2018|
Avinash De Sousa
Carmel, 18, St. Francis Road, Off S.V. Road, Santacruz West, Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
De Sousa A. Quantification of dementia: Are we there yet?. J Geriatr Ment Health 2018;5:79-80
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. 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.
Other parameters such as brain tissue loss and brain atrophy have also been posited to rate dementia quantitatively. 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.
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
Conflicts of interest
There are no conflicts of interest.
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