Kliniske vurderingsskalaer ved Alzheimers sykdom
Kliniske vurderingsskalaer ved Alzheimers sykdom
CDR-SB og Global CDR
- Kognitive domener: Hukommelse, orienteringsevne samt dømmekraft og problemløsning.
- Funksjonelle domener: Sosiale/generelle aktiviteter, Hjem og fritid og Personlig hygiene.
Vurdering av domener innen kognisjon og funksjon med CDR-SB
| Rating scale for each domain1 | 0 | 0.5 | 1 | 2 | 3 | |
|---|---|---|---|---|---|---|
| None | Questionable | Mild | Moderate | Severe | ||
|
Cognition
|
Memory | No memory loss, or slight inconsistent forgetfulness | Consistent slight forgetfulness; partial recollection of events; “benign” forgetfulness | Moderate memory loss, more marked for recent events; defect interferes with everyday activities | Severe memory loss; only highly learned material retained; new material rapidly lost | Severe memory loss; only fragments remain |
| Orientation | Fully oriented | Fully oriented except for slight difficulty with time relationships | Moderate difficulty with time relationship; oriented for place at examination; may have geographic disorientation elsewhere | Severe difficulty with time relationships; usually disoriented to time, often to place | Oriented to person only | |
| Judgement/Problem-solving | Solves everyday problems, handles business and financial affairs well; judgment good in relation to past performance | Slight impairment in these activities | Moderate difficulty in handling problems, similarities and differences; social judgment usually maintained | Severely impaired in handling problems, similarities and differences; social judgment usually impaired | Unable to make judgments or solve problems | |
|
Function
|
Community affairs | Independent function at usual level in job, shopping, volunteer and social groups | Life at home, hobbies and intellectual interests slightly impaired | Unable to function independently at these activities, although may still be engaged in some; appears normal to casual inspection | No pretense of independent function outside the home | |
| Appears well enough to be taken to functions outside the family home | Appears too ill to be taken to functions outside the home | |||||
| Home and hobbies | Life at home, hobbies and intellectual interests well maintained | Life at home, hobbies and intellectual interests slightly impaired | Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned | Only simple chores preserved; very restricted interests; poorly maintained | No significant function in the home | |
| Personal care | Fully capable of self-care | Needs prompting | Requires assistance in dressing, hygiene, keeping of personal effects | Requires much help with personal care; frequent incontinence | ||
Skår og assosiert alvorlighetsgrad av AD med CDR-SB og Global CDR2
| CDR-SB Total Score | Disease Severity | Global CDR-score |
|---|---|---|
| 0 | Normal | 0 (normal) |
| 0.5-4.0 0.5-2.5 3.0-4.0 |
Questionable cognitive impairment to very mild dementia Questionable impairment Very mild dementia |
0.5 (very mild) |
| 4.5-9.0 | Suggests mild dementia | 1 (mild) |
| 9.5-15.5 | Suggests moderate dementia | 2 (moderate) |
| 16.0-18.0 | Suggests severe dementia | 3 (severe) |
ADAS-Cog14
Evnen til å følge instruksjoner
Evnen til å huske ord
Evnen til å kopiere linjetegninger av former
ADCS MCI-ADL
MMSE
Sammendrag
Når man vurderer alvorlighetsgraden av Alzheimers sykdom (AD), brukes flere etablerte kliniske skalaer som måler kognisjon, funksjon eller en kombinasjon av begge.
CDR-SB og Global CDR vurderer både kognitiv og funksjonell svekkelse og brukes til å følge sykdomsprogresjon fra tidlig til alvorlig AD. CDR-SB har et bredt skåringsintervall og kan fange opp subtile endringer i sykdomsforløpet.
ADAS-Cog14 måler kognitiv funksjon gjennom 14 forskjellige oppgaver og brukes til å evaluere sykdomsprogresjon.
MMSE og ADCS MCI-ADL fokuserer på enten kognitive eller funksjonelle evner, hvor MMSE hovedsakelig brukes i klinisk praksis og ADCS MCI-ADL vurderer pasientens evne til å utføre daglige aktiviteter.
Disse vurderingsskalaene brukes i kliniske studier for å overvåke sykdomsutviklingen og for å evaluere behandlingseffekten av relevante legemidler ved AD. CDR-SB var det primære endepunktet i CLARITY-AD, fase 3-studien av lecanemab, og både ADAS-Cog14 og ADCS MCI-ADL var sekundære endepunkter. MMSE var en del av inklusjonskriteriene til CLARITY-AD.
Referanser
1. Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–4.
2. O’Bryant SE, et al. Staging dementia using Clinical Dementia Rating Scale sum of boxes scores. Arch Neurol. 2008;65(8):1091–5.
3. Williams MM, et al. Progression of Alzheimer’s disease as measured by Clinical Dementia Rating Sum of Boxes scores. Alzheimers Dement. 2013;9(1 Suppl):S39–44. doi:10.1016/j.jalz.2012.01.005
4. Petersen RC, et al. Expectations and clinical meaningfulness of randomized controlled trials. Alzheimers Dement. 2023;19(6):2730–6. doi:10.1002/alz.12959
5. van Dyck CH, et al. Lecanemab in early Alzheimer’s disease. N Engl J Med. 2023;388(1):9–21.
6. Mohs RC, et al. Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer’s Disease Assessment Scale that broaden its scope. Alzheimer Dis Assoc Disord. 1997;11:13–21.
7. Folstein MF, et al. ”Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
8. Pedrosa HH, et al. Functional evaluation distinguishes MCI patients from healthy elderly people: the ADCS/MCI/ADL scale. J Nutr Health Aging. 2010;14(8):703–9.
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