Continuing in our irregular series on dementia during Alzheimer’s Awareness month, I offer a quick screen to help you with the question of possible dementia of a family member.
When we are confronted difficult behaviors of an aging spouse or parent, we want to find out what’s wrong and get help. Perhaps the biggest problem is “what do I tell the doctor?” Usually we focus on a particularly troubling change in behavior, but wonder “what more should we report?” Now this conversation only takes place in the early stages of the disease process and at that time the “patient” is struggling to control the problem. Their valiant battle results in a denial that they have a problem and he or she will be of no help in making a report to the doctor.
In that spirit then I present the Quick Dementia Rating System developed by Dr. James E. Galvin of the Charles E. Schmidt College of Medicine, Florida Atlantic University. It is copyrighted 2013.
You can use this quick screen to make your report to the doctor. You will see it inquires into the whole range problems that a person with one of the various forms of dementia may have. It covers not just memory but cognitive ability, mood, decision making, communication, concentration, personal hygiene and on. While the caregiver family member may report any one of these areas, very few would think to report on all areas, with comments on how well or poorly he or she does in each one. Dr. Galvin reports that when the breadth of information is reported, a doctor can make a very good assessment of the problem.
Perhaps the most important point to remember to report is how the behavior represents change in behavior. Here is the note from Dr. Galvin:
“NOTE. The following descriptions characterize changes in the patient’s cognitive and functional abilities. You are asked to compare the patient now to how they used to be—the key feature is change. Choose one answer for each category that best fits the patient—NOTE, not all descriptions need to be present to choose an answer.”
The QDRS, Quick Dementia Rating System
1. Memory and recall
0 No obvious memory loss or inconsistent forgetfulness that does not interfere with function in everyday activities
0.5 Consistent mild forgetfulness or partial recollection of events that may interfere with performing everyday activities; repeats questions/statements, misplaces items, forgets appointments
1 Mild to moderate memory loss; more noticeable for recent events; interferes with performing everyday activities
2 Moderate to severe memory loss; only highly learned information remembered; new information rapidly forgotten
3 Severe memory loss, almost impossible to recall new information; long-term memory may be affected
2. Orientation
0 Fully oriented to person, place, and time nearly all the time
0.5 Slight difficulty in keeping track of time; may forget day or date more frequently than in the past
1 Mild to moderate difficulty in keeping track of time and sequence of events; forgets month or year; oriented to familiar places but gets confused outside familiar areas; gets lost or wanders
2 Moderate to severe difficulty, usually disoriented to time and place (familiar and unfamiliar); frequently dwells in past
3 Only oriented to their name, although may recognize family members
3. Decision making and problem-solving abilities
0 Solves everyday problems without difficulty; handles personal business and financial matters well; decision-making abilities consistent with past performance
0.5 Slight impairment or takes longer to solve problems; trouble with abstract concepts; decisions still sound
1 Moderate difficulty with handling problems and making decisions; defers many decisions to others; social judgment and behavior may be slightly impaired; loss of insight
2 Severely impaired in handling problems, making only simple personal decisions; social judgment and behavior often impaired; lacks insight
3 Unable to make decisions or solve problems; others make nearly all decisions for patient
4. Activities outside the home
0 Independent in function at the usual level of performance in profession, shopping, community and religious activities, volunteering, or social groups
0.5 Slight impairment in these activities compared with previous performance; slight change in driving skills; still able to handle emergency situations
1 Unable to function independently but still may attend and be engaged; appears “normal” to others; notable changes in driving skills; concern about ability to handle emergency situations
2 No pretense of independent function outside the home; appears well enough to be taken to activities outside the family home but generally needs to be accompanied
3 No independent function or activities; appear too ill to be taken to activities outside the home
5. Function at home and hobby activities
0 Chores at home, hobbies and personal interests are well maintained compared with past performance
0.5 Slight impairment or less interest in these activities; trouble operating appliances (particularly new purchases)
1 Mild but definite impairment in home and hobby function; more difficult chores or tasks abandoned; more complicated hobbies and interests given up
2 Only simple chores preserved, very restricted interest in hobbies which are poorly maintained
3 No meaningful function in household chores or with prior hobbies
6. Toileting and personal hygiene
0 Fully capable of self-care (dressing, grooming, washing, bathing, toileting)
0.5 Slight changes in abilities and attention to these activities
1 Needs prompting to complete these activities but may still complete independently
2 Requires some assistance in dressing, hygiene, keeping of personal items; occasionally incontinent
3 Requires significant help with personal care and hygiene; frequent incontinence
7. Behavior and personality changes
0 Socially appropriate behavior in public and private; no changes in personality
0.5 Questionable or very mild changes in behavior, personality, emotional control, appropriateness of choices
1 Mild changes in behavior or personality
2 Moderate behavior or personality changes, affects interactions with others; may be avoided by friends, neighbors, or distant relatives
3 Severe behavior or personality changes; making interactions with others often unpleasant or avoided
8. Language and communication abilities
0 No language difficulty or occasional word searching; reads and writes as in the past
0.5 Consistent mild word finding difficulties, using descriptive terms or takes longer to get point across, mild problems with comprehension, decreased conversation; may affect reading and writing
1 Moderate word finding difficulty in speech, cannot name objects, marked reduction in work production; reduced comprehension, conversation, writing, and/or reading
2 Moderate to severe impairments in speech production or comprehension; has difficulty in communicating thoughts to others; limited ability to read or write
3 Severe deficits in language and communication; little to no understandable speech is produced
9. Mood
0 No changes in mood, interest, or motivation level
0.5 Occasional sadness, depression, anxiety, nervousness, or loss of interest/motivation
1 Daily mild issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation
2 Moderate issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation
3 Severe issues with sadness, depression, anxiety, nervousness, or loss of interest/motivation
10. Attention and concentration
0 Normal attention, concentration, and interaction with his or her environment and surroundings
0.5 Mild problems with attention, concentration, and interaction with environment and surroundings, may appear drowsy during day
1 Moderate problems with attention and concentration, may have staring spells or spend time with eyes closed, increased daytime sleepiness
2 Significant portion of the day is spend sleeping, not paying attention to environment, when having a conversation may say things that are illogical or not consistent with topic
3 Limited to no ability to pay attention to external environment or surroundings
Cognitive subtotal (questions 1, 2, 3, 8)
Behavioral subtotal (questions 4, 5, 6, 7, 9, 10)
Total QDRS score
Copyright 2013 The Quick Dementia Rating System James E. Galvin and New York University Langone Medical Center.
