How to avoid 3 common errors in dementia screening.

The simple solutions outlined here will help you to sharpen your evaluative tools and improve accuracy.

The mini-Kingston Standardized Cognitive Assessment.

The Kingston Standardized Cognitive Assessment (KSCA) was designed to be a cognitive screening tool available for the health professionals who were not trained in specialized cognitive assessment techniques. It was introduced to bridge the gap between brief, narrowly focused rating scales and intensive, expensive, full neuropsychological assessments. We now present the mini-KSCA-Revised (mini-KSCAr). This is a shortened version of the full KSCAr that can be given in far less time and allows for a quick follow-up or screening technique retaining a substantial part of the full KSCAr's effectiveness. It is specifically targeted for use by family physicians who require rapid and accurate in-office dementia screening.

The progression of behavior in dementia: an in-office guide for clinicians.

This article examines the progression of behavioral changes in 200 community living and long term care patients using the Kingston Standardized Behavioral Assessment, a measure of traditional neuropsychiatric behaviors (behavioral and psychological symptoms of dementia) and neuropsychological behaviors. A group of patients diagnosed with probable Alzheimer's disease or mixed dementia (Alzheimer's disease and vascular dementia), was assessed using the Kingston Standardized Behavioral Assessment, ranked by total Kingston Standardized Behavioral Assessment score and were divided into quartile-based groups. The scores revealed changes in behavior patterns across quartiles. Significant behavior change appeared even in quartile one. Lower scores were predominantly associated with neuropsychological behaviors; as scores increased, neuropsychiatric behaviors became equally common. An at-a-glance guide characterizing the patterns of increasing behavioral change is provided for clinicians. Behavioral changes appear both early and throughout dementia; the type and pattern of these emerging behaviors change as the disease progresses. Clinicians can use the typical patterns of behavioral change to identify behavioral impairment in individual patients and anticipate future changes and related care needs.

The Kingston Standardized Behavioural Assessment.

The Kingston Standardized Behavioural Assessment (KSBA), a behavioral screening tool that assesses the behavioral changes associated with dementia, particularly Alzheimer's disease (AD), is introduced. Designed to be user friendly for clinicians not trained in specialized behavioral assessment techniques, it addresses some of the problems of existing scales. A group of patients diagnosed with probable AD, vascular dementia, or mixed (AD and vascular) was assessed using the KSBA. A subgroup was also given the Neuropsychiatric Inventory (NPI). Behavioral profiles and scores were obtained for all subjects. Factor analysis revealed 2 factors described as neuropsychiatric and neuropsychological. The KSBA efficiently collects neuropsychological and neuropsychiatric behavioral symptoms of dementia, is easy to score and interpret, and yields a behavioral profile that helps identify target behaviors for intervention. It can be used to facilitate clinical decision making around level of care and can be easily incorporated into clinically based research.

The brief Kingston Standardized Cognitive Assessment--revised.

OBJECTIVES: The Kingston Standardized Cognitive Assessment-Revised (KSCA-R) was designed to be a cognitive screening tool available to health professionals who were not trained in specialized cognitive assessment techniques. It was introduced to bridge the gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. We now present the Brief Kingston Standardized Cognitive Assessment-Revised (BriefKSCA-R). METHODS: Groups of Alzheimer's disease patients, patients suffering from other dementias, and a group of normal community dwelling elderly were assessed using the BriefKSCA-R. RESULTS: This shortened version of the full Kingston Standardized Cognitive Assessment-Revised can be given in half the time while retaining most of the full KSCA-R's effectiveness. CONCLUSIONS: Suitable for a quick screening, or follow-up of patients already more fully assessed.

Driving and dementia in Ontario: a quantitative assessment of the problem.

BACKGROUND: The population is becoming increasingly aged, and concomitantly, the prevalence of dementia is steadily rising. Persons aged 65 years and over are likely to continue driving for many years and often well into the dementia process. METHODS: Ontario Ministry of Transportation driving data, census data, and dementia prevalence data were combined to determine the number of persons with potential dementia who are driving, both now and in about 25 years' time. RESULTS: Actual and projected Ontario figures show that the number of senior drivers will increase markedly from just under 500,000 in 1986 to nearly 2,500,000 in 2028. Similarly, the number of drivers with dementia is also increasing. Although not all drivers with dementia are necessarily dangerous, most are estimated to continue driving well into the disease process. By combining the above-mentioned data sets, a best estimate of the number of drivers with dementia in Ontario was derived. It is estimated that this group has grown from just under 15,000 in 1986 to about 34,000 in 2000 and will number nearly 100,000 in 2028. INTERPRETATION: Increasingly, the responsibility for identifying drivers with dementia has fallen on the health care system, a role for which it was never designed nor equipped to handle. The risks associated with the dramatically increasing number of drivers with dementia demand a psychometrically sensitive and efficient screening procedure.

The Revised Kingston Standardized Cognitive Assessment.

The original Kingston Standardized Cognitive Assessment (KSCA) was designed to assess cognitive functioning in the elderly with suspected organic brain damage (i.e. dementia). It was specifically designed to be a relatively quickly administered assessment tool available to mental health professionals who were not trained in specialized cognitive assessment techniques. It was introduced over a decade ago to bridge a gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. Recently, a revision of the KSCA was completed. This revision includes the addition of a word-list memory task with immediate recall, delayed recall and recognition formats, as well as new norms for patients with Alzheimer's disease (AD). The updated norms reflect the abilities of higher-functioning (community-dwelling) patients. In order to facilitate the Revised KSCAs use we have developed a new scoring and analysis form as well as a more comprehensive scoring and administration manual. These changes have resulted in better detection of earlier Alzheimer's disease and use of comparison groups that reflect the changing referral base. The structure of the revised scale and updated normative data are described. An illustrative clinical case example is also provided.