The clinical examination in CSHA-1 and 2 included the following components:

1. A nurse administered the 3MS, tested hearing and vision, recorded vital signs, height and weight, collected information on medications and then obtained the subject's medical and family history from a relative;

2. A physician took a medical history and performed a neurological examination;

3. A psychometrist administered neuropsychological tests to all subjects deemed testable (3MS score over 50). The results were later interpreted by a neuropsychologist;

4. The physician and neuropsychologist independently made preliminary diagnoses and then met with the nurse to reach a consensus diagnosis according to the following criteria:

Diagnostic classification:

The DSM-III-R criteria were used to classify people as demented or not. Differential diagnoses used the NINCDS-ADRDA and DSM-IV criteria for Alzheimer's disease; the ICD-10 and the NINDS-AIREN criteria were used to define vascular dementia; operational criteria for Lewy body dementia were taken from McKeith et al. Those without dementia were classified as cognitively impaired but not demented (“CIND”), or as cognitively normal. Reisberg's Global Deterioration Scale was used for rating cognitive and functional capacity in all diagnoses.

These diagnoses formed the basis for estimating the prevalence and incidence of dementia, and served as the case definition for the risk factor studies.

Content of the CSHA clinical assessment:

Component	Topics	Data Collected	CSHA 1	CSHA 2	CSHA 3
Evaluation by Nurse	Cognitive screen	3MS (1)
	Vital signs	Hearing, Vision
		Blood pressure
	Medication use	Inspect medications
	Functioning and frailty	ADL questions (2)
		Mobility (3)
		Balance (4)
	Affective	Geriatric Depression Scale (5)
	Other	Alcohol use (6)
		Service use
Informant Interview	Cognitive history	CAMDEX history questions (7)
	Other	Income
Physician Assessment	History	ICD coding of coexisting disease
		Cumulative Illness Rating Scale (9)
	Neurological	Release signs
		Cranial nerves
		Motor system
		Sensory system
	Overall	Global Deterioration Scale
		Likert Scale for Frailty
Differential Dx	Laboratory	B12, folate, CBC, glucose, VDRL
		Genetic screen
	CT Scan

References:

(1) Teng EL, Chui HC. (1987). The Modified Mini-Mental State (3MS) Examination. Journal of Clinical Psychiatry, 48, 314-318.

(2) Fillenbaum, GG, Smyer, MA. (1981). The development, validity, and reliability of the OARS Multidimensional Functional Assessment Questionnaire. Journal of Gerontology, 36, 428-434.

(3) Podsiadlo D, Richardson S. (1991). The Timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148.

(4) Weiner DK, et al. (1992). Functional reach: a marker of physical frailty. Journal of the American Geriatrics Society, 40, 203-207.

(5) Yesavage JA. (1988). Geriatric Depression Scale. Psychopharmacology Bulletin, 24, 709-710.

(6) Ewing JA. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association, 252, 1905-1907.

(7) Roth M., et al. (1988). CAMDEX: the Cambridge examination for mental disorders of the elderly. Cambridge: Cambridge University Press.

(8) Crockett D, et al. (1989). The assessment of everyday functioning using the Present Functioning Questionnaire and the Functional Rating Scale in elderly samples. Clinical Gerontologist, 8, 3-25.

(9) World Health Organization. (1976). Manual of the international statistical classification of diseases, injuries and causes of death, ninth revision. Geneva: World Health Organization.

(10) Conwell Y, et al. (1993). Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. Journal of the American Geriatrics Society, 41, 38-41.



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Download the Consensus Diagnosis Form (PDF format 174 KB)