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.

Download
the Clinical Examination Form (PDF format 179KB)
Download
the Consensus Diagnosis Form (PDF format 174 KB)
|