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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.1 no.3 São Paulo July/Sept. 2007

https://doi.org/10.1590/S1980-57642008DN10300010 

Original Articles

The Dementia Rating Scale (DRS) in the diagnosis of vascular dementia

A Escala de Avaliação de Demência (DRS) e o diagnóstico de demência vascular

Cláudia Sellitto Porto 1  

Paulo Caramelli 2  

Ricardo Nitrini 3  

1PhD, Behavioral and Cognitive Neurology Unit, Department of Neurology of the University of São Paulo School of Medicine and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, SP, Brazil.

2MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

3MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Neurology of the University of São Paulo School of Medicine, and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, SP, Brazil.


Abstract

The Dementia Rating Scale (DRS) is considered a very useful instrument to assess patients with dementia. The tasks are grouped into five subscales, each one evaluating different cognitive areas, namely: Attention, Initiation/Perseveration (I/P), Construction, Conceptualization and Memory. Objective: To verify the ability of the DRS in discriminating vascular dementia (VaD) patients from healthy controls and VaD from Alzheimer disease (AD) patients. Methods: The DRS was applied to 68 patients with mild dementia (12 with VaD and 56 with AD) and 60 healthy controls. The clinical diagnosis was made by two neurologists based on the patients´ history, laboratory and neuroimaging results and neuropsychological tests. Results: In the comparison between VaD patients and controls, the subscales I/P, Memory, Conceptualization and Attention were those displaying best discrimination between the two groups. The cutoff <124 yielded 93.3% of sensitivity and 91.7% of specificity for the diagnosis of VaD. Only the I/P subscale differentiated VaD from AD patients. Conclusions: The DRS was found to be a useful instrument to discriminate VaD patients from controls. VaD patients showed worse performance in tasks of executive functions than AD patients. Executive dysfunction, evaluated through the I/P subscale of the DRS, might be useful in differentiating between VaD and AD patients.

Key words: dementia; neuropsychological tests; cognitive disorders; Alzheimer disease; vascular dementia.

Resumo

A Escala de Avaliação de Demência (Dementia Rating Scale - DRS) é considerada um instrumento de grande valor para avaliação de pacientes com demência. As tarefas estão agrupadas em cinco subescalas, as quais avaliam diferentes domínios cognitivos: Atenção, Iniciativa/Perseveração (I/P), Construção, Conceituação e Memória. Objetivo: Verificar a capacidade da DRS em discriminar pacientes com demência vascular (DV) de controles saudáveis e pacientes com DV de pacientes com doença de Alzheimer (DA). Métodos: A DRS foi administrada a 68 pacientes com demência leve (12 com DV e 56 com DA) e a 60 indivíduos controles saudáveis do ponto de vista cognitivo. Os diagnósticos de DV e de DA foram realizados por dois neurologistas baseando-se na história clínica, em exames laboratoriais e de neuroimagem e em testes neuropsicológicos. Resultados: Na comparação de pacientes com DV e controles, as subescalas I/P, Memória, Conceituação e Atenção foram as que melhor diferenciaram os dois grupos. A nota de corte <124 demonstrou sensibilidade de 93,3% e 91,7% de especificidade para o diagnóstico de DV. Em relação à comparação de pacientes com DV e DA, apenas a subescala I/P apresentou significância estatística na diferenciação dos dois grupos. Conclusões: A DRS mostrou ser um instrumento útil na discriminação entre pacientes com DV e controles. Pacientes com DV demonstraram pior desempenho em tarefas de funções executivas que pacientes com DA. Disfunção executiva, avaliada através das tarefas da subescala I/P, pode ser útil na diferenciação entre pacientes com DV e DA.

Palavras-chave: demência; testes neuropsicológicos; transtornos cognitivos; doença de Alzheimer; demência vascular.

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Claudia Sellitto Porto - Rua Itapeva, 378 / cj. 92 - 01332-000 São Paulo SP - Brazil . E-mail: claudiasporto@uol.com.br

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