The influence of schooling on performance in the Mattis Dementia Rating Scale (DRS)

Porto, Cláudia Sellitto; Caramelli, Paulo; Nitrini, Ricardo

doi:10.1590/S1980-57642010DN40200009

Abstract

Studies have shown the influence of schooling on performance in the Dementia Rating Scale (DRS), suggesting that a single cut-off score is not appropriate for all groups of elderly people.

Objectives:

To verify the influence of schooling on the DRS in a Brazilian elderly population.

Methods:

The DRS was applied to 118 cognitively healthy controls and to 97 patients with mild probable Alzheimer's disease (AD). In order to analyze the influence of education, patients and controls were divided into four groups of schooling (GRSC): GRSC 1 with 1 to 4 years of schooling, GRSC 2 with 5 to 8 years of schooling, GRSC 3 with 9 to 11 years of schooling, and GRSC 4 with more than 11 years of schooling.

Results:

In the intragroup analysis, the performance of controls within each schooling group was compared, revealing a significant difference on total score and the subscales Attention, I/P and Conceptualization. The same procedure was used for the AD patients and a significant difference was observed for total score and the subscales Attention, Construction, Conceptualization and Memory. In the intergroup analysis, the results on total DRS and for the I/P, Conceptualization and Memory subscales showed significant differences in GRSC 1, 2, 3 and 4. The Attention subscale showed differences in GRSC 3 and 4, and on the Construction subscale in GRSC 1 and 4.

Conclusions:

The results highlight the importance of norms for the DRS in the Brazilian population that take into account the effects of schooling on the scores of this scale.

Key words:
Alzheimer's disease; neuropsychological assessment; schooling.

Resumo

Estudos recentes têm demonstrado a influência da escolaridade no desempenho da Escala de Avaliação de Demência (DRS) sugerindo que uma única nota de corte não é apropriada para todos os grupos de pessoas idosas.

Objetivos:

Verificar a influência da escolaridade na DRS para uma população brasileira de idosos.

Métodos:

A DRS foi aplicada em 118 controles cognitivamente saudáveis e em 97 pacientes com doença de Alzheimer (DA) leve. Para a análise da influência da escolaridade, pacientes e controles foram separados em quarto grupos de escolaridade (GRESC): GRESC 1 com 1 a 4 anos de escolaridade, GRESC 2 com 5 a 8 anos de escolaridade, GRESC 3 com 9 a 11 anos de escolaridade, e GRESC 4 com mais de 11 anos de escolaridade.

Resultados:

Na análise intragrupo o desempenho de controles, em cada grupo de escolaridade, foi comparado e diferenças significativas foram estabelecidas no escore total e nas subescalas Atenção, I/P e Conceituação. O mesmo procedimento foi realizado com o grupo de pacientes com DA e diferenças significativas foram observadas no escore total e nas subscalas Atenção, Construção, Conceituação e Memória. Na análise intergrupos o resultado no escore total e nas subescalas I/P, Conceituação e Memória mostraram diferenças significativas no GRESC 1, 2, 3 e 4. A subescala Atenção mostrou diferenças no GRESC 3 e 4 e a subescala Construção nos GRESC 1 e 4.

Conclusões:

Os resultados mostraram a importância de normas de escolaridade apropriadas para a DRS na população brasileira levando-se em consideração os efeitos da escolaridade nos escores desta escala.

Palavras-chave:
doença de Alzheimer; avaliação neuropsicológica; escolaridade.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Mattis S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, Editors. Geriatric psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune & Stratton; 1976:77-121.
²
Mattis S. Dementia Rating Scale: professional manual. Florida: Psychological Assessment Resources, Inc; 1988.
³
Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations. Neurology 1990;40:1225-1230.
⁴
Karbe H, Kertesz A, Davis J, Kemp BJ, Prato FS, Nicholson RL. Quantification of functional deficit in Alzheimer's disease using a computer-assisted mapping program for Tc-HMPAO SPECT. Neuroradiology 1994;36:1-6.
⁵
Paolo AM, Trostr AI, Glatt SL, Hubble JP, Koller WCJ. Differentiation of the dementias of Alzheimer's and Parkinson's disease with the dementia rating scale. Geriatr Psychiatry Neurol 1995;8:184-188.
⁶
Lukatela K, Cohen R, Kessler H, et al. Dementia Rating Scale performance: a comparison of vascular and Alzheimer's dementia. J Clin Ex Neuropsychol 2000;22:445-454.
⁷
Paulsen JS, Butters N, Sadek JR, et al. Distinct cognitive profiles of cortical and subcortical dementia in advanced illness. Neurology 1995;45:951-956.
⁸
Kertesz A, Clydesdale S. Neuropsychological deficits in vascular dementia vs Alzheimer's disease. Arch Neurol 1994;51: 1226-1231.
⁹
Bennett A, Nadler J, Spigler M, et al. The Mattis Dementia Rating Scale in nursing home octagenarians and nonagenarians: effects of age and education. J Geriatr Psychiatry Neurol 1997;10:114-118.
¹⁰
Bank AL, Yochim BP, MacNeill SE, Lichtenberg PA. Expanded Normative Data for the Mattis Dementia Rating Scale for Use with Urban, Elderly Medical Patients. Clin Neuropsychol 2000;14:149-156.
¹¹
Schmidt R, Freidl W, Fazekas F, et al. The Mattis Dementia Rating Scale: normative data from 1,001 healthy volunteers. Neurology 1994;44:964-966.
¹²
Porto CS, Charchat-Fishman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
¹³
Foss MP, Vale Fde A, Speciali JG. Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS). Arq Neuropsiquiatr 2005;63:119-126.
¹⁴
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd Ed. Ver. Washington, DC: American Psychiatric Association; 1987.
¹⁵
Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
¹⁶
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁷
Brucki SMD, Nitrini R, Bertolucci PHP, Caramelli P, Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.
¹⁸
Wechsler D. Wechsler Memory Scale: manual. The Psychological Corporation Harcourt Brace Jovanovich; 1987.
¹⁹
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.
²⁰
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
²¹
Wechsler D. Teste de Inteligência para adultos (WAIS). Manual. 2nd Ed. Buenos Aires: Editorial Paidos; 1993.
²²
Raven JC, Raven J, Court JH. Manual matrizes progressivas coloridas. São Paulo: Casa do Psicólogo; 1988.
²³
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services; 1983.
²⁴
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37: 1731-1738.
²⁵
Spreen O and Strauss E. A compendium of neuropsychological tests: administration, norms, and commentary. 2nd Edition. Oxford University Press; 1998.
²⁶
Brucki SMD. Dados Normativos para o uso do teste de fluência verbal (categorias animais) em nosso meio. São Paulo 1996. Tese. Escola Paulista de Medicina - Universidade Federal de São Paulo.
²⁷
Caramelli P, Carthery MT, Porto CS, Charchat-Fichman H, Bahia V, Nitrini R. Análise qualitativa da fluência verbal no envelhecimento normal e na doença de Alzheimer: efeitos da escolaridade. Arq Neuropsiquiatr 2001:59(Suppl 3):18.
²⁸
Hohl U, Grundman M, Salmon DP, Thomas RG, Thal LJ. Mini-Mental State examination and Mattis Dementia Rating Scale performance differs in Hispanic and non-Hispanic Alzheimer's disease patients. J Int Neuropsychol Soc 199;5:301-307.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
30 Oct 2009
Accepted
05 May 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Mattis S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, Editors. Geriatric psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune & Stratton; 1976:77-121.

[2] ²
Mattis S. Dementia Rating Scale: professional manual. Florida: Psychological Assessment Resources, Inc; 1988.

[3] ³
Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations. Neurology 1990;40:1225-1230.

[4] ⁴
Karbe H, Kertesz A, Davis J, Kemp BJ, Prato FS, Nicholson RL. Quantification of functional deficit in Alzheimer's disease using a computer-assisted mapping program for Tc-HMPAO SPECT. Neuroradiology 1994;36:1-6.

[5] ⁵
Paolo AM, Trostr AI, Glatt SL, Hubble JP, Koller WCJ. Differentiation of the dementias of Alzheimer's and Parkinson's disease with the dementia rating scale. Geriatr Psychiatry Neurol 1995;8:184-188.

[6] ⁶
Lukatela K, Cohen R, Kessler H, et al. Dementia Rating Scale performance: a comparison of vascular and Alzheimer's dementia. J Clin Ex Neuropsychol 2000;22:445-454.

[7] ⁷
Paulsen JS, Butters N, Sadek JR, et al. Distinct cognitive profiles of cortical and subcortical dementia in advanced illness. Neurology 1995;45:951-956.

[8] ⁸
Kertesz A, Clydesdale S. Neuropsychological deficits in vascular dementia vs Alzheimer's disease. Arch Neurol 1994;51: 1226-1231.

[9] ⁹
Bennett A, Nadler J, Spigler M, et al. The Mattis Dementia Rating Scale in nursing home octagenarians and nonagenarians: effects of age and education. J Geriatr Psychiatry Neurol 1997;10:114-118.

[10] ¹⁰
Bank AL, Yochim BP, MacNeill SE, Lichtenberg PA. Expanded Normative Data for the Mattis Dementia Rating Scale for Use with Urban, Elderly Medical Patients. Clin Neuropsychol 2000;14:149-156.

[11] ¹¹
Schmidt R, Freidl W, Fazekas F, et al. The Mattis Dementia Rating Scale: normative data from 1,001 healthy volunteers. Neurology 1994;44:964-966.

[12] ¹²
Porto CS, Charchat-Fishman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[13] ¹³
Foss MP, Vale Fde A, Speciali JG. Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS). Arq Neuropsiquiatr 2005;63:119-126.

[14] ¹⁴
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd Ed. Ver. Washington, DC: American Psychiatric Association; 1987.

[15] ¹⁵
Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[16] ¹⁶
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[17] ¹⁷
Brucki SMD, Nitrini R, Bertolucci PHP, Caramelli P, Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.

[18] ¹⁸
Wechsler D. Wechsler Memory Scale: manual. The Psychological Corporation Harcourt Brace Jovanovich; 1987.

[19] ¹⁹
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.

[20] ²⁰
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[21] ²¹
Wechsler D. Teste de Inteligência para adultos (WAIS). Manual. 2nd Ed. Buenos Aires: Editorial Paidos; 1993.

[22] ²²
Raven JC, Raven J, Court JH. Manual matrizes progressivas coloridas. São Paulo: Casa do Psicólogo; 1988.

[23] ²³
Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services; 1983.

[24] ²⁴
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37: 1731-1738.

[25] ²⁵
Spreen O and Strauss E. A compendium of neuropsychological tests: administration, norms, and commentary. 2nd Edition. Oxford University Press; 1998.

[26] ²⁶
Brucki SMD. Dados Normativos para o uso do teste de fluência verbal (categorias animais) em nosso meio. São Paulo 1996. Tese. Escola Paulista de Medicina - Universidade Federal de São Paulo.

[27] ²⁷
Caramelli P, Carthery MT, Porto CS, Charchat-Fichman H, Bahia V, Nitrini R. Análise qualitativa da fluência verbal no envelhecimento normal e na doença de Alzheimer: efeitos da escolaridade. Arq Neuropsiquiatr 2001:59(Suppl 3):18.

[28] ²⁸
Hohl U, Grundman M, Salmon DP, Thomas RG, Thal LJ. Mini-Mental State examination and Mattis Dementia Rating Scale performance differs in Hispanic and non-Hispanic Alzheimer's disease patients. J Int Neuropsychol Soc 199;5:301-307.

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