Measurement of severity in advanced Alzheimer's disease

J Gerontol. 1994 Sep;49(5):M223-6. doi: 10.1093/geronj/49.5.m223.


Background: In late stages of dementia of the Alzheimer type (DAT), most scales measuring only cognitive or functional deficits lose their sensitivity to detect further disease progression.

Methods: By combining ratings of cognitive (speech, eye contact) and functional deficits (dressing, eating, ambulation) with occurrence of pathological symptoms (sleep-wake cycle disturbance, muscle rigidity/contractures), a scale was developed (BANS-S) which does not lose its sensitivity until the patient reaches a vegetative state. BANS-S was tested on three Special Care Dementia Units.

Results: Data from 74 patients with the clinical diagnosis of DAT indicated that BANS-S has good reliability and reproducibility. BANS-S scores correlated with scores of Mini-Mental State Examination, Katz ADL, Test for Severe Impairment, and Language Assessment. In 25 patients with the diagnosis of DAT confirmed by autopsy, BANS-S scores determined within 3 months of death correlated with density of neurofibrillary tangles in CA2 and CA3 areas of the hippocampus.

Conclusion: BANS-S may be a useful tool for the evaluation of different treatment strategies in severe DAT and for the correlation of clinical and pathological findings.

MeSH terms

  • Aged
  • Alzheimer Disease / diagnosis*
  • Alzheimer Disease / pathology
  • Female
  • Hippocampus / pathology
  • Humans
  • Male
  • Neurofibrillary Tangles / pathology
  • Psychometrics
  • Reproducibility of Results
  • Severity of Illness Index*