Medications currently approved for treatment of Alzheimer’s all work primarily by inhibiting breakdown of acetylcholine, a neurotransmitter that becomes deficient in the Alzheimer's brain as nerve cells degenerate and die. Although these drugs do not slow progression of the underlying disease process, they may temporarily stabilize or delay worsening of memory problems and other cognitive symptoms. But even temporary stabilization can be valuable to patients as well as to their caregivers and families.
Evaluating treatment efficacy in patients with Alzheimer’s disease can be complicated, particularly because treatments may benefit several types of function. Symptoms associated with the disease are primarily cognitive, but there are often other behavioral or physical conditions, making it difficult to assess problems in one area of functioning. Symptoms also vary by individual and stage of the disease process and require diversified assessments of treatment efficacy.
Current assessment tools are designed to evaluate several areas of function, including:
- functional capacity
- general physical health
- quality of life
Most assessment tools are designed to be completed either by the patient (in the early stages of disease), the caregiver or the patient’s primary health care provider. Most often, a combination of tests is needed to complete an evaluation of the patient’s overall condition. Assessments given by the primary caregiver often evaluate not only the patient’s condition but also the caregiver’s own well-being, which can be an important factor in deciding whether a particular treatment strategy has proven beneficial.
For patients with Alzheimer’s disease or a related dementia, there is no single test that can simultaneously assess all areas of functioning. The aim of such tests is to better understand the actual efficacy of treatments and to develop a comprehensive, practical assessment that can be administered quickly by a clinician. Numerous assessment tools have been developed, and several others are being studied:
Alzheimer’s Disease Assessment Scale, cognitive subsection (ADAS-cog)
Blessed Information-Memory-Concentration Test (BIMC)
Clinical Dementia Rating Scale (CDR)
Mini-Mental State Examination (MMSE)*
Functional Assessment Questionnaire (FAQ)*
Instrumental Activities of Daily Living (IADL)
Physical Self-Maintenance Scale (PSMS)*
Progressive Deterioration Scale (PDS)
Clinical Global Impression of Change (CGIC)
Clinical Interview-Based Impression (CIBI)
Global Deterioration Scale (GDS)
Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD)
Neuropsychiatric Inventory (NPI)*
*Used most often in clinical settings