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Assessment of cognition in advanced AD: The test for severe impairment

From the Departments of Neurology (Drs. Jacobs, S.M. Albert, Sano, Marder, Bell, and Stern, and C. del Castillo-Castañeda), Psychiatry (Dr. Stern), and the Gertrude H. Sergievsky Center (Drs. Jacobs, S.M. Albert, Sano, Marder, Bell, and Stern, and C. del Castillo-Castañeda), Columbia University College of Physicians and Surgeons, New York, NY; the Department of Biostatistics (Dr. Paik), Columbia University School of Public Heath, New York, NY; the Department of Psychiatry and Behavioral Sciences (Dr. Brandt), Johns Hopkins University, Baltimore, MD; and the Departments of Psychiatry and Neurology (Dr. M.S. Albert), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address correspondence to Dr. Diane Jacobs, Gertrude H. Sergievsky Center, 630 West 168th Street, New York, NY 10032; e-mail: dj32{at}columbia.edu

The Test for Severe Impairment (TSI) was compared with the Mini-Mental State Examination (MMSE) and a modified MMSE (mMMSE) in a multisite, longitudinal study of AD. The TSI correlated highly with the MMSE (r = 0.83) and the mMMSE (r = 0.82), but was not redundant. There was a wide range of scores on the TSI among those scoring in the severely impaired range on the MMSE and mMMSE. The slope of cognitive change over time detected by the TSI was greater than that revealed by the MMSE or the mMMSE. Performance on the TSI was a significant predictor of survival. The TSI is a valid measure that is sensitive to cognitive change over time in severely demented patients with AD.

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