Severe Impairment Battery: A Neuropsychological Test for Severely Demented Patients

Objective: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. Design: Case series. Setting: Geriatric long-term facility. Patients: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition , for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99±5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71±6.14. Main Outcome Measure: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. Results: The mean score on the SIB was 92.52±31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11,12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. Conclusion: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up.