The paper reviewed here is ‘Review of Alzheimer’s disease scales: is there a need for a new multi-domain scale for therapy evaluation in medical practice?’ by Robert and colleagues and freely available in draft format here. The authors sketch an outline of a hypothetical rating scale (in Table 1) for Alzheimer’s Disease which covers a number of areas and would be
– Useful for all stages of the illness
The authors include a number of other criteria and these were established by consensus. The criteria offer a starting point and the researchers then go on to search for rating scales which meet their criteria. Very broad details of the search strategy are given. The authors then cover each of the criteria discussing scales appropriate to each. In thie process, the reader can gain valuable insights into a number of rating instruments used in the assessment of Alzheimer’s Disease. They conclude at the end of the paper that none of the instrument met all of their criteria and then go on to discuss what the idealised instrument would look like. However my impression was that their proposed instrument would have a number of conceptual difficulties. The main difficulty is that an instrument that would meet their criteria would have to be both rigorous and flexible. The stipulation that it should be completed by a clinician in 30 minutes or so brings up additional difficulties. If they are going to cut down the assessment time then the quality of the assessment is most likely going to be compromised if compared to an aggregate of suitable instruments from each domain. There is a useful trade-off however. If the instrument takes 30 minutes to perform then it means that a reasonable proportion of the clinician’s assessment period can be efficiently structured while still leaving time for other essential aspects of the consultation.
The paper provides a useful overview of rating instruments used in the assessment of people with Alzheimer’s Disease and offers insights into how the assessment process can be influenced by a careful consideration of theoretical concepts.
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