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Glasgow Coma Scale and the Neurologic Examination

Curtis G. Benesch, MD; Keith D. McDaniel, MD; Christopher Cox, PhD; Robert W. Hamill, MD

Arch Neurol. 1993;50(12):1309-1315.

Abstract
Objective
To characterize the cognitive and neurologic features of patients with end-stage Alzheimer's disease using a standard neurologic examination and the Glasgow Coma Scale.

Design
Case series.

Setting
Local community nursing homes.

Patients
Forty patients with Alzheimer's disease were drawn from previously enrolled subjects in the Rochester Alzheimer's Disease Project with Clinical Dementia Rating scores of 3, 4, or 5.

Main Outcome Measures
Scores on the Glasgow Coma Scale and cognitive screening examinations and the prevalence of neurologic manifestations such as primitive reflexes and extrapyramidal signs were compared across the Clinical Dementia Rating groups.

Results
When compared with patients in the Clinical Dementia Rating stages 3 and 4, patients with a stage 5 scored significantly lower on the Glasgow Coma Scale, with the discriminating subscales being verbal and motor responses. Primitive reflexes, myoclonus, and dyskinesia were increasingly prevalent in the more terminal stages. Cognitive screening assessments did not discriminate between groups.

Conclusions
Rudimentary neurologic functions can be readily assessed and, when viewed together with the Glasgow Coma Scale, may circumvent the "floor effect" frequently encountered when using the currently available cognitive and functional scales and, thereby, better define patients with end-stage Alzheimer's disease.

Author Affiliations
From the Departments of Neurology (Drs Benesch, McDaniel, and Hamill), Psychiatry (Dr McDaniel), and Biostatistics (Dr Cox), University of Rochester (NY) School of Medicine and Dentistry. Dr Hamill is currently with the Department of Neurology, Medical Center Hospital of Vermont, Burlington.

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