End-stage Alzheimer's disease. Glasgow Coma Scale and the neurologic examination
C. G. Benesch, K. D. McDaniel, C. Cox and R. W. Hamill
Department of Neurology, University of Rochester School of Medicine and Dentistry, NY.
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.
