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Am J Psychiatry 1992; 149:190-194
Copyright © 1992 by American Psychiatric Association
An empirical evaluation of the Global Deterioration Scale for staging Alzheimer's disease [published erratum appears in Am J Psychiatry 1992 Aug;149(8):1129]
C Eisdorfer, D Cohen, GJ Paveza, JW Ashford, DJ Luchins, PB Gorelick, RS Hirschman, SA Freels, PS Levy and TP Semla
Department of Psychiatry, University of Miami, FL.
OBJECTIVE: Although the Global Deterioration Scale has been widely used
since its publication in 1982, its stages are based on implicit assumptions
about the linearity, temporality, and interdependence of cognitive,
functional, and behavioral impairment in Alzheimer's disease. The authors
evaluated the validity of these assumptions and tested the hypothesis that
psychopathology and functional impairment would occur in earlier stages
than the Global Deterioration Scale predicts. METHOD: The analyses were
based on data on 324 patients with Alzheimer's disease who were selected
from a registry of such patients. Data analyses included 1) descriptive
statistics on the frequency of psychiatric symptoms and difficulties with
activities of daily living and 2) logistic regression, with symptoms and
functional impairment as independent variables, to test for significant
changes in patients' status between stages of the Global Deterioration
Scale. RESULTS: More than 50% of the patients at stage 2 displayed
psychopathology, and 32% had two or more symptoms. The significant increase
in psychiatric symptoms occurred between stages 3 and 4, not between stages
5 and 6 as predicted by the Global Deterioration Scale. Impairment in
functional status was observed at all stages, and significant increases
occurred between stages 3 and 4 as well as between stages 5 and 6.
CONCLUSIONS: Psychiatric symptoms and functional impairment occur earlier
than predicted by the Global Deterioration Scale, and the rate of change is
also different from that specified in the scale. Separate scales to
describe cognitive, clinical, and functional status may be the best way to
describe the illness until better multidimensional instruments are
developed.
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