Cognitive assessment of severe dementia: The test for severe impairment (TSI)

We verified the characteristics and usefulness of a slightly modified version of the test for severe impairment (mTSI) on a nursing-home sample of 130 subjects suffering from moderate to end-stage dementia clinical dementia rating (CDR) scale, range: 1-4; mini mental state examination (MMSE) range: 0-18. The mTSI and the MMSE could be applied to 87 subjects (66.9 %): unresponsiveness and uncooperation were the main reasons for the lack of applicability in the remaining subjects. The mTSI and the MMSE scores were different from 0 in 76/87 (87.4 %) and 59/87 (67.8 %) subjects, respectively; 41 subjects were in CDR stage of 3 or 4: their mTSI and MMSE range was 0-36, and 0-5, respectively. The mTSI mean score decreased significantly at each CDR stage from stage 2 to stage 4, whereas no mean mTSI difference was detectable at the comparison between CDR stages 1 and 2. The mTSI did not appear more informative than the original version of the test. The TSI looks promising in the evaluation of the moderate to severe stages of dementia, although a floor effect remains detectable for the severe to end stages.