Adaptation of Scale D in Greek Elderly People

Dementia of the Alzheimer's Type is a disease, which affects many elderly people. One of the serious consequences of the disease is the effect it has on Activities of Daily Living. The D-Scale -a modified version of Ferm's D-Test (1974)- refers to 16 basic physical functions in a 6-grade informant rating scale which assesses demented patients' ability to dress, move, eat, control bladder and bowel functions, wash, communicate, orientate in space, recognize persons, and participate in group activities and hobbies. The scale also assesses the patients' sleeping/waking rhythm and behavior while measuring at which rate the patient can perform activities of daily living, if at all. The 6-grade rating scale specifically measures complete and reduced independence, minimal, limited and maximum assistance, and finally total dependence.

In the present study we examined the functionality of Greek patients with dementia using the D-Scale. The D-Test was translated into the Greek language and adequate clarification was given to ensure the better comprehension of questions. This part of the research required increased attention so that explanations did not direct to the answer and contributed in the rejection of the closed-end type answer "yes/no" by the caregiver. Our intention was to prove the validity of D-Scale's results. The scale was addressed to patients suffering from moderate to severe dementia. However, information about the scale was obtained from their caregivers to ensure result objectivity as the patients' cognitive functions were affected in the later stages of the disease.

We examined 128 patients who visited Memory's and Dementia's Ward at "G. Papanikolaou" General Hospital, whose diagnosis had been confirmed by a neurologist according to the criteria of NINCDS-ARDRA. After the participants were assessed on a number of psychosocial and cognitive scales, they were examined on the D-Scale of their own free will. The purpose of this research was to find out the differences between D-Scale and other functional scales. Our sample was divided into two groups: those who suffered from Alzheimer's disease and those who suffered from other types of dementia (vascular dementia, frontal, fronto-temporal, mixed and mild cognitive impairment). there eas also one more group, consisting of healthy subjects. we also examined variables such as the Mini Mental State Examination (MMSE), the existence of depression or not (GDS, HAMILTON), the type and the duration of dementia. According to the variables that we mentioned above, our sample was also separated in corresponding groups. In addition, we analyzed variables, which may affect the ability to perform the Activities of Daily Living such as age, sex and education. Finally, we compared the results of D-Scale with the results of other functional scales such as FRSSD and FUCAS.

For the statistical analysis, we used SPSS 8.0 software and specifically, the Independent-Samples T Test. Results indicated that variables such as the score of MMSE, the stage of dementia and depression affect the ability to perform the Activities of Daily living. Statistically, significant correlation was found between MMSE and D-Scale (p=0,00), the stage of dementia and D-Scale (p=0,01), and depression and D-Scale (p=0,00). on the other hand, variables such as age, sex, education and the type of dementia did not seem to correlate with functionality. The analysis between D-Scale and the type of dementia showed no statistically significant correlation, as we already mentioned. However, a statistically significant correlation was found between FRSSD and the type of dementia.

Key words: Functional Scale D, Dementia, Greek population.