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The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale

Two methods to assess fluctuating confusion in dementia

Medical Research Council, Neurochemical Pathology Unit, Newcastle upon Tyne

G. A. AYRE, PhD and K. WESNES, PhD

Human Cognitive Neuroscience Department, University of Northumbria

J. L. CUMMINGS, MD, Professor of Neurology

University of California

I. G. McKEITH, FRCPsych and J. T. O'BRIEN, MRCPsych

Department of Old Age Psychiatry, University of Newcastle upon Tyne

Correspondence: C. G. Ballard, Medical Research Council, Neurochemical Pathology Unit, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK. Tel: 0191273 5251; fax: 0191272 5291; e-mail: c.g.ballard{at}ncl.ac.uk

Declaration of interest None; source of funding: Medical Research Council.

Background The identification of fluctuating confusion is central to improving the differential diagnosis of the common dementias.

Aims To determine the value of two rating scales to measure fluctuating confusion.

Method The agreement between the clinician-rated scale and the scale completed by a non-clinician was determined. Correlations between the two scales were calculated; variability in attention was calculated on a computerised cognitive assessment and variability in delta rhythm on an electroencephalogram (EEG).

Results The Clinician Assessment of Fluctuation and the computerised cognitive assessment were completed for 155 patients (61 Alzheimer's disease, 37 dementia with Lewy bodies, 22 vascular dementia, 35 elderly controls). A subgroup (n=40) received a further evaluation using the One Day Fluctuation Assessment Scale and an EEG. The two scales correlated significantly with each other, and with the neuropsychological and electrophysiological measures of fluctuation.

Conclusions Both scales are useful instruments for the clinical assessment of fluctuation in dementia.

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