Blessed Scale: what it is, parts, what it is used for and how to use it.

A summary about the characteristics of the Blessed scale, a psychodiagnostic tool.

Dementias are a group of medical conditions in which the patient shows diverse symptomatology. Apart from a clear loss of memory, as in Alzheimer's disease, there may also be changes in personality, interests and impulses.

To measure the changes and progress of dementias, there is the Blessed Scale, a tool that has been shown to be very useful.a tool that has been shown to be very reliable in identifying cases of people with this type of condition. Let's see more in depth what it is, its history, what items it has and its psychometric properties.

What is the Blessed Scale?

The Blessed Dementia Scale (Blessed Dementia Scale), more popularly known as the Blessed Dementia Scale, is a hetero-applied psychodiagnostic instrument (it is not the patient who answers it, but an informant) specially designed to assess dementia..

This scale was designed with the intention of being able to quantify the degree of intellectual and personality impairment in elderly people who showed symptoms of suffering from some type of dementia.

History

The Blessed Scale was elaborated in 1968 by G. Blessed and his colleagues B. E. Tomlinson and M. Roth. The Blessed Scale was originally developed as an attempt to compare the impairment of intelligence and personality caused by underlying neuropathy in patients with dementia symptomatology.

Over the years a revised version, the Revised Dementia Scale, was introduced in 1988. This only included items reflecting changes seen by informants in the daily activities and habits of the evaluee. This new version was more sensitive and specific than the original scale when it came to discriminating the degree of severity of the person being evaluated.

The scale has proven to be so important in the assessment of dementia that its items have been included in other instruments.. Some examples of this are the case of the standardized interview with close relatives as part of the "Cambridge Mental Disorders of the Elderly Examination" and the battery of the "Consortium to Establish a Registry for Alzheimer's Disease", an American institution in charge of establishing how many cases of Alzheimer's there are in the United States and how they progress.

Characteristics and application

The Blessed Scale is a semi-structured instrument of hetero-applied application, since it is not the patient being evaluated who answers it, but a relative, friend or close person who knows him/her. This informant should indicate what changes he/she has seen in the patient's behavior in the last 6 months. As we have seen, the group that is usually evaluated with this instrument are elderly people with suspected dementia, taking about 10 minutes to administer.

The Blessed Scale is used to assess the mental state of the person, how he/she is doing in his/her daily activities.. It is quick to apply and easy to administer, and also quantifies the degree of dementia and its severity. It is quite useful for physicians in general and psychologists, both to identify a possible case of dementia and to assess its progression over time. It is preferred over the MMSE because the Blessed Scale has the advantage of measuring functional aspects of dementia.

The scale consists of 22 items that are asked of an informant close to the patient, questions which are collected in the following 3 main areas:

1. Changes in the performance of activities of daily living.

This area consists of 8 items, which ask about daily tasks, handling and use of money, remembering lists, finding one's way around the house and in the urban space, recognizing family membersIn this area, a score of 1 indicates a complete inability to perform the task asked about, handling and use of money, remembering lists, finding one's way around the house and in the urban space, recognizing relatives, valuing the environment, remembering recent events and remembering the past.

In this section, a score of 1 is indicative of a complete inability to perform the task asked, a score of ½ is indicative of partial, variable or intermittent inability for that activity and a score of 0 indicates that the patient has no problem doing that task.

2. Changes in Habits

This area consists of 3 items that evaluate aspects related to eating, dressing and sphincter control.. This section is scored from 0 to 3, being the part that contributes most to the overall score of the questionnaire.

3. Changes in personality, interests and impulses

This area consists of 11 items that evaluate changes in personality and impulses, such as increased withdrawal, increased egocentrism, as well as loss of interest in feelings, blunted affectivity, loss of emotional control, laughter for no apparent reason, decreased emotional responsiveness and sexual indiscretions.

If the behavior is present it is scored 1 and if absent it is scored 0.

How is it used?

The Blessed Scale is scored from 0 to 28.. Higher values indicate greater impairment in the functional capacity of the evaluee. This instrument indicates that the evaluee may have some type of dementia-related problem at a score of 4 or higher.

• From 4 to 9 indicates a low impairment.
• From 10 to 14 indicates moderate impairment.
• More than 15 indicates severe impairment.

In subsequent revisions and analyses of the revised Blessed Scale it has been proposed to subdivide the items into 4 groups, each with its own score.

• Cognitive: items 1 to 7, scored from 0 to 7.
• Personality changes: items 12 to 17, scored from 0 to 6.
• Apathy/withdrawal: items 18, 20 and 21, score 0 to 3.
• Basic self-care: items 9 to 11, score 0 to 3.

Information-Memory-Concentration Test

Apart from the three main areas of the Blessed Scale explained so far, in its original version this instrument included a second section, comprising a short battery of simple cognitive tasks called the "Information-Memory-Concentration Test". called the "Information-Memory-Concentration Test". This section was similar to other instruments that assessed mental status.

It consisted of 12 items related to information and orientation, 11 items assessing long-term memory, a brief test of recalling, after 5 minutes, the name and address of a person described to the patient, and three sequential tasks requiring concentration.

Psychometric data

The Blessed Scale has shown a high discriminative capacity, identifying patients with dementia.identifying patients with senile dementia from those with depression, paraphrenia, delusions and diseases of physical origin. Thanks to the characteristics of the Blessed Scale it is possible to monitor the progression of dementia.

Age correlates moderately with Blessed Scale scores. However, taking into account the degree of dementia assessed, age does not seem to be a factor that differentiates patients with dementia from older patients. Differences in race have been detected. In the U.S. case, African Americans have been found to score higher than white Americans.

The scale has been translated and validated in several countries, such as China, Korea, the Czech Republic and Spain, in the latter case by J. Peña-Casanova's group.in the latter case by the group of J. Peña-Casanova. The results of its validation show that this scale has adequate psychometric properties for its use. It is an instrument with high reliability, high internal consistency (a=0.925) and high test-retest reliability (ICC=0.98). It has a sensitivity close to 90% on average in different populations, being in the Spanish case 87.39%, with a specificity of 90% for a cut-off point of 3.5.

Bibliographic references:

• Blessed, G., Tomlinson, B. E., & Roth, M. (1968). The association between quantitative measures of dementia and of senile changes in the cerebral gray matter of elderly subjects. British Journal of Psychiatry, 114(512), 797–811.
• Blessed, G., Tomlinson, B. E., & Roth, M. (1988). Blessed-Roth Dementia Scale (DS). Psychopharmacology Bulletin, 24(4), 705–708.
• Erkinjuntti, T., Hokkanen, L., Sulkava, R., & Palos, J. (1988). The Blessed Dementia Scale as a screening test for dementia. International Journal of Geriatric Psychiatry, 3, 267–273.
• Keller A.J., Sherman E.M.S., Strauss E. (2011) Blessed Dementia Scale. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY.