Blessed Scale: What It Is, Parts, What It Is For And How To Use It
Dementias are a set of medical conditions in which the patient shows diverse symptoms. Apart from a clear memory loss, as happens in Alzheimer’s, there may also be changes in personality, interests and impulses.
To measure the changes and progress of dementia there is the Blessed Scale, a tool that has proven to be very reliable when it comes to identifying cases of people with this type of condition. Let’s take a closer look at what it is, its history, what items it has and its psychometric properties.
The Blessed Dementia Scale, more popularly known as the Blessed Scale, is a hetero-applied psychodiagnostic instrument (it is not the patient who answers it, but an informant) focused especially on evaluating dementia
This scale was designed with the intention of being able to quantify the degree of intellectual and personality deterioration of elderly people who showed symptoms of suffering from some type of dementia.
History
The Blessed Scale It was developed in 1968 by G. Blessed and his colleagues BE Tomlinson and M. Roth The Blessed Scale was originally developed as an attempt to compare the deterioration of intelligence and personality caused by underlying neuropathy in patients with dementia symptoms.
Over the years, a revised version was made, the “Revised Dementia Scale”, introduced in 1988. This only included items that reflected the changes seen by the informants in the daily activities and habits of the person evaluated. This new version was more sensitive and specific than the original scale when it came to discriminating the degree of severity of the person evaluated.
The scale has turned out to be so important in the evaluation of dementia that its items have been included in other instruments Some examples of this are the case of the standardized interview with close people 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”, a North American institution in charge of establishing how many cases of There is Alzheimer’s in the United States and how they progress.
Features and application
The Blessed Scale is a semi-structured and hetero-applied instrument, given that it is not the evaluated patient who answers it, but a family member, friend or close person who knows him or her. This informant should indicate what changes he or 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 It is used to evaluate the mental state of the person, how they develop in their 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 doctors in general and psychologists, both to identify a possible case of dementia and to evaluate 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 execution of activities of daily living
This area It consists of 8 items, which ask about daily tasks management and use of money, remembering lists, finding one’s way around the house and in the urban space, recognizing family members, evaluating the environment, remembering recent events and remembering the past.
In this section, a score of 1 is an indicator of a complete inability to perform the task asked, a score of ½ is an indicator of partial, variable or intermittent inability for that activity and a score of 0 indicates that the patient does not have any problem in do 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 the most to the overall score of the questionnaire.
3. Changes in personality, interests and drives
This area consists of 11 items that evaluate changes in personality and impulses, such as increasing withdrawal, increased egocentrism, as well as loss of interest in feelings, blunted affectivity, loss of emotional control, laughter for no apparent reason, decreased emotional response, and indiscretions. sexual.
If the behavior is present it is scored 1 and if it is absent it is scored 0.
How to use it?
The Blessed Scale is scored from 0 to 28 Higher values indicate a great deterioration in the functional capacity of the evaluated person. This instrument indicates that the person evaluated could suffer some type of problem related to dementia starting with a score of 4.
In subsequent reviews and analysis of the revised Blessed Scale It has been proposed to subdivide the items into 4 groups, each with its own score
Information-Memory-Concentration Test
Aside from the three main areas of the Blessed Scale explained so far, In its original version, this instrument included a second section, which included a brief battery of simple cognitive tasks called the “Information-Memory-Concentration Test”. This section was similar to other instruments assessing mental status.
It consisted of 12 items related to information and orientation, 11 items that evaluated long-term memory, a brief test of remembering, after 5 minutes, the name and address of a person that had been described to the patient, and three tasks. sequential sequences that required concentration.
Psychometric data
The Blessed Scale has shown a high discriminative capacity, identifying patients with senile dementia from those who suffer from depression, paraphrenia, delusions and diseases of physical origin. Thanks to the characteristics of the Blessed Scale, it is possible to monitor the progress of dementia.
Age correlates moderately with Blessed Scale scores. Even so, if the degree of dementia evaluated is taken into account, age does not seem to be a factor that marks differences between patients with dementia and others who are older. Yes, differences have been detected in terms of race. In the North American case, it has been seen that African Americans score higher than white Americans.
The scale It has been translated and validated in several countries, such as China, Korea, the Czech Republic and Spain, in this last 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 87.39% in the Spanish case, with a specificity of 90% for a cut-off point of 3.5.
