Blessed scale: what it is, parts, what it is for and how it is used

Dementias are a set of medical conditions in which the patient shows diverse symptoms. Apart from a clear loss of memory, as in Alzheimer's, 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 reliable when it comes to identifying cases of people with these types of pictures. Let's take a closer look at what it is, its history, what items it has and its psychometric properties.

• Related article: "Types of psychological tests: their functions and characteristics"

What is the Blessed Scale?

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) specially focused on evaluating dementia.

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

Story

The Blessed Scale It was made in 1968 by the hand of G. Blessed and his colleagues B. AND. Tomlinson and M. Roth. The Blessed Scale was originally developed as an attempt to compare the deterioration of the intelligence and personality caused by an underlying neuropathy in patients with symptoms of dementia.

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

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 is 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 Alzheimer's there are in the United States and how they progress.

Features and application

The Blessed Scale is a semi-structured instrument with heteroapplication, since it is not the evaluated patient who answers it, but rather a family member, friend or close person who knows him or her. This informant should indicate what changes he 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 it.

The Blessed Scale it is used to evaluate the mental state of the person, how he develops in his daily activities. It is quick to apply and easy to administer, and it also quantifies the degree of dementia and its severity. It is quite useful for general practitioners 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 that it measures functional aspects of dementia.

The scale consists of 22 items that are asked to 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, handling and use of money, remembering lists, orienting oneself around the house and in the urban space, recognizing family members, valuing the environment, remembering recent events and recalling 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 has no problem doing that homework.

2. Changes in habits

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

3. Changes in personality, interests, and drives

This area consists of 11 items that assess changes in personality and impulses, such as increasing withdrawal, increased egocentricity, in addition to loss of interest in feelings, dull affectivity, loss of emotional control, laughter for no apparent reason, decreased emotional response and indiscretions sexual.

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

How to use?

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 evaluated person could suffer some type of problem related to dementia from a score of 4.

• 4-9 indicates low impairment.
• 10 to 14 indicates moderate deterioration.
• More than 15 indicates severe deterioration.

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.

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

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 short battery of simple cognitive tasks. 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 that evaluated long-term memory, a short recall test, after 5 minutes, the name and address of a person who had been described to the patient and three sequential tasks 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 moderately correlates with scores on the Blessed Scale. Even so, if the degree of dementia evaluated is taken into account, age does not seem to be a factor that marks differences between some 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 has been translated and validated in various countries, such as China, Korea, the Czech Republic and Spain, in the latter case by the hand of the 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, with high internal consistency (a = 0.925) and high test-retest reliability as well (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.

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.