The Blessed Ladder: What It Is, The Parts, What It Is And How It Is Used

Dementias are a collection of medical conditions in which the patient presents with diverse symptoms. Besides a loss of clear memory, as in Alzheimer’s disease, there may also be changes in personality, interests and impulses.

To measure the changes and progression of dementias, there is the blessed scaleA very reliable tool for identifying cases of people with this type of condition. Let’s take a closer look at what it is, its history, elements and psychometric properties.

    What is the blessed ladder?

    The Blessed Dementia Scale, better known as the Blessed Scale, is a hetero-applied psychodiagnostic instrument (not the patient responding to it, but an informant) focused in particular on the assessment of dementia.

    This scale was designed to be able to quantify the degree of intellectual and personality impairment of older people who presented with symptoms of suffering from a certain type of dementia.

    the story

    The ladder of the blessed was produced in 1968 by G. Blessed and his colleagues BE Tomlinson and M. Roth. The Blessed Scale was originally developed as an attempt to compare altered intelligence and personality caused by underlying neuropathy in patients with symptoms of dementia.

    Over the years, a revised version was made, the “Revised Dementia Scale”, introduced in 1988. It only included items reflecting changes observed by informants in the daily activities and habits of the person assessed. This new version was more sensitive and specific than the original scale to discriminate against the severity of the person being assessed.

    the scale it has been shown to be so important in the assessment of dementia that its components have been included in other instruments. Let us cite as an example the case of the standardized interview with relatives within the framework of the “Cambridge Mental Disorders of the Elderly Examination” and of the battery of the “Consortium to Establish a Registry for Alzheimer’s Disease”, an institution of the North. American organization responsible for establishing how many cases of Alzheimer’s in the United States and how they progress.

    Features and application

    The Blessed Scale is a semi-structured instrument with a hetero-applied application, as it is not the assessed patient who responds to it, but a relative, friend or relative who knows him or her. This informant should indicate the behavioral changes observed by the patient during the last 6 months. As we have seen, the group that is usually assessed with this instrument are the elderly with suspected dementia, taking approximately 10 minutes to administer.

    The ladder of the blessed it is used to assess the mental state of a person, as 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 very useful for general practitioners and psychologists, both to identify a possible case of dementia and to assess its progression over time. It is preferred to the MMSE because the Blessed Scale has the advantage of measuring the functional aspects of dementia.

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

    1. Changes in the performance of activities of daily living

    this zone it consists of 8 elements, which ask questions about daily tasks, Handling and using money, remembering lists, orienting yourself around the house and in urban space, recognizing loved ones, valuing the environment, remembering recent events and remembering the past.

    In this section, a score of 1 is an indicator of total inability to perform the requested task, a score of ½ is an indicator of partial, variable or intermittent incapacity for that activity, and a score of 0 indicates that the patient is not. you have no problem doing this task.

    2. Changes in habits

    This area consists of 3 elements which assess aspects related to diet, 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 impulses

    This domain consists of 11 items that assess personality changes and impulses, such as increased withdrawal, increased self-centeredness, as well as loss of interest in feelings, blunted affectivity, loss of emotional control, laughter for no apparent reason, less emotional response and sexual indiscretions. .

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

    How is it used?

    The blessed scale is noted from 0 to 28. Higher values ​​indicate a great deterioration in the functional capacity of the assessor. This instrument indicates that the person being assessed may have some type of dementia related problem starting from a score of 4.

    • 4 to 9 indicate little deterioration.
    • 10 to 14 indicates moderate deterioration.
    • More than 15 indicate serious deterioration.

    In subsequent revisions and analyzes of the revised Blessed Ladder it was proposed to subdivide the items into 4 groups, each with its own score.

    • Cognitive: elements 1 to 7, score 0 to 7.
    • Personality changes: items 12 to 17, score 0 to 6.
    • Apathy / withdrawal: items 18, 20 and 21, score from 0 to 3.
    • Basic Personal Care: Items 9-11, Score 0-3.

    Information-memory concentration test

    In addition to the three main areas of the Blessed Ladder 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 state.

    It included 12 items related to information and advice, 11 items assessing long-term memory, a short test to remember, after 5 minutes, the name and address of a person who had been described in the patient and three sequential tasks that required concentration.

    psychometric data

    The Blessed Ladder has shown a great capacity for discrimination, Identify patients with senile dementia from those with depression, paraphrenia, delirium and physical illness. Thanks to the features of the Blessed Scale, it is possible to follow the progression of dementia.

    Age is moderately correlated with Blessed Scale scores. However, if the degree of dementia assessed is taken into account, age does not appear to be a factor that differentiates some patients with dementia from others who are older. Yes, differences were detected in terms of race. In the American case, we have seen that African Americans score higher than white Americans.

    the scale it has been translated and validated in several countries, such as China, Korea, Czech Republic and Spain, In the latter case by the hand of the group of J. Peña-Casanova. The results of its validation show that this scale has suitable 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 of 87.39%, with a specificity of 90% for a threshold of 3.5.

    Bibliographical references:

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

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