Review of Alzheimer's disease scales: is there a need for a new multi-domain scale for therapy evaluation in medical practice?

The National Library of Medicines' MEDLINE database was searched for the years 1981 to September 2008, using a set of keywords aiming to select instruments which cover at least some of the requirements for an ideal practical AD scale for therapy evaluation. Measures for AD staging and screening tests were not considered for review.Of 1,902 articles resulting from the literature search, 68 relevant AD scales were identified. Most of them were scales that predominantly measure the severity of major dysfunctions in particular AD domains. Only five scales met some of the requirements for a practical multi-domain AD scale, but did not possess all required characteristics.Despite the multitude of AD scales for various purposes, there remains a need for a new multi-domain and easy to administer AD scale for assessment of disease progression and response to therapy in daily medical practice.Alzheimer's disease (AD), together with other forms of dementia, represents a major challenge for health care systems with aging populations. AD is associated with neurodegenerative changes which compromise not only cognitive functioning but also lead to a decline in functional abilities and induce a spectrum of psychological or behavioral symptoms [1]. Many efforts are currently undertaken to investigate AD pathology and develop appropriate treatment strategies. These strategies focus on long-term preservation of cognitive and functional abilities or slowing down disease progression along with reducing behavioral symptoms and maintaining the patient's quality of life [2,3]. As long as there is no treatment leading to reversal or stopping of disease progression, an amelioration of the disease symptoms, which may delay institutionalization, as well as a reduction of caregiver burden and costs, are realistic treatment goals today.Rating scales are essential tools for AD diagnosis, staging, assessment and careful monitoring of AD symptoms as well as for evaluation of treatment effects. For