The SKT, which was first published in 1977 by Erzigkeit and has since been revised twice, is a short cognitive performance test for assessing deficits of memory and attention. The test is most frequently used in the area of mild cognitive impairment and mild to moderate degrees of dementia. The present literature survey informs about cross-sectional and longitudinal studies, which have shown the SKT to be a sensitive measure of cognitive impairment. Although dementing disorders of the elderly have been the focus group of the test - first and foremost, studies seeking to proof the efficacy of anti-dementia drugs -, numerous investigations from the fields of surgery and anesthesia demonstrate the applicability of the SKT also with other diagnostic groups. The availability of five parallel SKT forms (A, B, C, D and E) has been identified as advantageous for repeated testing even within short periods of time. The fine graduation of test norms for different age groups, which also take into account the premorbid level of intelligence, makes the SKT an instrument with a broad range of applicability.

Zusammenfassung: Der SKT nach Erzigkeit ist ein 1977 publizierter, seitdem zweimal überarbeiteter Kurztest zur Erfassung von Störungen des Gedächtnisses und der Aufmerksamkeit. Der Test wird hauptsächlich bei Patienten mit leichten kognitiven Beeinträchtigungen oder mit leichter bis mittelgradiger demenzieller Symptomatik eingesetzt. Der vorliegende Literaturüberblick informiert über quer- und längsschnittliche Studien, in denen sich der SKT als störungsgradsensitives Untersuchungsverfahren bewährt hat. Auch wenn der Schwerpunkt des Testeinsatzes im Bereich demenzieller Alterserkrankungen liegt - hier insbesondere auf dem Wirksamkeitsnachweis therapeutischer Maßnahmen -, belegen zahlreiche Untersuchungen beispielsweise aus der Chirurgie und Anästhesie seine Verwendbarkeit auch bei anderen Diagnosegruppen. Als besonderer Vorteil des SKT erwies sich hierbei das Vorliegen von fünf Parallelformen für Wiederholungstestungen innerhalb kurzer Zeitabstände. Die differenzierte Altersnormierung, die auch das prämorbide Ausgangsniveau des Patienten berücksichtigt, macht den SKT zu einem Verfahren mit einem breiten Einsatzbereich.

The Syndrom Kurztest SKT is a brief neuropsychological test battery that consists of nine subtests and defines two independent factors of memory and attention deficit. The aim of this study was to validate the Korean version of the SKT. The reliability of each subtest among three parallel Forms (A, B and C) of the Korean version was high (r = 0.46-0.95). The SKT had good concurrent validity with the Mini-Mental State Examination (r = -0.83, p < 0.001). Factor analysis confirmed the presence of two primary factors, memory and attention. The overall similarities of the factor structures for the Korean data and those for the data from Germany and the USA provide evidence of the transcultural stability of the SKT.

The Bayer-activities of daily living (B-ADL) is a brief and internationally applicable ADL instrument which has been validated in three European countries. The B-ADL has been developed to provide a tool for the assessment of functional deficits in performance of every day tasks as they are observed in mild to moderate stages of dementia. The B-ADL has been constructed for use in clinical trials as well as in clinical practice. From an international perspective the major application is the evaluation of treatment effects in clinical studies and the current study was to validate the Korean version of the B-ADL. The B-ADL was administered to a total of 129 subjects with varying degrees of cognitive decline. A substantial cross-sectional correlation between B-ADL and MMSE scores was found. The internal consistency of B-ADL was above 0.98. A factor analysis revealed that a one factor solution accounted for most of the total variance. The B-ADL global score significantly increased as the severity of dementia, assessed by global deterioration scale increased from stage 1 to 5. Test-retest reliabilities of B-ADL global score and each item were very high. All of these results were very similar to those from three European countries except for the proportion of 'non-applicability' in some ADL items. These findings provide evidence that the Korean version of B-ADL can be useful not only for clinical purposes but also for international multicentre studies.

Background : Activities of daily living (ADL) deficits are integral components of dementia disorders, and ADL measures are among the most robust markers of the course of Alzheimer's disease (AD). Despite this acknowledged importance, no clearly useful ADL instrument for cross-cultural application in pharmacologic trials in the early stages of AD had been available. Method : An international effort was launched to develop an ADL scale for pharmacologic trials in early AD. Steps taken from 1990 to the present included: (1) international scientific working group meetings and reviews, (2) reviews of existing measures, (3) collating of existent, nonredundant items, (4) querying experts for new items, (5) interviews with informants and subjects in the USA, France, and Germany, toward the identification of potential new items, (6) identification of an item pool based upon these procedures, (7) creation of a trial instrument, (8) piloting of this instrument, and (9) refinement of the scale based upon statistical analysis of the pilot data. Final item selection was based upon: (1) relevance for ≥ 80% of subjects in severity-stratified USA and German samples; (2) absence of gender and national biases; (3) significant ( p < .05) discrimination between (a) normal versus mildly impaired and (b) mildly impaired versus moderately to moderately severely impaired subjects; and (4) Global Deterioration Scale (GDS) scores accounting for ≥ 12% of variance in the item after controlling for age and gender. Results : An ADL scale consisting of 40 items that correlate with the global and cognitive progress of AD is developed for international usage in pharmacologic trials in incipient, mild, moderate, and moderately severe AD. The scale contains 40 items falling within 13 ADL categories. The 40-item scale is shown to have .81 correlation with GDS staging,.81 with mental status assessment (Mini-Mental State Examination), and .81 with a psychometric test (the SKT) ( p values < .001). Conclusion : This scale can be used to measure therapeutic response in AD.

The Bayer-Activities of Daily Living Scale (B-ADL) is a 25-item, informant-rated questionnaire which was developed as a brief and internationally applicable instrument for assessing functional disabilities. The scale's target group are elderly patients suffering from mild to moderate dementia or cognitive impairment. To investigate the reliability and validity of different language versions, the B-ADL was administered in the UK, Germany, and Spain to a total of 1,433 subjects with a wide range of cognitive decline. The results from the three country samples were very similar, with internal consistency being above 0.98 (Cronbach alpha). A factor analysis revealed that a one-factor solution accounted for most of the variance. The B-ADL total score significantly increased between adjacent Global Deterioration Scale (GDS) stages 1 to 5. A second factor analysis entering additional variables (GDS stage, Mini-Mental State Examination or MMSE subscores, age, years of education, gender, and country) revealed that all B-ADL items loaded on the same factor, 'dementia severity', and that they were not related to age, education, gender, or country. In the identification of subjects with clinically manifest dementia symptoms (GDS stages 4 and 5), the B-ADL proved to be as efficient as the MMSE in the UK and German samples and superior to the MMSE in the Spanish sample.Copyright (C) 2001 S. Karger AG, Basel.

In addition to cognitive performance tests, the assessment of activities of daily living (ADL) is becoming increasingly important in diagnosing and following up dementia. Therefore, we compared results obtained from ADL informant and self reports and from the SKT short test for assessing deficits of memory and attention. Data were available from a total of 193 elderly subjects in different stages of cognitive decline (GDS stages 1-5). First, we determined for each GDS group separately the numbers of subjects assessed as being impaired by each of the three methods alone as well as in combination. Furthermore, the contribution of the two ADL measures, the SKT total score, age, depression and education in the prediction of the global severity assessment according to GDS was evaluated. Finally, the influence of the latter three variables on the ADL and SKT results was estimated by existing correlations. in GDS stage 2, ADL self rating was the only approach revealing impairment with a majority of patients. The number of patients assessed as being impaired by ADL informant ratings and the SKT only increased after GDS stage 2. Analyses of patterns of impairment showed that 66% of subjects in GDS stage 1 were rated as unimpaired by each of the three methods. Of patients classified as GDS 4 and 5, 85% and 92% respectively were unanimously rated as impaired. In GDS stages 2 and 3 a great heterogeneity of patterns was found. in a logistic regression model predicting clinically manifest dementia symptomatology (GDS 4+5 vs GDS 1+2+3) the SKT and ADL informant ratings were included. In a second model predicting membership in a group without cognitive impairment (GDS 1+2) or in a group suffering from mild cognitive impairment (GDS 3) self-rated ADL and age were additionally entered. Especially for an early diagnosis of dementia, on the basis of the study results the usage of different assessment methods (ADL informant rating, ADL self rating, psychometric test) is suggested.

In addition to cognitive performance tests, the assessment of activities of daily living (ADL) is becoming increasingly important in diagnosing and following up dementia. Therefore, we compared results obtained from ADL informant and self reports and from the SKT short test for assessing deficits of memory and attention. Data were available from a total of 193 elderly subjects in different stages of cognitive decline (GDS stages 1-5). First, we determined for each GDS group separately the numbers of subjects assessed as being impaired by each of the three methods alone as well as in combination. Furthermore, the contribution of the two ADL measures, the SKT total score, age, depression and education in the prediction of the global severity assessment according to GDS was evaluated. Finally, the influence of the latter three variables on the ADL and SKT results was estimated by existing correlations. In GDS stage 2, ADL self rating was the only approach revealing impairment with a majority of patients. The number of patients assessed as being impaired by ADL informant ratings and the SKT only increased after GDS stage 2. Analyses of patterns of impairment showed that 66% of subjects in GDS stage 1 were rated as unimpaired by each of the three methods. Of patients classified as GDS 4 and 5, 85% and 92% respectively were unanimously rated as impaired. In GDS stages 2 and 3 a great heterogeneity of patterns was found. In a logistic regression model predicting clinically manifest dementia symptomatology (GDS 4 + 5 vs GDS 1 + 2 + 3) the SKT and ADL informant ratings were included. In a second model predicting membership in a group without cognitive impairment (GDS 1 + 2) or in a group suffering from mild cognitive impairment (GDS 3) self-rated ADL and age were additionally entered. Especially for an early diagnosis of dementia, on the basis of the study results the usage of different assessment methods (ADL informant rating, ADL self rating, psychometric test) is suggested.

Decline in functional abilities is a major component of the dementia syndrome. The definition of dementia in the International Classification of Diseases (10th rev.) requires a cognitive impairment sufficient to impair personal activities of daily living (ADL). The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) also requires cognitive deficits sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a higher level of functioning. However, the term disability is more appropriate than impairment to describe a loss in activities, as opposed to a loss of elementary functions, and is consistent with World Health Organization definitions of impairment, disability, and handicap. There is no doubt that ADL outcomes are required in therapeutic drug studies on vascular dementia, and there is a good rationale and some evidence for the use of ADL scales developed for therapeutic research in Alzheimer disease, favoring scales devoid of items sensitive to physical disabilities. Similarly, ADL-related clinical milestones could be used for longer-term studies aiming predominantly at slowing progression of disease in both early and later stages of dementia. Slower decline in ADL and delay in reaching ADL-related clinical milestones should be considered as valid outcomes by regulatory bodies in the process of dementia drug approval.

Zusammenfassung: In einer multizentrischen Studie wurden mit MMST, ADAS, BCRS und SKT vier im Bereich der dementiellen Alterserkrankungen international eingesetzte Testverfahren miteinander verglichen. Es wurde überprüft, inwieweit die Verfahren zwischen Patientengruppen mit klinisch unterschiedlich schwer beurteilten kognitiven Einbußen differenzieren können, ob die mit den einzelnen Tests getroffenen Störungsgradzuordnungen übereinstimmen und welche Entsprechungen zwischen den Testscores bestehen. Weiterhin wurde die faktorielle Struktur der Testbatterie analysiert. Die Ergebnisse legen eine unterschiedliche Störungsgradsensitivität von MMST, ADAS, BCRS und SKT in verschiedenen Stadien der Demenz nahe. Die auf der Grundlage der vier Tests vorgenommenen Schweregradbeurteilungen des dementiellen Syndroms weichen voneinander ab. In einer Regressionsanalyse konnten dafür in erster Linie die zwischen den verschiedenen Testverfahren bestehenden Unterschiede in der Definition von Schweregraden kognitiver Beeinträchtigungen verantwortlich gemacht werden. Die Faktorenanalyse erbrachte eine Lösung, die die Kernsymptomatik der Demenz abbildet und damit auf die faktorielle Validität der eingesetzten Tests hinweist.

The Bayer Activities of Daily Living Scale (B-ADL) has been developed on an international basis to assess deficits in the performance of everyday activities. The scale's main target group is community dwelling patients who suffer mild cognitive impairment or mild-to-moderate dementia. It comprises 25 items and takes the form of a questionnaire to be completed by a caregiver or other informant sufficiently familiar with the patient. Statistical, clinical and domain-related criteria were used to select items from among a large number of activities of daily living (ADL) questions field tested in pilot studies in the USA, Germany, UK, Russia and Greece. The items included in the B-ADL have been chosen for their sensitivity to cognitive impairment, simplicity of concept, international applicability and their relevance to patients coping with the demands of everyday life. The scale uses items which reflect a wide range of domains. On account of its brevity, it is thought especially suitable for application within a GP and primary care context for both screening a patient's ADL capacities as well as for documentation of treatment effects and the progress of dementia. This paper focuses on a description of the scale and its application.

The SKT is a simple and short test for assessing cognitive impairment of memory and attention. The test consists of nine subtests, each limited to a maximum performance time of 60 seconds. Thus, total testing time normally does not exceed 10 to 15 minutes. Test scoring and auditing are also accomplished within a short time and are easily learned. The test is useful for staging the severity of cognitive deficits and for assessing the benefits of therapy, especially with patients suffering from dementia. The SKT is highly accepted both by patients, who are motivated by the appealing character of the tasks and their play-like nature, and hospital clinicians and general practitioners (GPs) because of its brevity and simplicity. The SKT was introduced in Germany two decades ago and has been successfully validated. Test versions of the SKT in English and other languages have confirmed its international applicability and validity, a point of particular importance in light of the current attempts to harmonize methods for assessing the efficacy of pharmaceutical products.

The analyses of an international pilot study presented in this article focused on the development of a cross-nationally valid activities-of-daily-living (ADL) scale sensitive to therapeutic effects in patients with mild memory impairment and mild to moderately severe dementia The present report, which is part of an ongoing international research project, describes field testing results for 141 informant-rated items. The comparability of samples investigated in research centers in the U.S.A., Germany, Russia, and Greece concerning cognitive decline was evaluated globally as well as psychometrically using the Global Deterioration Scale, the Short Cognitive Performance Test, and the Mini-Mental State Examination. In the participating countries, a composite ADL score discriminated well between different stages of cognitive impairment because of dementia. However, international differences between the applied measures were observed. A practical ADL scale showing therapeutic sensitivity and international utility, will be constructed from the 141 informant-rated items under investigation in this pilot work.

Psychometric characteristics of the Alzheimer's Disease Assessment Scale (ADAS) were examined on the basis of data from 440 patients with dementia of the Alzheimer type that were collected before treatment in a multicenter clinical drug trial. Coefficients of internal consistency of above .80 for the cognitive (ADAS-Cog) and the noncognitive section (ADAS-Noncog) indicated a high degree of homogeneity of item contents within the two assessment domains. Test-retest reliability was estimated to be .93, .98, and .96 for ADAS-Cog, ADAS-Noncog, and the total score (ADAS-Total), respectively. Reliably detectable individual changes, which were derived from the reliability estimates, were 7, 3, and 8 points for ADAS-Cog, ADAS-Noncog, and ADAS-Total, in that order. Factor analysis and correlations with MMSE, SKT, and NOSGER scores support the validity of the ADAS-Cog and ADAS-Noncog scores with regard to the cognitive and the noncognitive assessment domains. The ADAS summary scores, almost all of the cognitive items, and some of the noncognitive items discriminated significantly between stages of severity of dementia, as classified independently by MMSE and SKT scores.

Many of the psychometric instruments employed in dementia research are adapted versions of tests developed in countries different from those in which they are applied. The validity of these instruments has been established in their countries of origin; however, there is little information available regarding their validity when transferred to other cultures. The SKT, a short cognitive performance test for the assessment of memory and attention deficits developed and validated in Germany, was administered in research centers in Chile, Greece, Russia, and England. SKT raw scores were factor analyzed with regard to a prespecified target structure, i.e., the factor solution found for a large German reference sample. The cross-cultural stability of the test was assessed using a statistical method that combined the perfect congruent weights approach and the bootstrapping technique. This procedure allowed for testing the similarity between factorial solutions obtained for the different centers. Results clearly indicate the factorial stability of the SKT in the countries participating in the study.