We would like to congratulate Benesch and coworkers1 for their article that appeared in the December issue of the Archives. We agree that very little is known about the advanced stages of Alzheimer's disease. The authors report on the neurologic examination and Glasgow Coma Scale performance of 40 patients with Alzheimer's disease with clinical dementia rating scores of 3 and greater (Mini-Mental State Examination score of less than 20 points). The Glasgow Coma Scale, a 15-point scale originally designed to assess the depth and prognosis of comatose patients, measures the quality of responses in three domains, namely, eye opening, motor response, and verbal response.
Saxton et al2 recently designed the Severe Impairment Battery (SIB) that consists of a brief cognitive scale to assess patients who are demented to such a degree that they cannot complete conventional neuropsychologic testing. The questions are grouped into nine subscales assessing attention, language,
Panisset M, Saxton J, Boiler F. End-Stage Alzheimer's Disease: Glasgow Coma Scale and the Neurologic Examination. Arch Neurol. 1995;52(2):127–128. doi:https://doi.org/10.1001/archneur.1995.00540260029010
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