End-Stage Alzheimer's Disease: Glasgow Coma Scale and the Neurologic Examination-Reply

We thank Panisset and colleagues for their supportive comments regarding our initial characterization of subjects with clinical dementia rating scores of 3, 4, and 5, using the Glasgow Coma Scale (GCS.)1 We fully agree that it is important to assess patients with end-stage dementia and to develop means by which to stratify their function. Our initial goals were to apply a well-characterized, internationally used and standardized, easily performed bedside test (time of performance less than 5 minutes) that could be administered by nurses and physicians without expertise in neuropsychology or neurology, and determine if patients with severe dementia could be stratified. Our results indicate that patients in the groups with clinical dementia rating scores of 4 and 5 may be stratified with this simple approach. We agree with Panisset et al2 that in comparison with the GCS, the Severe Impairment Battery (SIB) provides a more detailed.