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6
Diagnostic and Statistical Manual of Mental Disorders,
4thedition (DSM - IV h TRTM)
Dementia*
A : The development of multiple cognitive deficits manifested by both
(1) Memory impairment (impaired ability to learn new information or to recall previously
learned information)
(2) one (or more) of the following cognitive disturbances:
(a) Aphasia (language disturbance)
(b) Apraxia (impaired ability to carry out motor activities despite intact motor
function)
(c) Agnosia (failure to recognize or identify objects despite intact sensory function)
(d) Disturbance in executive functioning (i.e., planning, organizing, sequencing,
abstracting)
B: The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or
occupational functioning and represent a significant decline from a previous level of
functioning.
C: The deficits do not occur exclusively during the course of a delirium.
D: The deficits may be associated with mental disorders such as anxiety mood delusions,
hallucinations, personality change wandering agitation. The cognition disturbance may be
accompanied by a clinically significant behavior disturbance
E: Dementia may be progressive, stable, remitting

*
American Psychiatry Association. Diagnostic and Statistic Manual of Mental Disorders.4th Edition
Text Revision. (DSM-IV-TRTM) Washington (DC): American Psychiatric Press.

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2 #?"1#
1. Prayurahong B, Chanjanakijskul S, Supawan P, et al. Vitamin B12, Folic Acid and
Hematological status in elderly thais. J Med Assoc Thai 1993:76;71-78.
2. Assantachai P, Yamwong P, Chongsuphaijaisiddhi T. Relationship of vitamin B1, B12m Folate
and the cognitive ability of the Thai rural elderly. J Med Assoc Thai 1997;80:700-705.

"
3.3 Management of caregivers
1. New Zealand Guidelines Group ƒ New Zealand Guidelines Completed: Guide.(1998-
2003),Site Development and Management by ENIGMA.
2. Brien J., Ames D,Burns A. eds. Dementia:Family Carers for People with Dementia.2nd ed.
London:Arnold,2000.
3. % q !%h%.  "V(#. :V%: ;(:':": ,2537
4. /"L  q .L&  *%# $ )
      :%" 
$:(*V,^( 27,[  ( 3,%% 2537.
5. Alzheimer , Association . Alzheimer , s Disease Guidelines: A Summary for Patients,Family
and Friends.American Academy of Neurology.

"
3.4 >zQ%{Q 
1. Mender MF. Cummings TL. Dementia: A Clinical Approach. Elsevier: Butterworth
Heinemann, 2003
2. Spar TE, Rue AL. Clinical Mann cal of Geriatric Psychiatry. Washington, DC: A Mercian
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3. $%' L  (Clinical Practice Guideline for Dementia). [  ( 1
4. http://www. Inet.nswo.moph.go.th. `V$: ! 19-36, 420-437. &
  29
'%. 2551.

99
"
3.5 |}~|X  
 %
O (Physical rehabilitation)
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function of persons with dementia. Gerontologist 2001 ; 41 : 4-14.

"
3.6 %& !% (end of life care)
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Psychiatry 2004; 12: 457-72

100
5. ( %"%%"!. End-of-life care. *%: Q" W, (% $
', /;". 
Z" !""m% 3. :†: V
%, 2547: 575-601
6. Post SC, Whitehouse PJ. Fairhill guidelines on ethics of the care of people with Alzheimer€s
disease: a clinical summary. J Am Geriatr Soc 1995; 43: 1423-9
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eds. Severe dementia. Paris: Serdi Publisher, 2003: 194-9
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degenerative dementia. Am J Psychiatr 1982; 139: 1136-9
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Alzheimer€s disease. Arch Neurol 2002; 59: 1764-7
11. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: A
review of the evidence. JAMA 1999; 282: 1365-70

"
4.1 (%  )  (non-pharmacological management of cognitive function)
1. APA : Treating Alzheimer€s Disease and Other Dementias of Late Life, a quick
reference/guide, May 1997.
2. Brown E J: Sndezelen, in Enhancing the Quality of Life in Advanced Dementia. Edited by
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of Daily Living in Patients with Dementia. Am J Geriatr Psychiatry 9 : 41-48, 2001.

101
8. Patten BM : The Ancient Art of Memory ƒ usefulness in treatment. Arch Neurol 26:25-31,
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9. Piaget J. The Construction of Reality in Child. New York, Basic Book, 1954.
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Gerostol 8 :217-229, 1982.

"
4.2 (% )  (pharmacological management)
Rogers SL, Farlow MR, Doody RS, et al. A 24-week, double-blind, placebo-controlled trial of
donepezil in patients with Alzheimer€s disease. Neurology 1998;50:136-45.
Rogers SL, FriedhoffLT, for the Donepezil Study Group. The efficacy and safety of donepezil in
patients with Alzheimer's disease: results of a US multicentre, randomized, double-blind,
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disturbances in patients with Alzheimer's disease. J geriatr Psychiatry 2000;8:134-140.
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in moderate to severe Alzheimer€s disease. Neurology 2001;57:613-20.
Corey-Bloom J, Anand R, Veach J. A randomized trial evaluating the efficacy and safety of ENA 713
(rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to
moderately severe Alzheimer€s disease. Int J Geriatr Psychopharmacol 1998;1:55-65.
Rosler M, Anand R, Cicin-Sain A, et al. Efficacy and safety of rivastigmine in patients with
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cholinesterase inhibitors rivastigmine on behavioural symptoms in Alzheimer's disease.
Behavioural neurology 1998/1999;11:211-6.

102
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moderate Alzheimer€s disease: multicentre randomised controlled trial. BMJ 2000;321 :
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Tariot PN, Solomon PR, Morris JC, et al. A 5-month, randomized, placebo-controlled trial of
galantamine in AD. Neurology 2000;54:2269-76.
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controlled trial with a 6-month extension. Neurology 2000;54:2261-8.
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Aug 26;61(4):479-86.
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Multicenter, International, Randomized, Placebo-controlled Clinical Trial, Stroke. 2003
Sep 11.
"
5 (>zQO#$ &?$#
(Management of behavior & psychological symptoms of dementia)
Alistair Burns, Bengt Winblad, Wiley. Bright light therapy. severe dementia, John wiley & sons
Ltd.
Satlin A, Volicer L, Ross V, Herz L, Campbell S (1992): Bright light trial of Behavioral & sleep
disturbance in patients with dementia ,Am J Psychiatry 149(8):1028-1032.
Skjeerve A, Holstein F, Agrsland D, Improvement in behavioral symptoms and advance of activity
acrophone acter short steam bright light treatment in severe dementia
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disturbance in dementia; a randomized controlled trial Int J Geriatr psychiatry, 16
(10):1010-1013.
Lord TR, Garner JE (1993) Effects of music therapy on Alzheimer patients Percept Mot skill,
76(2) : 451-455.
#
Schneider LS et al. Risk of death with atypical antipsychotic drug treatment for dementia: meta-
analysis of randomized placebo-controlled trials. JAMA 2005 Oct 19;294(15):1934-43.

103


1
Larrieu S, Letenneur L, Orgogozo JM. Et al. Incidence and outcome of mild cognitive impairment
in a population ƒ based propective cohort. Neurology 2002; 59:1594-9.


4 Reversible dementia
Martyn C, Gale C: The British Medical Association.London: Dorling kindersley, 2002


5 Diagnostic and Statistical Manual of Mental Disorders,4thedition (DSM - IV h TRTM)
American Psychiatry Association. Diagnostic and statistic manual of mental disorders.
(DSM-IV-TRTM) 4th edition. Washington (DC): American Psychiatric Press; 2000.

&""%"
1. Folstein MF, Folstein SE, Mc Hugh PR. Mini ƒ Mental State: a practical method for grading the
cognitive state of patient for the clinician. J Psychiatr Res 1975;12:189-98.
2. /N% (%":%; :"% ;%). Train the Brain Forum (Thailand). Thai Mini ƒ
Mental State Examination (TMSE). Siriraj Hosp Gaz 1993;45:359-74.
3. M %m!)
  $: ;/&. $ # L: 
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% [  L' MMSE-Thai 2002.
4. %%" "!",/L :. :h%$ #)
( (L %"#
: %":%;!
%[  , :Yh"$m!)
 ; 5(4)2-7,2545.

104

 MMSE Thai 20023
Mini - Mental State Examination : Thai version (MMSE Thai 2002)
1. Orientation for time (5 )  !"#$%&'()*"#+,-

(  1 ) (%"$;9)%#& PI.)
1.1 !"#$!"%#&'%()*+ ,,,,,,,,,,,,,,,,..
1.2 !"#$!"*+ ,,,,,,,,,,,,,,,,..
1.3 './#'$ ./*+ ,,,,,,,,,,,,,,,,..
1.4 12#$ 12*+ ,,,,,,,,,,,,,,,,..
1.5 3.#$3.*+ ,,,,,,,,,,,,,,,,..
2. Orientation for place (5 ) (78' /%9)7.8:&;)
(  1 )
2.1 +<#=(%#&>)?=))
2.1.1 >)%#&+;#$'+#=!() *+ ,,@/&!()*+ ,,,...,,,,,,,,,,,,..
2.1.2 <#$=(%#&@"$%#&'%()*+;"!))+ ,,,...,,,,,,,,,,,,.
2.1.3 %#&#&=(79)'A-'*+ ,,,,,,,,,,,,..,,,..
2.1.4 %#&#&C";8!".*+ ,,,,,,,,,,,,,.,,,
2.2.5 %#&#&A)*+ ,,,,,,,,,,,,,,,.. ..
3. Registration (3 )
(*1#$'1G)+%.>!)HC9) .IJ"C@/&; 3 =(); K<(),=)=,,) "$;7CMN;78.# 
'?+)C'?#=;+"$;'.#=! *H(H#)+O$9)# 'H/& PH (.IJ") ?.C 78 K<(),=)=,,)
?.%%!)H%#&*.=I 78+ %"$; 3 @/&  !?=)=)HC9)*!78.# '.#Q=!.IJ")HO$9)
* )+@/&( 9)788();"1+H)<8:&;!I)%# ;*H(@)8+/'+S!'I*1
( 1 9) *. 1 )

.*H
H($9)
+*M ,,,,,,,,,,,..
7+<#%#&%9)%.>O$9)A)=7 2 './ 787@9)!()

*H
%'
+=T ,,,,,,,,,,,.
4. Attention/Calculation (5  ) (78' /%9)7.8:&;)
#$'1G)+I.' 77C'?/&%.>>H)YI K< (),=)=,) I.' 77C'1G*8H?
)I.'1G78%9) 4.1 )I.*H('1G8+/*H(78%9) 4.2
4.1 "#$.I 77C') 100 "$; %#  7
*1'+/&= \ *.P "?YT'%()*+H)] .......... .......... .......... ........
"%:9)"!' *!%K+";$ (%"$;9)%#& PI.) %9)%"$;8H. 5 +"$;
) *. 1,2, 8+/3  !*H(*. SI.'%()%#%& 9)*. *H(;=)=*1%9) 4.2

107
 
4.2 "PH (.IJ") C>.9)!() H)! 78K< (),=)=,) MN; !78K< (),=)=,) >.=8 ";C)
?="_@"!8 ";*1"!+ 9)!()H)!>.!() HH)->+-8->+)-!8!
*8K< (),=)=,) >.=8 "; 78MN;OI" .......... .......... .......... .......... ,,,.
! )   H
5. Recall (3 )
`'H/&>"+(%#&78C9); 3 =(); C9)*.*8HH#*+);] ( 1 9) *. 1 )

.*H
H($9)
+*M ,,,,,,,,,,,
7+<#%#&%9)%.>O$9)A)=7 2 './ 787@9)!()

*H
%'
+=T ,,,,,,,,,,,
6. Naming (2 )
6.1 =/&.I>78P%.>. )H!()
`;>I&;#$'+#=!()*+] ,,..,,...,,,......
6.2 @#$)cI)H/78P%.>. )H!() ,,,,..,,,,...,
`;>I&;#$'+#=!()*+]
7. Repetition (1 )
(?.)H*.;*. 1 )
""$;7CMN;PH (.IJ") 'H/&PH (.IJ") ?.!)H#$
 !78K< (),=)=,) ?.)H PH (.IJ") C'?#=;'%#&=!'.#=!"
".#+.#+/0%1'"/'0/" ,,,,,,,,,,,
8. Verbal command ( 3  )
#$'1G9)>"&; "MN;.# \ '.#Q=!PH (.IJ") C>(;+.)g78  ! 78K< (),=)=,)
+".!=H/!) ?"+:&;+.)g  !!);*!%#&................"(?/$, hi, '#=; )
P%.>>.;+.)g'1 ()).1+H)< '-4
*H(H#+=?" 78P%.>

+".!=H/!)
?"+:&;
!);*!%#& (?/$, hi, '#=; ) ,,,,,,,,,,,
9. Written command (1 )
(*1#$'1G9)>"&;%#&'#='1G"!8";>/ ;)+78K< (),=)=,) ()
 !%9))H (),=)=,) C()'>#=;8+/()77CS*.
P%.>>.;+.)g%#&'#=!() `23&%]
8 ")*. ,,,,,,,,,,,..
10. Writing (1 )
#$'1G9)>"&; "78K< (),=)=,) '#=!)H*+S*.%#&() !+'+/&;
8+/H#!)H8H)=H) 1 1+h=] ,,,,................................

1+h=H#!)H8H)= ,,,,,,,,,,,,..

108
 
11.Visuoconstruction (1 )
#$'1G9)>"&; "C;!).A)?78'8H/A)?"!=();]
(7%#&!();.)!);A)?"!=();) ,,,,,,,,,,,..

#4
5&67 30
• 9%(47-5:;7  ≤ 22

MMSE-Thai 2002*
 Positive Negative
+.")+l:g) Sensitivity Specificity predictive predictive efficiency
CK.". 'SH
value value
*H(*.'+#=8";>/ (() < 14 23 35.4 76.8 64.5 50.0 54.3
*H('#=*H(*.)
C < 17 30 56.6 93.8 88.9 71.0 76.3
1+Hl:g)
>;!() < 22 30 92.0 92.6 91.2 93.3 92.4
1+Hl:g)

109

#"+-=>)?;7?9%(47-5:;7@ A3'B57+CD%"E%&A2+:=>)>
34

E%&A0-/% 7?%"%+&/'G ?,2+:'7/ 7? (.@/) '7/7? ('7/.@/)

1. @)H9))H'.IHO$9)\ ( ) ( )
2. 8 ; /H(=:$ H#1N_8)=K(;=)'+/&;!)HC9)+=>"$ ( ) ( )
3. ;H#='/78%9)IC++H%#&C9)'1G ( ) ( )
4. /H!"". /Hh)>%#&>9)"_;++"! '@( !"'I. ( ) ( )
!"++(;;) 8+/!"8=K.?I'lg
5. .O:H ; 'l+)8H; 8+/+=*8(=!()'.IH ( ) ( )
6. '+I&HH#!)H=K(;=)7)+I.'  I.';I 8+/ 9))H):$ ( ) ( )
7)+. C".)+'+/&;';I%;
7. *H(>7CIC++H%#&'=@%9) '@( ;).I'+%#&'=%9) ( ) ( )
IC++H>";H%#&'=*1
8. '+I&H;H#=@(!='8 /7IC++H1+C9)!" '@( ( ) ( )
)++"1+%))8)+
9. 8;K.8;I. )+H<T'>#=(=:$ @();>;>"= '+I&H'8S *.=I ( ) ( )
'@/&7>I&;%#&*H('1GC+I;
10. '+I&HH#1N_8)'+/&;%Il%); ()'="+S8 ;%);(= ( ) ( )
C9)%Il%);*H(*. "+"+)= *H(1 .A"= 8+/' I"+*1' =)
11. H#!)H=K(;=) 9))7)+8)9)?.%#&;)+C?. ( ) ( )
'+#=@/&>I&;;*H( ?.*H(C1+h=

1I +!H < 4 

P%#&=(7()=>;>"=H#A)!>H;'>/&H@I." *O'H+T +!H > 4 

110
 &(1/
ACh = Acetylcholine
AChE = Acetylcholine esterase
AD = Alzheimerxs disease
ADL = Activities of daily living
APP = Amyloid precursor protein
BuChE = Butyrylcholine esterase
CADASIL = Cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy
CAG = Cytosine  arginine - guanine
ChEIs = Cholineesterase inhibitors
CJD = Creutzfeldt  Jakob disease
CNS = Central nervous system
CPG = Clinical practice guideline
CVD = Cerebrovascular disease
CYP = Cytochrome
DLB = Dementia with Lewy bodies
DRPLA = Dentatorubropallidoluysian atrophy
EEG = Electroencephalography
EPS = Extrapyramidal side effects
fMRI = functional Magnetic resonance imaging
FTD = Frontotemporal dementia
LP = Lumbar puncture
MCI = Mild cognitive impairment
MMSE Thai 2002 = Mini - Mental State Examination : Thai version 2002
MMSE = Mini - Mental State Examination : Folstien et al 1975
MOCA = Montreal cognitive assessment
MRI = Magnetic resonance imaging
NPH = Normal pressure hydrocephalus
NC = Negative correlation

111
PC = Postive correlation
PDD = Parkinsonxs disease dementia
PET = Position emission tomography
SCA = Spinocerebellar ataxia
SPECT = Single  photon emission computed tomography
TMSE = Thai Mental State Examination : Train the Brain Forum
VaD = Vascular dementia

112
 00#*H

I1C
34*#3%"+%-"%+
I1C?;50)%+/(7G+4@*7
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H 2)-(-7DL% M+-
+7
7/ ,$% +A5(+C'BC 50&%-#
237 "+*-5I72% #+
( ?; 24 - 25 "+"O%#7 2551

1. ?.K_H# !;lT>I!I* +K(; +.?.' I.>I +K;'%?H8)+

2. ?_.+Il+) +"g)K l=T+I)+>)Y)+<>K 54 %"lT'#&=H +K;'%?H8)+
3. ?.1+>I%YIˆ '?S@+%!#?+'.@ l=T+I)+>)Y)+<>K 66 +K;'%?H8)+
9)8"?+H(!IH h@@"= 4
4. ?_.+") HT1+C"gT l=T+I)+>)Y)+<>K 42 H %;>IH) +K;'%?H8)+
5. ?.!#+A"%+ MK‰;>)?+ l=T+I)+>)Y)+<>K 57 K_'+/; $9)' Il +K;'%?H8)+
6. );>)=Š ' Il!)>) l=T+I)+>)Y)+<>K 65 +K;'%?H8)+
+"g)lK );
7. ?.>YT I;'l+g‹T l=T+I)+>)Y)+<>K 21 !".Y)K%; +K;'%?H8)+
8. );%I?=T!" =T K<!"ŒT l=T+I)+>)Y)+<>K 13 *H+#!)I@ +K;'%?H8)+
9. .>.9)A) C)() l=T+I)+>)Y)+<>K 55 '@>"H?"YT +K;'%?H8)+
10. ?.!I+=T %!#!"Œ)IC!+ l=T+I)+>)Y)+<>K 63 +K;'%?H8)+
>H)HCIQ!8(;1+'%l*%=
11. );K*+!++< K H)l l=T+I)+>)Y)+<>K 63 +K;'%?H8)+
>H)HCIQ!8(;1+'%l*%=
12. );'=)!IC C+"_'!h+CTlI+I l=T+I)+>)Y)+<>K 23 >#&?+=) +K;'%?H8)+
13. ?.Y"+ '@I_+K(;h+CT +.?.>;?#&; C"%K+#
14. );cKc#_) h@)+> l=T>H'.SC?+>";Ž+)@_)<>";!+'?/& @ K+#
P>;)=K
15. ?.YI 'HY#lI+I!"ŒT +.?.8") @"=)%
16. ?.'1G' Y;%; +.?.>!# @KH?+
17. ?_.+") C"%+TC(H +.?.1+>)%'@#=;78H( '@#=;78H(
18. ?.Y!"@@"= J"%!KŒI"%T +.?.>)+A# '@#=;78H(
19. ?.!+!I%=T "I!"Œ%+"?=T +.?.KHP); )
20. ?_.>K!?"+T lI+I'.@*@=!;lT +.?.l+#>;+)H +?H

113
21. ?.!lI %;%+;3g<T +.?.')' #$=! +>!++T
22. ?.@+ 8+)+"gT +.?.K+K+#@"=?"ŒT ?";;)
23. ?.A)<KH)l !"_'+/ +.?.?+( ?+(
24. ?_.>K+"HA) 1+A">>+!ICI+ +.?.>H'.SC?+=K?+)@' I;%) =h>Y+
25. ?.!"Œ) !)I@>K>H"I +.?.' );T+-+)H 9)1);
26. ?.C"+3g<T 1+Ih +.?.> + > +
27. ?_.lI+I+"T !++<lI+I +.?.8;h. >+K+#
28. ?_.8">=) ! '#=H +.?.l+#>"@) "= >Kh%"=
29. ?.1='.@ ! #?I%"gT'.@ +.?.8;)= 8;)=
30. ?.1I @)+I=)Kh= +.?. /9))C 9))C'C+I_
31. ?_.?"@+"=T "$;+"=+"K +.?. " K+.IT

114