Dementia

Modified Clinical Dementia Rating Scale Impairment Memory

Orientation

Judgment and problem

Community affairs

None (0) No memory loss or slight, inconstant, forgetfulness

Mild (1) Moderate memory loss, more marked for recent events, defect interferes with every day activities Fully oriented Fully oriented or slight Moderate difficulty with difficulty with time time relationships, oriented relationship for place at examination, may have geographic disorientation elsewhere Solves everyday problems Slight impairment to Moderate difficulty in and handles business and solving problems, handling problems, financial affairs well, similarities, differences similarities, differences. judgment good in relation to Social judgment usually past performance maintained Independent function at Slight impairment in these Unable to function usual level in job, shopping, activities independently at these volunteer and social groups activities though may still be engaged in some appears normal to casual inspection

Home and office Life at home, office, intellectual interests well maintained

Personal care

Fully capable of self care

Questionable (0.5) Consistent, slight forgetfulness, partial recollection of events

Moderate (2) Severe (3) Severe memory loss only Severe memory loss, only highly learned material fragments remain retained, new material rapidly lost Severe difficulty with Oriented to person only time relationship; usually disoriented in time, often to place

Severely impaired in handling problems, similarities, differences. Social judgment usually impaired No pretense of independent function outside of the home, appears well enough to be taken to functions outside of family home Life at home, office, Mild but definite Only simple chores intellectual interests impairment of function at preserved, very restricted slightly impaired home, more difficult chores interests poorly abandoned, more maintained complicated hobbies and interests abandoned Fully capable of self care Needs prompting Requires assistance in dressing, hygiene keeping of personal effects

Unable to make judgment or solve problems

No pretense of independent function outside of the home, appears too ill to be taken to functions outside of family home No significant function in home

Requires much help with personal care, personal incontinency

Note: CDR rating of 4 &5 are based on overall status, stage 4 indicates profound dementia and in stage 5 indicated terminal dementia 1

AYURVEDIC METHODOLOGY OF CLINICAL EXAMINATION (MENTAL DISORDERS) 1. Sila (habits, etc.)

2. Chesta (Psychomotor activity)

i. Habits

i. General motor activity

ii. Temperature

ii. Speech

iii. Physiological functions

iii. Facial expression

iv. Leisure time activity

iv. Posture

3. Achara (conduct) i. Personal standards

4. Manah (mind) i. Indriyabhigraha (perception and motor

control) ii. Social standards

ii. Manonigrahaha (mental control) iii. Ooha (guess) iv. Vicharana (tought)

5. Budhi (decision)

6. Smriti (Memory)

i. Ability to take quick decisions

i. Ability to recall what is seen

ii. Ability to decide complex issues

ii. Ability to recall what is heard iii. Ability to recall what is experienced

7. Sanjnajnanam(orientation and responsiveness) i. Orientation to

8. Bhakti (desire) Desire in relation to: i. Ahara (food)

(a) Desha (place)

ii. Vyavaya (sex)

(b) kala (time)

iii. Vesma (dress)

(c) Atmajnana (person)

iv.Ranjanam

ii. Responsiveness to external stimuli

v. Anya (others)

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“Unmadam punarmanobuddhi sanjnajnana smriti bhakti sheela chesta achara vibhramsam vidyat” – Ch.Nid.7 ch.

3

AYURVEDIC RESEAERCH UNIT AND ADVANCED CENTRE FOR AYURVEDA, NIMHANS, BANGALORE MANAH PARIKSHA PATRAKAM (PROFORMA FOR MENTAL EXAMINATION) VI. Seela (habits, etc.)

Intact (0)/Moderately changed (3)/Grossly changed (6) (i) Habits

(0)

(3)

(6)

1. Vinidra (insomnia) 2. Svapnanityata (desirous of seclusiveness) 3. Rahaskamata (desirous of seclusiveness) 4. Abhikshnam asthane Hasanam (excessive and /or inappropriate laught/smiling) 5. Abhikshnam asthane Rodanam (excessive and /or inappropriate Weeping/crying) 6. Arochakam (tastelessness) 7. Chardhi (vomiting) 8. Alpaharam (undereating) 9. Bahubhuki (overeating) 10. Bhunkte Balam (post pandral aggravation) 11. Firne balam (post digestion aggravation) 12. Ratrau Bhrisham bhavati (nocturnal aggravation) 13. Gridhirabhyvahareshu (excessive desire for food articles) 14. Anya (others)_________________________________ (ii) Temperament 1. Krodhaha (anger) 2. Santarjanam (threatening) 3. Anya (others)_________________________________

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(iii) Physiological Functions 1. Swedabahulya (excessive perspiration) 2. Trishnabahulya (excessive thirst) 3. Swasaturaha (dyspnoea) 4. Kasa (cough) 5. Naripriyata (desirous of women/sex) 6. Sadanam (weakness) 7. Ananane swayathu (oedema on the face) 8. Anya (others)____________________________________ (iv) Personal care Preserved (0)/ not preserved (3)

(0)

(3)

1. Malopadigdhakshitva (eyes covered with mucosal discharge) 2. Lalasrava (dribbling of saliva) 3. Asyat Phenagamanam (frothing from mouth) 4. Singhanaka Sravaha (excessive flow of nasal discharge) 5. Analankairalankaranam(adorning person with un ornamental things) 6. Anya (others)_________________________________________ (v) Leisure time activity: Normal (0)/ moderate abnormality (3)/gross abnormality (6) VII. Chesta (psychomotor activity) (i) General motor activity Intact (0)/moderately changed (3)/grossly-changed (6) 1. Abhikshanam Asthane nartanam (excessive and/or inappropriate dancing) 2. Abhikshanam Asthane Vandanam (excessive and/or inappropriate playing of musical instrument) 3. Abhikshanam Asthane Gayanam (excessive and/or inappropriate singing) 4. Ajasram Parisaranam (constant rambling) 5. Akasmat anga vikshepanam (sudden jerking of body parts)

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6. Abhidravanam (escaing) 7. Asthane Samrambhaha (inopportune excitement) 8. Asthane Akroshaha (inopportune shouting) 9. Pareshan Abhihananam (assaulting) 10. Nabda Chesta (reduced motor activity) 11. Venu geetadi shabdhanukaranam (imitating the tunes of various musical instruments) 12. Anya (others)____________________________________ (ii) Speech Intact (0)/moderately changed (3)/grossly-changed (6)

(0)

(3)

(6)

1. Satatam Giramutsargaha (continuous/excessive talk) 2. Aniyatam Giramutsargaha (irregular/incoherent/ indefinite talk) 3. Parushavak (harsh/rude talk) 4. Vakmanda (slowness of speech) 5. Anya (others)___________________________________ (iii) Facial expression and postures Intact (0)/abnormal (3)

(0)

(3)

1. Svayatuscanane (puffiness of face) 2. Sthimitakshata (fixed eyes) 3. Utpindikakshata (protruded eyes) 4. Samrabdhakshata (furious eyes) 5. Aruna/Tamra/Haridra/Haritakshata (reddish/coppery/ yellowish/greenish eyes) 6. Nakhadi Shouklyam (pallor of nails, etc.) 7. Pitikhabha (yellowish aura) 8. Rukshachhavi (dry skin) 6

9. Dhamanitataha (having prominent veins) 10. Karshyam (emaciation) 11. Sphurita sandhi (throbbing of joints) 12. Sthanamekadeshe (confining to one place) 13. Anya (others)________________________________________ III. Acharah (conduct)

Intact(0)/abnormal(3) (i) Personal standards 1. Soucha Dveshaha/Bhibhatsatvam (hating cleanliness and remaining very dirty and shabby without caring for personal hygiene) (ii) Social standards 1. vinagnabhavah (nudity) 2. Anya (others)_______________________________________ IX. Manah (mind)

Intact/Moderately changed/Grossly changed/ cannot be tested (i) Indriyabhigrahah (perception and motor control) (a) Cannot be tested because of non co-operation (b) Disturbed because of peripheral factors (c) Disturbed: Mild/Moderate/Severe Description: (d) Indriyasapekshayatharthajnanam (hallucination): Absent (0)/Present (3)

(0)

(3)

1. Asatya Jvaladi Darshanam (hallucination of flame, star, etc.) 2. Anya (others)_____________________________________ (ii) Manonigrahah (mental control) Intact (0)/ Loose occasionally (3)/ Loose frequently (6)

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Description: (iii) Vicharah (thought) Intact (0)/Mildly impaired (3)/Grossly-impaired (6)

(0)

(3)

(6)

(0)

(3)

(6)

(a) Discriminative ability Intact (0)/Mildly impaired (3)/Grossly-impaired (6) 1. Ativelam Santapa (continuous causeless mental distress) 2. Ayanairyanam (raiding on things which are neither movable nor mounts) 3. Anya (others)___________________________________ (b) Indriyanirapekshayatharthajnanam (delusion) Absent (0)/Present (3)

(0)

(3)

1. Himambunicayepicha Vahnishanki (doubting fire/ hotness in cool surroundings) 2. Aushnyam (feeling of hotness) 3. Anya (others)____________________________________ X. Budhi (decision)

Intact (0)/Partly impaired (3)/Grossly impaired (6) (0)

(3)

(6)

1. Vividhashabdanukaranam (imitation of different sounds) 2. Sveshambhihananam (beating oneself) 3. Alpamati (feeling of hotness mentally dull) 4. Anya (others)____________________________________

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XI. Smriti (memory)

Intact

(0)/Mild

impairment

(3)/Moderate

impairment

(6)/Gross

impairment (9) (0)

(3)

(6)

(9)

XII. Sanjnajnanam (orientation and responsiveness)

Intact

(0)/Mild

impairment

(3)/Moderate

impairment

(6)/Gross

impairment (9) (0)

(3)

(6)

(9)

(a) Orientation to place: (b) Orientation to time: (c) Orientation to person: Description: (d) Responsiveness: Description XIII. Bhakti (desire)

Intact (0)/Mild impairment (3)/Moderate impairment (6)/Gross impairment (9) (0)

(3)

(6)

(9)

(i) Physiological desires (ii) Desires in relation to attire (iii) Desires in relation to entertainment (iv) Others____________________________________

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Absent (0)

Present(3)

1. Ushnasevi (desirous of hot things) 2. Sheetabhilashi (desirous of cool things) 3. Alabdheshu Abhyavaharyesu Tivra Lobha (craving for securing unobtainable things) 4. Labdheshu Abhyavaharyesu Tivramatsaryam (hitting things craved for, when they are available) 5. Anya (others)_____________________________________________ XIV. (I) Prakriti (constitution) (a) Shareera (physical)

V

(b) Manasika (psychological)

SATWA

XV. Satvam (mental stamina):

Pravara

P

K

VK

VP

RAJO

Madhyama

PK

VPK TAMO

Awara

ASSESSMENT OF RESULTS AFTER THE MANAH PAREEKSHA MANAH PAREEKSHA SEELA (habits,etc.)

SCORE BEFORE TREATMENT AFTER TREATMENT

(i) Habits (ii) Temperament (iii) Physiological functions (iv) Personal care (v) Leisure time activity CHESTA (psychomotor activity) (i) General motor activity (ii) Speech (iii) Facial expression and postures ACHARA (conduct) (i) Personal standards (ii) Social standards MANAH (mind) (i) Indriabhigraha (perception&motor 10

control) (ii) Manonigraha (mental control) (iii) Vichara (thought) BUDHI (decision) SMRITI (memory) SANJNAJNANAM (orientation &responsiveness) BHAKTI (desire)

TOTAL APPENDIX AYURVEDIC METHODOLOGY OF CLINICAL EXAMINATION (MENTAL DISORDERS)

1. Sila (habits, etc.) i. Habits ii. Temperature iii. Physiological functions iv. Leisure time activity personal cure v. Leisure time activity 2. Chesta (Psychomotor activity) i. General motor activity ii. Speech iii. Facial expression and posture 3. Achara (conduct) i. Personal standards ii. Social standards 4. Manah (mind) i. Indriyabhigraha (perception and motor control0 ii. Manonigrahaha (mental control) iii. Ooha (guess) iv. Vicharana (tought) 5. Budhi (decision) 6. Smriti (Memory) 7. Sanjnajanana (orientation and responsiveness) i. Orientation to (a) Desha (place)

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(b) kala (time) (c) Atmajnana (person) ii. Responsiveness to external stimuli 8. Bhakti (desire) Desire in relation to: i. Ahara (food) ii. Vyavaya (sex) iii. Vesma (dress) iv. Ranjanam (entertainment) v. Anya (others) .

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