Clinical Dementia Rating

Short description: Numeric scale for severity of dementia

Clinical Dementia Rating

Medical diagnostics
Purpose| measures severity of symptoms of dementia

The Clinical Dementia Rating or CDR is a numeric scale used to quantify the severity of symptoms of dementia (i.e. its 'stage').

## Contents

* 1 Scale
* 2 Validity
* 3 Importance
* 4 References

## Scale

Using a structured-interview protocol developed by Charles Hughes,[1] Leonard Berg, John C. Morris and other colleagues at Washington University School of Medicine, a qualified health professional assesses a patient's cognitive and functional performance in six areas: memory, orientation, judgment & problem solving, community affairs, home & hobbies, and personal care. Scores in each of these are combined to obtain a composite score ranging from 0 through 3.[2] Clinical Dementia Rating Assignment Qualitative equivalences are as follows:NACC Clinical Dementia Rating

Composite Rating  | Symptoms

|

0  | none
0.5  | very mild
1  | mild
2  | moderate
3  | severe

CDR is credited with being able to discern very mild impairments, but its weaknesses include the amount of time it takes to administer, its ultimate reliance on subjective assessment, and relative inability to capture changes over time.[3]

## Validity

While the assessment is ultimately subjective in nature, recent studies have suggested a very high interrater reliability.[4] Thus the CDR is a reliable and valid tool for assessing and staging dementia.[5]

## Importance

With increasing clinical focus on dementia, there is likewise increasing interest in pharmacology in the development of drugs to halt, or slow the progression of dementia-related illness such as Alzheimer's Disease. Therefore, early and accurate diagnosis of dementia and staging can be essential to proper clinical care. Without the ability to reliably assess dementia across the board, the misuse of anti-dementia compounds could have negative consequences, such as patients receiving the wrong medication, or not receiving treatment in the early stages of dementia when it is most needed.[6]

## References

1. ↑ Br J Psychiatry. 1982 Jun;140:566-72. A new clinical scale for the staging of dementia. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL.
2. ↑ "CDR Scoring Table". https://knightadrc.wustl.edu/professionals-clinicians/cdr-dementia-staging-instrument/cdr-scoring-table/.
3. ↑ Utility of the Clinical Dementia Rating in Asian Populations - Lim et al. 5 (1): 61 - Clinical Medicine & Research
4. ↑ Rockwood, K.; Strang, D.; MacKnight, C.; Downer, R.; Morris, J. C. (2000). "Interrater reliability of the Clinical Dementia Rating in a multicenter trial". Journal of the American Geriatrics Society 48 (5): 558–9. doi:10.1111/j.1532-5415.2000.tb05004.x. PMID 10811551.
5. ↑ Nyunt, Ma Shwe Zin; Chong, Mei Sian; Lim, Wee Shiong; Lee, Tih Shih; Yap, Philip; Ng, Tze Pin (2013-10-29). "Reliability and Validity of the Clinical Dementia Rating for Community-Living Elderly Subjects without an Informant". Dementia and Geriatric Cognitive Disorders Extra 3 (1): 407–416. doi:10.1159/000355122. ISSN 1664-5464. PMID 24348502.
6. ↑ Morris, J. C.; Ernesto, C.; Schafer, K.; Coats, M.; Leon, S.; Sano, M.; Thal, L. J.; Woodbury, P. (1997). "Clinical Dementia Rating training and reliability in multicenter studies". Neurology 48 (6): 1508–1510. doi:10.1212/WNL.48.6.1508. PMID 9191756. http://www.neurology.org/content/48/6/1508.short.

* v
* t
* e

Neuropsychological tests

Battery|

* Cognistat
* Halstead-Reitan Neuropsychological Battery
* Luria-Nebraska neuropsychological battery
* Montreal Cognitive Assessment
* Repeatable Battery for the Assessment of Neuropsychological Status

Arousal/Attention|

* Continuous Performance Task
* d2 Test of Attention
* Four boxes test
* Galveston Orientation and Amnesia Test
* Morningness-eveningness questionnaire
* Paced Auditory Serial Addition Test
* Posner cueing task
* Test of everyday attention
* Test of Variables of Attention

Sensation/Perception|

* Bender-Gestalt Test
* Benton Visual Retention Test
* Dot cancellation test
* Judgment of Line Orientation
* Navon figure
* Rey–Osterrieth complex figure

Memory|

* 1-2-AX working memory task
* California Verbal Learning Test
* Corsi block-tapping test
* Digit symbol substitution test
* Doors and People
* MCI Screen
* Wechsler Memory Scale

Language|

* Boston Diagnostic Aphasia Examination
* Boston Naming Test
* Comprehensive Aphasia Test
* Controlled Oral Word Association Test
* Thurstone Word Fluency Test

Motor|

* Compensatory tracking task
* Purdue Pegboard Test

Problem-solving|

* Delis–Kaplan Executive Function System
* Hayling and Brixton tests
* Tower of London
* Trail Making Test
* Wisconsin Card Sorting Test

Sleep|

* Epworth Sleepiness Scale

Specific impairments|

* British Columbia Postconcussion Symptom Inventory
* Clinical Dementia Rating
* Digit Cancellation Test (Alzheimer's)
* Disability Rating Scale
* Florida Cognitive Activities Scale
* Glasgow Coma Scale
* Glasgow Outcome Scale
* Pediatric Attention Disorders Diagnostic Screener
* Rivermead post-concussion symptoms questionnaire

Intelligence|

* National Adult Reading Test
* Wechsler Adult Intelligence Scale
* Wechsler Intelligence Scale for Children
* Wechsler Preschool and Primary Scale of Intelligence
* Wechsler Test of Adult Reading

Bed-side|

* Abbreviated mental test score
* Addenbrooke's cognitive examination
* General Practitioner Assessment Of Cognition
* Mini–mental state examination

Social|

Vineland Adaptive Behavior Scale

Malingering|

Test of Memory Malingering

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