clinical dementia rating scale (CDR)

Type: overall staging Procedure: components 1) memory 2) orientation 3) judgment & problem solving 4) community affairs 5) home & hobbies 6) personal care Number of items: 6 Time: variable Advantages: - brief cognitive, functional, behavioral scale Disadvantages: 1) not a thorough examination 2) memory loaded Interpretation: CDR = 0: healthy 1) memory -> no memory loss or slight inconsistant forgetfulness 2) orientation: fully oriented 3) judgment & problem solving a) solves everyday problems well b) judgment good in relation to past performance 4) community affairs -> independent function at usual level in job, shopping, business & financial affairs & volunteer & social groups 5) home & hobbies -> life at home, hobbies, intellectual interests well maintained 6) personal care: fully capable self care CDR = 0.5: questionable dementia (approximate MMSE = 25) 1) memory a) consistent slight forgetfulness b) partial recollection of events c) 'benign forgetfulness' 2) orientation -> fully oriented except for slight difficulty with time relationships 3) judgment & problem solving -> doubtful impairment in solving problems 4) community affairs: slight impairment 5) home & hobbies -> life at home, hobbies, intellectual interests well maintained or only slightly impaired 6) personal care: fully capable self care CDR = 1.0: mild dementia (approximate MMSE = 19-24) 1) memory a) moderate memory loss, more marked for recent events b) memory disturbance interferes with everyday activity 2) orientation a) moderate difficulty with time relationships b) oriented for place at examination c) may have geographical disorientation elsewhere 3) judgment & problem solving a) moderate difficulty in handling complex problems b) social judgment usually maintained 4) community affairs a) unable to function independently at these activities b) may still be engaged in some c) may still appear normal to casual inspection 5) home & hobbies a) mild but definite impairment of function at home b) more difficult chores abandoned c) more complicated hobbies & interests abandoned 6) personal care: needs occasional prompting CDR = 2.0: moderate dementia 1) memory a) severe memory loss b) only highly learned material retained c) new material rapidly lost 2) orientation a) severe difficulty with time relationships b) usually disoriented in time c) often disoriented to place 3) judgment & problem solving a) severely impaired handling problems b) difficulty recognizing similarities & differences c) social judgement generally impaired 4) community affairs - no pretense of independent function outside of home 5) home & hobbies a) only simple chores preserved b) very restricted interests, poorly sustained 6) personal care - requires assistance in dressing, with hygiene & keeping of personal effects CDR = 3.0: severe dementia 1) memory a) severe memory loss b) only fragments of memory remain 2) orientation: oriented only to person 3) judgment & problem solving -> unable to make judgments or solve problems 4) community affairs - no pretense of independent function outside of home 5) home & hobbies - no significant function at home outside of own room 6) personal care a) requires much help with personal care b) frequent incontinence Management: 1) CDR = 0.5: caution about driving 2) CDR = 1.0: patients should cease driving [2]

Specific

clinical dementia rating - sum of boxes (CDR-SB)

General

mental status examination (MSE) cognitive scale

References

Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000, pg 93, 95
Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009

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