Journal
DEMENTIA AND GERIATRIC COGNITIVE DISORDERS EXTRA
Volume 3, Issue 1, Pages 407-416Publisher
KARGER
DOI: 10.1159/000355122
Keywords
Mild cognitive impairment; Clinical Dementia Rating; Alzheimer's disease; Community-living elderly subjects; Mini-Mental State Examination; Neuropsychological tests
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Funding
- Biomedical Research Council [03/1/21/17/214, 08/1/21/19/567]
- Agency for Science, Technology and Research (ASTAR)
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Background: The Clinical Dementia Rating (CDR) scale is widely used to assess cognitive impairment in Alzheimer's disease. It requires collateral information from a reliable informant who is not available in many instances. We adapted the original CDR scale for use with elderly subjects without an informant (CDR-NI) and evaluated its reliability and validity for assessing mild cognitive impairment (MCI) and dementia among community-dwelling elderly subjects. Method: At two consecutive visits 1 week apart, nurses trained in CDR assessment interviewed, observed and rated cognitive and functional performance according to a protocol in 90 elderly subjects with suboptimal cognitive performance [Mini-Mental State Examination (MMSE) < 26 and/or Montreal Cognitive Assessment (MOCA) <26] and without informants according to a protocol. CDR domains and global scores were assigned after the second visit based upon corroborative information from the subjects' responses to questions, role-play, and observed performance in specifically assigned tasks at home and within the community. Results: The CDR-NI scores (0, 0.5, 1) showed good internal consistency (Crohnbach's alpha 0.83-0.84), interrater reliability (kappa 0.77-1.00 for six domains and 0.95 for global rating) and test-retest reliability (kappa 0.75-1.00 for six domains and 0.80 for global rating), good agreement (kappa 0.79) with the clinical assessment status of MCI (n = 37) and dementia (n = 4) and significant differences in the mean scores for MMSE, MOCA and Instrumental Activities of Daily Living (ANOVA global p < 0.001). Conclusion: Owing to the protocol of the interviews, assessments and structured observations gathered during the two visits, CDR-NI provides valid and reliable assessment of MCI and dementia in community-living elderly subjects without an informant. (C) 2013 S. Karger AG, Basel
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