clinical dementia rating scale (CDR)

Introduction

Type: overall staging

Advantages

• brief cognitive, functional, behavioral scale

Disadvantages

• not a thorough examination
• memory loaded

Procedure

components

• memory
• orientation
• judgment & problem solving
• community affairs
• home & hobbies
• personal care

Number of items: 6

Time: variable

Interpretation

CDR = 0: healthy

• memory
  • no memory loss or slight inconsistant forgetfulness
• orientation: fully oriented
• judgment & problem solving
  • solves everyday problems well
  • judgment good in relation to past performance
• community affairs
  • independent function at usual level in job, shopping, business & financial affairs & volunteer & social groups
• home & hobbies
  • life at home, hobbies, intellectual interests well maintained
• personal care: fully capable self care

CDR = 0.5: questionable dementia (approximate MMSE = 25)

• memory
  • consistent slight forgetfulness
  • partial recollection of events
  • 'benign forgetfulness'
• orientation
  • fully oriented except for slight difficulty with time relationships
• judgment & problem solving
  • doubtful impairment in solving problems
• community affairs: slight impairment
• home & hobbies
  • life at home, hobbies, intellectual interests well maintained or only slightly impaired
• personal care: fully capable self care

CDR = 1.0: mild dementia (approximate MMSE = 19-24)

• memory
  • moderate memory loss, more marked for recent events
  • memory disturbance interferes with everyday activity
• orientation
  • moderate difficulty with time relationships
  • oriented for place at examination
  • may have geographical disorientation elsewhere
• judgment & problem solving
  • moderate difficulty in handling complex problems
  • social judgment usually maintained
• community affairs
  • unable to function independently at these activities
  • may still be engaged in some
  • may still appear normal to casual inspection
• home & hobbies
  • mild but definite impairment of function at home
  • more difficult chores abandoned
  • more complicated hobbies & interests abandoned
• personal care: needs occasional prompting

CDR = 2.0: moderate dementia

• memory
  • severe memory loss
  • only highly learned material retained
  • new material rapidly lost
• orientation
  • severe difficulty with time relationships
  • usually disoriented in time
  • often disoriented to place
• judgment & problem solving
  • severely impaired handling problems
  • difficulty recognizing similarities & differences
  • social judgement generally impaired
• community affairs
  • no pretense of independent function outside of home
• home & hobbies
  • only simple chores preserved
  • very restricted interests, poorly sustained
• personal care
  • requires assistance in dressing, with hygiene & keeping of personal effects

CDR = 3.0: severe dementia

• memory
  • severe memory loss
  • only fragments of memory remain
• orientation: oriented only to person
• judgment & problem solving
  • unable to make judgments or solve problems
• community affairs
  • no pretense of independent function outside of home
• home & hobbies
  • no significant function at home outside of own room
• personal care
  • requires much help with personal care
  • frequent incontinence

Management

• CDR = 0.5: caution about driving
• CDR = 1.0: patients should cease driving

More general terms

• mental status examination (MSE)
• cognitive scale

More specific terms

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

Additional terms

• Folstein Mini-Mental Status Examination (MMSE)