Understanding the Dementia Rating Scale

Senior man with doctor

Like any other illness, dementia has different levels from mild to severe. The Dementia Rating Scale (DRS) helps assess and track the mental functions of people suffering from a brain dysfunction that is causing cognitive impairment in attention, conceptualization, memory, and other areas. Using this DRS, you can work to understand the severity of your or a loved one's disease.

The Dementia Rating Scale 2

Written by Steven Mattis, Christopher Leitten, and Paul Jurica, the rating scale for dementia, known as the DRS-2, replaced the original rating scale for dementia called the DRS, or the MDRS (Mattis Dementia Rating Scale).

Who Does the DRS-2 Assess?

Published by Psychological Assessment Resources, the DRS-2 is administered on an individual basis to patients aged fifty-five to eighty-nine. The rating scale consists of thirty-six tasks with thirty-two stimulus cards and takes fifteen to thirty minutes to administer.

What Does the DRS-2 Assess?

The DRS-2 assesses individuals in five areas resulting in five sub-scale scores. These scores are used to determine the overall score and level of cognitive functioning ability. The five areas include:

  • Attention - measured using eight items
  • Construction - measured using six items
  • Conceptualization - measured using six items
  • Initiation/Preservation - measured using eleven items
  • Memory - measured using five items

When Is the DRS-2 Useful?

This rating scale has been found to be especially useful in the initial assessment of, tracking the progression of, and measuring the changes of cognitive functions over time. Widely used to measure the cognitive abilities at the lower level ability of the spectrum, the DRS-2 is especially useful for assessing and tracking certain types of dementia including:

Alternate Version of the DRS-2

Websites that offer the DRS-2 to professionals also often provide an alternate form of the assessment. The purpose of the alternate version is to reduce the possibility of practice effects, which often occur with multiple assessment administrations.

DRS-2 and Alternate Form Components

Included in the DRS-2 kit are:

  • A professional manual
  • Thirty-two stimulus cards
  • Fifty scoring booklets
  • Fifty profile forms

Included in the alternate version of the DSR-2 kit are:

  • A supplement to the manual
  • Alternate form stimulus cards
  • Fifty alternate form scoring booklets
  • Fifty profile forms

Clinical Dementia Rating

The Clinical Dementia Rating, known as the CDRS, was developed in 1979 at the Washington University School of Medicine in St. Louis, Missouri, by John C. Morris as part of the Memory and Aging Project. The rating scale measures the stages and severity of several forms of dementia although it was originally developed to measure dementia of the Alzheimer's type.

Five-Point Rating System

The CDRS is a five-point rating system:

  • A score of 0 indicates no cognitive impairment or dementia.
  • A score of 0.5 indicates questionable or very mild cognitive impairment or dementia.
  • A score of 1 indicates mild cognitive impairment or dementia.
  • A score of 2 indicates moderate cognitive impairment or dementia.
  • A score of 3 indicates severe cognitive impairment or dementia.

How Scores Are Determined

senior patient in a nursing home

Scores are determined based on information gathered in an interview that is strictly structured. The person administering the interview must follow strict guidelines and rules in administering and scoring the CDRS. The six areas, or cognitive domains, covered in the interview are:

  • Memory
  • Orientation
  • Community affairs
  • Homes and hobbies
  • Judgment/Problem-solving
  • Personal care

In most cases, the severity of the impairment differs from one cognitive domain to another since dementia does not progress uniformly in the brain. For example, an individual may score a 2 in memory, a 1 in orientation and community affairs, and a 0.5 in the remaining three cognitive domain areas. To accurately score the CDRS, the administrator uses the individual box scores of each area to derive a global CDR score following the strict published scoring rules.

Additional Dementia Rating Scales

The following are several additional scales and assessments used in rating the stages and severity of various forms of dementia.

The Alzheimer's Disease Assessment Scale

The Alzheimer's Disease Assessment Scale was developed in the 1980s and was originally designed as a rating scale to evaluate the level of both cognitive and non-cognitive dysfunction. The results are presented on a scale from mild to severe.

The Blessed Dementia Scale

The Blessed Dementia Scale was developed in the 1960s and attempts to measure the deterioration of both personality and intellectual function. Data for the analysis comes from relatives of caretakers of the individual being assessed.

Standardized Alzheimer's Disease Assessment Scale

The Standardized Alzheimer's Disease Assessment Scale was initially developed in the 1980s but has been revised since inception. The test is an attempt to better measure the degree of cognitive impairment in individuals with Alzheimer's. The score can reveal what stage of Alzheimer's the individual is in.

Mini-Mental State Examination

The Mini-Mental State Examination measures cognitive impairment through a questionnaire administered by a clinician. This examination is considered an assessment to detect the presence of dementia.

Wechsler Adult Intelligence Scale

The Wechsler Adult Intelligence Scale is an IQ test, featuring a portion that specifically tests memory. This memory section, in particular, is considered valuable in the detection and diagnoses of the early stages of Dementia and Alzheimer's.

Medical Tests

When first assessing whether a patient has Dementia or Alzheimer's, a variety of medical tests are typically ordered by physicians including, but not limited to:

  • MRI brain scan
  • Lumbar puncture
  • CT Scan

Effective Evaluation Tools

Both the DRS-2 and the CDRS are effective tools in evaluating the cognitive functions of individuals aged fifty-five or older that have various forms of dementia. Diagnostic tests are important to rule out other causes for cognitive decline or memory impairment.

Understanding the Dementia Rating Scale