clinical dementia rating (cdr), chinese version · tion to mini-mental status examination (mmse)...
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Acta Neurologica Taiwanica Vol 12 No 3 September 2003
From the Neurological Institute, Taipei Veterans GeneralHospital and National Yang-Ming University School ofMedicine, Taipei, Taiwan.Received May 28, 2003. Revised and Accepted June 12, 2003.
Reprint requests and correspondence to: Ker-Neng Lin, PhD.The Neurological Institute, Taipei Veterans General Hospital,Taipei, Taiwan.E-mail: [email protected]
Clinical Dementia Rating (CDR), Chinese Version
Ker-Neng Lin and Hsiu-Chih Liu
Summary
Due to the continuing increase in elder population in Taiwan, aging has become one of the majorpublic health and socioeconomic problems nowadays. Dementia is a disease commonly seen in theelderly and Alzheimer’s disease (AD) comprises almost 60% of the elderly demented patients. In addi-tion to Mini-Mental Status Examination (MMSE) and Cognitive Abilities Screening Instrument(CASI), Clinical Dementia Rating (CDR) is a global rating scale in assessing the severity of AD. TheCDR-Chinese version has been frequently used in the routine cognitive assessment of the suspectedAD patients to assess the severity of AD. The results from several research projects demonstrate sub-stantial reliability and validity of the CDR-Chinese version.
Key Words: Alzheimer’s disease, CDR, CASI
Continuing Medical Education 154
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Acta Neurologica Taiwanica Vol 12 No 3 September 2003
2003 5 28 2003 612
201E-mail: [email protected]
30
( ) (Alzheimer’s Disease)
65 85 5% 15%
(MMSE) (CASI)
(CDR)
CDR
CDR
CDR
CDR = 1
CDR
Acta Neurol Taiwan 2003;12:155-165
(Clinical Dementia Rating;
CDR) Hughes (1)
(Alzheimer’s disease)
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Acta Neurologica Taiwanica Vol 12 No 3 September 2003
(2-5)
(Memory) (M)
(Orientation) (O)
(Judgment - problem solving)
(JPS)
(Community affairs) (CA)
(Home hobbies) (HH)
(Personal care) (PC)
0 ~ 3
0 (Health)
0.5 (Questionable impair-
ment)
1 (Mild impairment)
2 (Moderate impairment)
3 (Severe impairment)
(
(CDR = 0.5))
( )
CDR
CDR = 0
CDR = 0.5
CDR = 1
CDR = 2
CDR = 3
CDR = 4
(
)
CDR = 5
(
)
CDR
24
CDR = 1
CDR = 2
CDR
( ~ )
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1
?
2
? ?
?
? ? ?
3
?
?
4
7 50
?
5
6
7
8
(MMSE)(6-9) (CASI)(10-12)
(MMSE: 0~30;
CASI: 0~100)
(1)
(2)
? ? ?
? ? ?
( , ) ? ?
? ?
? ?
? ?
158
Acta Neurologica Taiwanica Vol 12 No 3 September 2003
? ?
?
?
? ?
?
?
?
?
? 265
?
( )
(Health)
(Questionable) (Mild) (Moderate)
(Severe)
( )
(0.5) (M)
9 ( * )
0.5
( ) 0
( )
CDR=4 CDR=5
? ?
CDR
CDR
(1,13)
72%(14)
159
Acta Neurologica Taiwanica Vol 12 No 3 September 2003
70 (15)
0,0.5,1,2, 3
CDR
CDR CDR
71% (50 ) CDR
CDR kappa 0.63
kappa 0.62 ( )
(5)
(CASI)
CASI
CASI 100 (LTM)
(STM) (ATTEN)
(MENMA) (ORIEN) (ABSTR)
(LANG) (DRAW)
(ANML)
CDR 709
405 304 56 96
0 25
67 (CDR = 0) 149
(CDR = 0.5) 493 (CDR ≥ 1)
(t - tests, p < 0.05)
CASI CASI MMSE
(t - tests, p < 0.01)
( 0 1
5 6 )
(t - tests, p < 0.05)
475 ( 2 )
( 1 )
(CASI)(16)
. CDR Kendell tau-b Cohen kapp
Kendall tau-b p Cohen kappa p
CDR 0.85 <0.01 0.63 <0.010.89 <0.01 0.74 <0.010.92 <0.01 0.77 <0.010.79 <0.01 0.62 <0.010.91 <0.01 0.78 <0.010.87 <0.01 0.71 <0.010.86 <0.01 0.79 <0.01
. CDR CDR CDR
0 0.5 1 2 30 10 3 130.5 5 11 6 221 18 2 20
CDR 2 1 9 2 123 1 2 3
15 14 25 12 4 70
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475 238
(CDR = 1) 155 (CDR = 2)
82 (CDR = 3)
(t - tests,
p > 0.05) CASI
CASI
Z
CASI
(CDR=0) (CDR=0.5)
(CDR=1) (CDR=2) (CDR=3)
(CDR=4) (CDR=5)
CDR
Hughes (1)
(1,17)
V313
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CDR
(Memory) (M)
(Orientation) (O) (Judgment - problem solving) (JPS)
(Community affairs) (CA)(Home hobbies) (HH)
(Personal care) (PC)
3 ( ) (M)
(No)
3 M 2
(No)
CDR= M
M=0 2 0 CDR=0.5M=0.5 3 1 CDR=1M>0 0 CDR=M
M; M; M CDR=M
(Yes)
CDR=M
(Yes)
CDR=M
161
Acta Neurologica Taiwanica Vol 12 No 3 September 2003
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Standardized Semi-Structured Interview for Dementia --
according to CDR and DSM-IV
Subject
I. Recent memory1. recall
*2. 29683 3. 4. 5.
II. Orientation
III. Similarity & Difference
IV. Judgement7 50
V. Apraxia
1. 2. 3.
VI. Aphasia1. 2. 3. 4. 5. 6.
VII. Agnosia1. Visual agnosia 2. Tactile agnosia
VIII. Executive function1. Verbal fluency: 2. 3.
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Family
I. Memory
1. 1. 2.
*2. 1. 2.
*3. 1. 2.
*4. 1. 2.
*5. 1. 2.
*6. 1. 2.
*7. 1. 2.
8. 1. 2.
9. 1. 2.
10. 1. 2.
11. 1. 2.
12. 1. 2.
13. 1. 2.
14. 1. 2.
II. Orientation
1. 1. 2.
*2. 1. 2.
3. 1. 2.
4. 1. 2.
5. 1. 2.
6. 1. 2.
III. Judgement
1. 1. 2.
2. 1. 2.
3. 1. 2.
IV. Community affairs
1.
*2.
3.
1. 2.
4. 1. 2.
5. 1. 2.
1. 2.
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Acta Neurologica Taiwanica Vol 12 No 3 September 2003
V. Home hobbies1.
VI. Personal care1. 1. 2. 3. 4. 2.
1. 2. 3. 4. 3. 1. 2. 3. 4. 4.
1. 2. 3. 4. 5. 1. 2. 3.
VII. Personality & Behavioral Problem1. 1. 2. 2. 1. 2. 3. 1. 2. 4. 1. 2. 5. 1. 2. 6. 1. 2. 7. 1. 2. 8. 1. 2. 9. 1. 2.
VIII. Language1. 1. 2. 2. 1. 2. 3. 1. 2. 4. 1. 2. 5. 1. 2. 6. 1. 2.
I-VIII1.
(1) 6 (2) 6 12 (3) 1 2 (4) 2
2. (1) (2) 1 3 (3) 1 (4)
3. (1) (2) (3) (4)
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Clinical Dementia Rating (CDR)
Health Questionable Mild Moderate Severe CDR 0 CDR 0.5 CDR 1 CDR 2 CDR 3
Memory * * * * ** * * *
* **
Orientation * * * ** *
*Judgment * * * * *& Problemsolving * *
*Community * * * *affairs
Home & * * * * *hobbies
* *
Personal * * * *care
CDR 4Profound
CDR 5Terminal
0 0.5 1 2 3
M
O
JPS
CA
HH
PC