THE QUICK DEMENTIA RATING SYSTEM (QDRS): A RAPID DEMENTIA STAGING TOOL

James E Galvin, James E Galvin

Abstract

Introduction: Test the validity and reliability of the Quick Dementia Rating System (QDRS), a rapid dementia staging tool.

Methods: The QDRS was tested in 267 patient-caregiver dyads compared with Clinical Dementia Ratings (CDR), neuropsychological testing, and gold standard measures of function, mood, and behavior. Psychometric properties including, item variability, floor and ceiling effects, concurrent and construct validity, and internal consistency were determined. The QDRS was used to derive an independent CDR and sum of boxes. Interscale reliability between QDRS and CDR was tested using intraclass correlation coefficients (ICC). Area under the receiver operator characteristic curves (AUC) tested discrimination properties of QDRS across CDR stages.

Results: QDRS scores increased with higher CDR staging and poorer neuropsychological performance (p's <.001). The QDRS demonstrated low floor and ceiling effects; excellent known-groups validity across CDR stages (p's<.001); construct validity against cognitive, behavioral, and functional measures (p-value's:0.004 to <0.001); and reliability (Cronbach α: 0.86-0.93). The QDRS demonstrated differential scores across different dementia etiologies. The AUC for the QDRS was 0.911 (95%CI 0.86-0.96) and for the CDR-SB was 0.996 (95% CI: 0.99-1.0) demonstrating comparable ability to discriminate normal controls from dementia. The QDRS-generated CDR demonstrated excellent correspondence with the CDR (ICC=0.90) and sum-of-boxes (ICC=0.92).

Discussion: The QDRS validly and reliably differentiates individuals with and without dementia and accurately stages dementia without extensive training or clinician input, and is highly correlated with our gold standard measures. The QDRS provides a rapid method to determine study eligibility; stage patients in clinical practice; and improve case ascertainment in population studies.

Keywords: Clinical Dementia Rating; Clinical Trials; Dementia; Staging; neurocognitive disorders.

References

    1. Albert M.S., DeKosky S.T., Dickson D., Dubois B., Feldman H.H., Fox N.C. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:270–279.
    1. Petersen R.C., Doody R., Kurz A., Mohs R.C., Morris J.C., Rabins P.V. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58:1985–1992.
    1. McKhann G.M., Knopman D.S., Chertkow H., Hyman B.T., Jack C.R., Jr., Kawas C.H. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269.
    1. Galvin J.E., Roe C.M., Powlishta K.K., Coats M.A., Muich S.J., Grant E. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65:559–564.
    1. Holsinger T., Deveau J., Boustani M., Williams J.W., Jr. Does this patient have dementia? JAMA. 2007;297:2391–2404.
    1. Galvin J.E. Dementia screening, biomarkers and protein misfolding: implications for public health and diagnosis. Prion. 2011;5:16–21.
    1. Cacchione P.Z., Powlishta K.K., Grant E.A., Buckles V.D., Morris J.C. Accuracy of collateral source reports in very mild to mild dementia of the Alzheimer type. J Am Geriatr Soc. 2003;51:819–823.
    1. Carr D.B., Gray S., Baty J., Morris J.C. The value of informant vs. individual's complaints of memory impairment in early dementia. Neurology. 2000;55:1724–1726.
    1. Galvin J.E., Roe C.M., Xiong C., Morris J.C. The validity and reliability of the AD8 informant interview for dementia. Neurology. 2006;67:1942–1948.
    1. McCarten J.R., Anderson P., Kuskowski M.A., McPherson S.E., Borson S. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc. 2011;59:309–313.
    1. Morris J.C. The Clinical Dementia Rating (CDR)—current version and scoring rules. Neurology. 1993;43:2412–2414.
    1. Teri L., Truax P., Logsdon R., Uomoto J., Zarit S., Vitaliano P.P. Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychol Aging. 1992;7:622–631.
    1. Logsdon R.G., Gibbons L.E., McCurry S.M., Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002;64:510–519.
    1. Herbert R., Bravo G., Preville M. Reliability, validity, and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Can J Aging. 2000;19:494–507.
    1. Galvin J.E., Valois L., Zweig Y. Collaborative transdisciplinary team approach for dementia care. Neurodegener Dis Manag. 2014;4:455–469.
    1. McKeith I.G., Dickson D.W., Lowe J., Emre M., O'Brien J.T., Feldman H., Consortium on DLB Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65:1863–1872.
    1. Rascovsky K., Hodges J.R., Knopman D., Mendez M.F., Kramer J.H., Neuhaus J. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134:2456–2477.
    1. Gorno-Tempini M.L., Hillis A.E., Weintraub S., Kertesz A., Mendez M., Cappa S.F. Classification of primary progressive aphasia and its variants. Neurology. 2011;76:1006–1014.
    1. Sachdev P., Kalaria R., O'Brien J., Skoog I., Alladi S., Black S.E. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28:206–218.
    1. Reisberg B. Global measures: utility in defining and measuring treatment response in dementia. Int Psychogeriatr. 2007;19:421–456.
    1. Goetz C.G., Fahn S., Martinez-Martin P., Poewe W., Sampaio C., Stebbins G.T. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord. 2007;22:41–47.
    1. Kaufer D.I., Cummings J.L., Ketchel P., Smith V., MacMillan A., Shelley T. Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci. 2000;12:233–239.
    1. Ferman T.J., Smith G.E., Boeve B.F., Ivnik R.J., Petersen R.C., Knopman D. DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. Neurology. 2004;62:181–187.
    1. Johns M.W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545.
    1. Pfeffer R.I., Kurosaki T.T., Harrah C.H., Jr., Chance J.M., Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37:323–329.
    1. Kroenke K., Spitzer R.L., Williams J.B., Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50:613–621.
    1. Folstein M.F., Folstein S.E., McHugh P.R. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.
    1. Brandt J., Corwin J., Krafft L. Is verbal recognition memory really different in Huntington's and Alzheimer's disease. J Clin Exp Neuropsychol. 1992;14:773–784.
    1. Thurstone L.L., Thurstone L.G. Science Research Associates; Chicago: 1949. Examiner manual for the SRA Primary Mental Abilities Test.
    1. Goodglass H., Kaplan E. 2nd ed. Lea & Febiger; Philadelphia: 1983. The assessment of aphasia and related disorders.
    1. Crowe S.F. Does the letter number sequencing task measure anything more than digit span? Assessment. 2000;7:113–117.
    1. Reitan R.M. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–276.
    1. Yamamoto S., Mogi N., Umegaki H., Suzuki Y., Ando F., Shimokata H. The clock drawing test as a valid screening method for mild cognitive impairment. Dement Geriatr Cogn Disord. 2004;18:172–179.
    1. Snaith R.P. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes. 2003;1:29.
    1. Streiner D.L., Norman G.R. 4th ed. Oxford University Press; Oxford, England: 2008. Health measurement scale: a practical guide to their development and use.
    1. Monahan P.O., Boustani M., Alder C., Galvin J.E., Perkins A.J., Healey P. A practical clinical tool to monitor dementia symptoms: The HABC-Monitor. Clin Interv Aging. 2012;7:143–157.
    1. Fleiss J.L., Chilton N.W. The measurement of interexaminer agreement on periodontal disease. J Periodontal Res. 1983;18:601–606.
    1. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
    1. Galasko D., Bennett D., Sano M., Ernesto C., Thomas R., Grundman M. An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer' Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11(suppl 2):S33–S39.
    1. Schneider L.S., Olin J.T., Doody R.S., Clark C.M., Morris J.C., Reisberg B. Validity and reliability of the Alzheimer's Disease Cooperative Study—Clinical Global Impression of Change. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11(Suppl 2):S22–32.
    1. Nasreddine Z.S., Phillips N.A., Bédirian V., Charbonneau S., Whitehead V., Collin I. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–699.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren