CLINICALDEMENTIARATING(CDR)：臨床癡呆評定量表（CDR）

1

CLINICALDEMENTIARATING(CDR)Patient'sInitials

Author:ProfessorJohnCMorris,DepartmentofNeurology,WashingtonUniversitySchoolofMedicine,StLouis,MO,USA

Citation:Morris,J.C.TheClinicalDementiaRating(CDR):CurrentvisionandscoringrulesNeurology,1993;43:2412-2414

Thisisasemi-structuredinterview.Pleaseaskallofthesequestions.Askanyadditionalquestionsnecessarytodeterminethesubject'sCDR.Pleasenoteinformationfrom

additionalquestions.

MemoryQuestionsforInformant:

1.Doeshe/shehaveaproblemwithhis/hermemoryorthinking?

□Yes

□

No

1a.Ifyes,isthisaconsistentproblem(asopposedtoinconsistent)?

□Yes

□

No

2.Canhe/sherecallrecentevents?

□Yes

□

No

3.Canhe/sherememberashortlistofitems(shopping)?

□Yes

□

No

4.Hastherebeensomedeclineinmemoryduringthepastyear?

□Yes

□

No

5.Ishis/hermemoryimpairedtosuchadegreethatitwouldhaveinterferedwithhis/heractivitiesofdailylifeafewyearsago(orpre-retirement

activities)?(collateralsource'sopinion)

□Yes

□

No

6.Doeshe/shecompletelyforgetamajorevent(e.g.atrip,aparty,

afamilywedding)withinafewweeksoftheevent?

□Yes

□

No

7.Doeshe/sheforgetpertinentdetailsaboutthemajorevent?

□Yes

□

No

8.Doeshe/shecompletelyforgetimportantinformationofthedistantpast

(e.g.dateofbirth,weddingdate,placeofemployment)?

□Yes

□

No

9.Tellmeaboutsomerecenteventinhis/herlifesheshouldremember.

(Forlatertesting,obtaindetailssuchaslocationoftheevent,timeofday,

participants,howlongtheeventwas,whenitendedandhowthepatient

orotherparticipantsgotthere)

Within1week:

Within1month:

10.Whenwashe/sheborn?

11.Wherewashe/sheborn?

12.Whatwasthelastschoolhe/sheattended?

Name

Place

Grade

13.Whatwashis/hermainoccupation/job(orspouse'sjobifpatientwasnotemployed)?

14.Whatwashis/hermajorjob(orspouse'sjobifpatientwasnotemployed)?

15.Whendidhe/she(orspouse)retireandwhy?

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

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CLINICALDEMENTIARATING(CDR)Patient'sInitials

OrientationQuestionsforInformant:

Howoftendoeshe/sheknowtheexact:

1.DateoftheMonth?

□Usually□Sometimes

2.Month?

□

Rarely

□

Don't

Know

□Usually□Sometimes

3.Year?

□

Rarely

□

Don't

Know

□Usually□Sometimes4.DayoftheWeek?

□

Rarely

□

Don't

Know

□UsuallySometimes

□

Rarely

□

Don't

Know

5.Doeshe/shehavedifficultywithtimerelationships(wheneventshappenedinrelationtoeachother)?

□Usually□Sometimes□Rarely□Don'tKnow6.Canhe/shefindhis/herwayaroundfamiliarstreets?

□Usually□Sometimes□Rarely□Don'tKnow

7.Howoftendoeshe/sheknowhowtogetfromoneplacetoanotheroutsidehis/herneighbourhood?

□Usually□Sometimes□Rarely□Don'tKnow8.Howoftencanhe/shefindhis/herwayaroundindoors?

□Usually□Sometimes□Rarely□Don'tKnow

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

3

CLINICALDEMENTIARATING(CDR)Patient'sInitials

JudgementandProblemSolvingQuestionsforInformant:

1.Ingeneral,ifyouhadtoratehis/herabilitiestosolveproblemsatthepresenttime,wouldyouconsiderthem:

□Asgoodastheyhaveeverbeen

□Good,butnotasgoodasbefore

□Fair

□Poor

□Noabilityatall

2.Ratehis/herabilitytocopewithsmallsumsofmoney(e.g.calculatechange,leaveasmalltip):

□Noloss

□Someloss

□Severeloss

3.Ratehis/herabilitytohandlecomplicatedfinancialorbusinesstransactions(e.g.balancechequebook,paybills):

□Noloss

□Someloss

□Severeloss

4.Canhe/shehandleahouseholdemergency(e.g.plumbingleak,smallfire)?

□Aswellasbefore

Worsethanbeforebecauseoftroublethinking

□Worsethanbefore,anotherreason(why)

5.Canhe/sheunderstandsituationsorexplanations?

□Usually□Sometimes□Rarely□Don'tKnow

6.Doeshe/shebehave*appropriately(i.e.inhis/herusual(premorbid)manner)insocialsituationsandinteractionswithotherpeople?

□Usually□Sometimes□Rarely□Don'tKnow

*Thisitemratesbehaviour,notappearance

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

4

CLINICALDEMENTIARATING(CDR)Patient'sInitials

CommunityAffairsQuestionsforInformant

Occupational

□Yes□No□N/A

1.Isthepatientstillworking?

lfnotapplicable,proceedtoitem4

lfyes,proceedtoitem3

lfno,proceedtoitem2

2.Didmemoryorthinkingproblemscontributetothepatient's□Yes□No□D/Kdecisiontoretire?(Question4isnext)

3.Doesthepatienthavesignificantdifficultyinhis/herjobbecauseofproblemswithmemoryorthinking?

□RarelyorNever□Sometimes□Usually□Don'tKnow

Doesthepatientdriveacarnow?□Yes□No

lfno,isthisbecauseofmemoryorthinkingproblems?□Yes□No

4.Didhe/sheeverdriveacar?□Yes□No

5.Ifhe/sheisstilldriving,arethereproblemsorrisks□Yes□No

becauseofpoorthinking?

6.*Ishe/sheabletoindependentlyshopforneeds?

□RarelyorNever□Sometimes□Usually□Don'tKnow(Needstobeaccompanied(Shopsforlimitednumber

onanyshoppingtrip)ofitems:buysduplicate

itemsorforgetsneededitems)

7.Ishe/sheabletocarryoutactivitiesindependentlyoutsidethehome?

□RarelyorNever

□Sometimes

(Limitedand/orroutine

e.g.superficialparticipation

□Don'tKnow

□Usually(Meaningful

participationin

(Generallyunabletoperform

Activitieswithouthelp)

Inchurchormeetings;tripstoactivitiese.g.voting)

beautysalons)

8.Ishe/shetakentosocialfunctionsoutsidethefamilyhome?□Yes□No

lfno,whynot

9.Wouldacasualobserverofthepatient'sbehaviourthinkthepatientwasill?□Yes□No

10.Ifinanursinghome,doeshe/sheparticipatewellinsocialfunctions(thinking)?□Yes□No

IMPORTANT:

lsthereenoughinformationavailabletoratethesubject'slevelofimpairmentincommunityaffairs?

lfnot,pleaseprobefurther.

CommunityAffairs:Suchasgoingtochurch,visitingfriendsorfamily,politicalactivities,professionalorganisationssuchasbarassociation,otherprofessionalgroups,socialclubs,serviceorganisations,educationalprograms.

*Pleaseaddnotesifneededtoclarifypatient'sleveloffunctioninginthisarea

HomeandHobbiesQuestionsforInformant:

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

5

CLINICALDEMENTIARATING(CDR)Patient'sInitials

1a.Whatchangeshaveoccurredinhis/herabilitiestoperformhouseholdtasks?

1b.Whatcanhe/shestilldowell?

2a.Whatchangeshaveoccurredinhis/herabilitiestoperformhobbies?

2b.Whatcanhe/shestilldowell?

3.Ifinanursinghome,whatcanhe/shenolongerdowell(HomeandHobbies)?

EverydayActivities(TheDementiaScaleofBlessed):

4.Abilitytoperformhouseholdtasks

NoLoss

0

0.5

SevereLoss

1

Pleasedescribe

5.Ishe/sheabletoperformhouseholdtasksatthelevelof:

(Pickone.Theinformantdoesnotneedtobeaskeddirectly)

□Nomeaningfulfunction

(Performssimpleactivities,suchasmakingabed,onlywithmuchsupervision)

Functionsinlimitedactivitiesonly

(Withsomesupervision,washeddisheswithacceptablecleanliness;setstable)

□Functionsindependentlyinsomeactivities

(Operatesappliances,suchasavacuumcleaner;preparessimplemeals)

□Functionsinusualactivitiesbutnotatusuallevel

□Normalfunctioninusualactivities

IMPORTANT:

Isthereenoughinformationavailabletoratethepatient'slevelofimpairmentinHOME&

HOBBIES?

lfnot,pleaseprobefurther.

HouseholdTasks:suchascooking,laundry,cleaning,groceryshopping,takingoutgarbage,frontandbackyardwork,simplecaremaintenanceandbasichomerepair.

Hobbies:Sewing,painting,handicrafts,reading,entertaining,photographygardening,goingtctheatreorconcert,woodworking,participatinginsports

PersonalCareQuestionsforInformant:

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

6

CLINICALDEMENTIARATING(CDR)Patient'sInitials

*Whatisyourestimateofhis/hermentalabilityinthefollowingareas:

Unaided

Occasionally

misplacedbuttons

etc.

Wrongsequencecommonly

forgottenitems

Unabletodress

A.Dressing(The

DementiaScale

ofBlessed)

0

1

2

3

UnaidedNeedspromptingSometimesneedsAlwaysornearly

helpalwaysneeds

help

B.Washing.

grooming

C.Eatinghabits

0123

Cleanly;properutensils

0

Messily;spoon

1

Simple

solids

2

Hastobefedcompletely

3

D.Sphincter

control

(TheDementia

ScaleofBlessed)

NormalcompleteOccasionallywetsFrequentlywetsDoubly

controlbedbedincontinent

0123

*Abox-scoreof1canbeconsideredifthepatient'spersoncareisimpairedfromapreviouslevel,eveniftheydonotreceiveprompting.

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

7

CLINICALDEMENTIARATING(CDR)Patient'sInitials

MemoryQuestionsforPatient

1.Doyouhaveproblemswithmemoryorthinking?□Yes□No

2.Afewmomentsagoyour(spouseetc)toldmeafewrecentexperiencesyouhad.Will

youtellmesomethingaboutthose?(Promptfordetailsifneeded,suchaslocationoftheevent,timeofday,participants,howlongtheeventwas,whenitendedandhowthe

patientorotherparticipantsgotthere.)

1.0-Largely0.5

0.0-Largely

1.0-Largely0.5

0.0-Largely

Within1week

correct

incorrect

Within1month

correct

incorrect

3.Iwillgiveyouanameandaddresstorememberforafewminutes.Repeatthisnameandaddressafterme:(Repeatuntilthephraseiscorrectlyrepeatedortoamaximumofthreeattempts)

3

1

2

4

5

Elements

John

Brown

42

Market

St

Sydney

John

Brown

42

Market

St

Sydney

John

Brown

42

Market

St

Sydney

(Underlineelementsrepeatedcorrectlyineachattempt)

4.Whenwereyouborn?

5.Wherewereyouborn?

6.Whatwasthelastschoolyouattended?

Name.

PlaceGrade7.Whatwasyourmainoccupation/job(orspouse'sifnotemployed)?8.Whatwasyourlastmajorjob(orspouse'sifnotemployed)?9.Whendidyou(oryourspouse)retireandwhy?

10.Repeatthenameandaddresslaskedyoutoremember:

Elements

John

2

Brown

3

42

4

MarketSt

5

Sydney

(Underlineelementsrepeatedcorrectly.)

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

8

CLINICALDEMENTIARATING(CDR)Patient'sInitials

OrientationQuestionsforPatient:

Recordthepatient'sanswerverbatimforeachquestion

1.Whatisthedatetoday?□Correct□Incorrect

2.Whatdayoftheweekisit?

□Correct

□

Incorrect

3.What

isthemonth?

□Correct

□

Incorrect

4.Whatistheyear?

□Correct

□

Incorrect

5.Whatname

istheofthisplace?

□Correct

□

Incorrect

6.Whattownorcityarewein?

□Correct

□

Incorrect

7.Whattimeisit?

□Correct

□

Incorrect

8.Doesthepatientwhotheinformantis(inyourjudgement)?

□Correct

□

Incorrect

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

9

CLINICALDEMENTIARATING(CDR)Patient'sInitials

JudgementandProblemSolvingQuestionsforthePatient:

Instructions:Ifinitialresponsebysubjectdoesnotmeritagrade0,pressthemattertoidentifythepatient'sbestunderstandingoftheproblem.Circlethenearestresponse.

Similarities:

Example:“Howareapencilandpenalike?”(writinginstruments)

“Howarethesethingsalike?”Patient'sResponse

1.turnip……………cauliflower

(0=vegetables)

(1=ediblefoods,livingthings,canbecooked,etc)

(2=answersnotpertinent;differences;buythem)

2.desk………………bookcase

(0=furniture,officefurniture;bothholdbooks)

(1=wooden,legs)

(2=notpertinent,differences)

Differences:

Example:“Whatisthedifferencebetweensugarandvinegar?”(sweetvs.sour)“Whatisthedifferencebetweenthesethings?"Patient'sResponse

3.lie……mistake

(0=onedeliberate,oneunintentional)

(1=onebad,theothergood-orexplainsonlyone)

(2=anythingelse,similarities)

4.river………canal

(0=natural-artificial)

(2=anythingelse)

Calculations:

5.Howmanyfivecentpiecesinadollar?

□

Correct

□

Incorrect

6.Howmany20centpiecesin$5.40?

□

Correct

□

Incorrect

7.Subtract3from20andkeepsubtracting3fromeachnewnumberallthewaydown.

□

Correct

□

Incorrect

Judgement:

8.Uponarrivinginastrangecity,howwouldyoulocateafriendthatyouwishedtosee?

(0=trythetelephonebook,citydirectory,gotothecourthouseforadirectory;calla

mutualfriend)

(1=callthepolice,calltheoperator(usuallywillnotgiveaddress)

(2=noclearresponse)

9.Patient'sassessmentofdisabilityandstationinlifeandunderstandingofwhyhe/sheispresentattheexamination(mayhavecovered,butratehere):

□GoodInsight□PartialInsight□LittleInsight

Reprintedwithpermission.TheClinicalDementiaRating(CDR)isacopyrightedinstrumentofthe

Alzheimer'sDiseasesResearchCenter,WashingtonUniversity,St.Missouri,USA.Allrightsreserved.

10

CLINICALDEMENTIARATING(CDR)Patient'sInitials

CLINICALDEMENTIARATING(CDR)

0

0.5

1

2

3

Impairment

None

0

Questionable

0.5

Mild

1

Moderate

2

Severe

3

Memory

Nomemorylossorslightinconsistentforgetfulness

Consistentslight

forgetfulness;partial

recollectionofevents;“benign”forgetfulness

Moderatememoryloss;

moremarkedforrecentevents;defectinterfereswitheverydayactivities

Severememoryloss;onlyhighlylearned

materialretained;newmaterialrapidlylost

Severememoryloss;onlyfragmentsrem