BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet Test: Alzheimer’s Disease Assessment Scale (ADAS) – 21 item version Year: 1984 Domain: Psychological Assessment Tool Category: Dementia/Alzheimer's Variations/Translations: 40 item version and 21 item version (not a short form), many translations have been made Setting: Clinical Method of Delivery: Physician evaluates cognitive, affective and behavioural deficits Description: The ADAS is a clinical rating scale that evaluates the severity of cognitive, affective, and behavioural deficits in patients with Alzheimer’s disease (AD) and gives an index of the overall severity of dementia. It assesses the clinical symptoms most frequently reported in patients with neuropathologically confirmed AD. The items were drawn from existing scales or written by the authors. The ADAS contains 21 items, shortened from the original 40 as it selected those with the highest inter-rater and test-retest reliabilities. Cognitive performance, memory, and noncognitive functioning in the form of behaviour are all tested. Scoring/Interpretation: For each severity scale, 0 signifies no impairment on a task or the absence of a particular behaviour. A rating of 5 reflects severe impairment or high frequency of a behaviour. The ADAS scores are generally calculated separately for the cognitive section (range 0-70) and for the noncognitive section (range 0-50) – these can be combined to give a total score ranging from 0-120. Scores on the two memory items (range 0-22) are occasionally presented separately. For the ADAS cognitive section, scores less than or equal to 10 may be considered in the normal range. A score between 16.5 and 16.8 on the cognitive section (based on the two separate analyses) has been shown to be equivalent to a Mini-Mental State Exam score of 23. Time to Administer: Approximately 30 minutes Availability: Strictly clinical Software: N/A Website: N/A Quantitative/Qualitative: Quantitative Validity (Quantitative): Factor analysis identified three factors in the cognitive scale – mental status, verbal fluency and praxis. Rosen et al. assessed the criterion validity of the ADAS using a group of 15 patients with AD and matched controls. The Sandoz Clinical Assessment-Geriatric score correlated 0.52 with the ADAS total score. Equivalent correlations for the Blessed Memory Information Test were at 0.67. Burch and Andrews found that ADAS scores to be slightly less influenced by education than the Mini-Mental State Exam. The ADAS cognitive section is capable of detecting changes in function following treatment and shows a dose-response. Reliable scores were reported by Weyer et al., who found that a change in ADAS cognitive scores of 7 or higher represented a reliable change. Reliability (Quantitative): One-month test-retest reliability was rho = 0.92 for cognitive score but only 0.59 for the noncognitive score and 0.84 for the overall score. Inter-rater reliability was 0.99 for the cognitive and total scores, and 0.95 for the noncognitive score. Test-retest reliability was 0.93 for the cognitive and 0.96 for noncognitive. References: McDowell, I. & Newell, C. (1996). Measuring Health: A Guide to Rating Scales and Questionnaires. (2nd ed.). New York: Oxford University Press. Rosen, W.G., Mohs, R.C., & Davis, K.L. (1984). A new rating scale for Alzheimer’s disease. American Journal of Psychiatry, 141,1356–1364. Comments: Mostly used in drug trials