CLINICAL DEMENTIA RATING

SUMMARY

DATE: 06/01/2011
ID NUMBER: FORM CODE: C D S
Version 1.0

ADMINISTRATIVE INFORMATION
0a. Completion Date: / / 0b. Staff ID:
Month Day Year

Instructions: This form is to be completed by the clinician or other trained health professional based on informant
report and neurological exam of the subject. In the extremely rare instances when no informant is available the
clinician or other trained health professional must complete this form utilizing all other available information and his/her
best clinical judgment. Score only as decline from previous level due to cognitive loss not impairment due to other
factors.

SECTION 1: STANDARD CDR

IMPAIRMENT
Please enter None Questionable Mild Moderate Severe
scores below. 0 0.5 1 2 3
1. MEMORY No memory Consistent slight Moderate Severe memory Severe
__.__ loss, or slight forgetfulness; memory loss, loss; only highly memory loss;
inconsistent partial recollection more marked learned material only
forgetfulness. of events; “benign” for recent retained; new fragments
forgetfulness. events; defect material rapidly remain.
interferes with lost.
everyday
activities.
2. Fully Fully oriented Moderate Severe difficulty Oriented to
ORIENTATION oriented. except for slight difficulty with with time person only.
__.__ difficulty with time time relationships;
relationships. relationships; usually
oriented for disoriented to
place at time, often to
examination; place.
may have
geographic
disorientation
elsewhere.

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 IMPAIRMENT
Please enter None Questionable Mild Moderate Severe
scores below. 0 0.5 1 2 3
3. JUDGMENT Solves Slight impairment Moderate Severely Unable to
& PROBLEM everyday in these activities. difficulty in impaired in make
SOLVING problems, handling handling judgments or
__.__ handles problems, problems, solve
business and similarities and similarities and problems.
financial differences; differences;
affairs well; social judgment social judgment
judgment usually usually impaired.
good in maintained.
relation to
past
performance.
4. Independent Life at home, Unable to No pretense of No pretense
COMMUNITY function at hobbies and function independent of
AFFAIRS usual level in intellectual independently function outside independent
__.__ job, shopping, interests slightly at these the home; function
volunteer and impaired. activities, appears well outside the
social groups. although may enough to be home;
still be engaged taken to appears too ill
in some; functions outside to be taken to
appears normal the family home. functions
to casual outside the
inspection. family home.
5. HOME & Life at home, Life at home, Mild but definite Only simple No significant
HOBBIES hobbies and hobbies, and impairment of chores function in the
__.__ intellectual intellectual function at preserved; very home.
interests well interests slightly home; more restricted
maintained. impaired. difficult chores interests; poorly
abandoned; maintained.
more
complicated
hobbies and
interests
abandoned.
6. PERSONAL Fully capable of self-care. Needs Requires Requires
CARE prompting. assistance in much help
__.__ dressing, with personal
hygiene, keeping care; frequent
of personal incontinence.
effects.
7. ___.___ STANDARD CDR SUM OF BOXES
8. ___.___ STANDARD GLOBAL CDR
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SECTION 2: SUPPLEMENTAL CDR
IMPAIRMENT
Please enter None Questionable Mild Moderate Severe
scores below. 0 0.5 1 2 3
9. BEHAVIOR, Socially Questionable Mild but Moderate Severe
COMPORTMENT appropriate changes in definite behavioral behavioral
AND behavior. comportment, changes in changes, changes,
PERSONALITY empathy, behavior. affecting making
__.__ appropriateness interpersonal interpersonal
of actions. relationships interactions all
and interactions unidirectional.
in a significant
manner.
10. LANGUAGE No Consistent mild Moderate word Moderate to Severe
__.__ language word finding finding difficulty severe comprehension
difficulty or difficulties; in speech; impairment in deficit; no
occasional simplification of cannot name either speech intelligible
mild tip-of- word choice; objects in or speech.
the-tongue. circumlocutions; environment; comprehension;
decreased reduced has difficulty
phrase length; phrase length communicating
and/or mild and/or thoughts;
comprehension agrammatical writing may be
difficulties. speech; and/or slightly more
reduced effective.
comprehension
in conversation
and reading.
11. ___.___ SUPPLEMENTAL CDR SUM OF BOXES
12. ___.___ STANDARD & SUPPLEMENTAL CDR SUM OF BOXES

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 INSTRUCTIONS FOR THE
CLINICAL DEMENTIA RATING (CDR) – SUMMARY;
(CDS) FORM

I. General Instructions
The Clinical Dementia Rating or CDR was developed at the Memory and Aging Project at Washington
University School of Medicine in 1979 for the evaluation of staging severity of dementia. The CDR is a
five-point scale in which CDR-0 connotes no cognitive impairment, and then the remaining four
points are for various stages of dementia:
0.5 = questionable, or very mild dementia
1 = mild
2 = moderate
3 = severe
The CDR score is derived from information collected from the informant interview as well as the
subject interview. The six domains used to construct the overall CDR score are: Memory,
Orientation, Judgment and Problem-Solving, Community Affairs, Home and Hobbies, and Personal
Care. Each of the domains is rated separately based on the participant’s cognitive ability to function
in these areas. If the participant is limited in performing activities at home because of physical frailty,
this should not affect their scoring on the CDR.
To aid in rating the severity in each of the domains, the CDR table, which shows the six cognitive
domains the various severity levels, also provides descriptors for each severity at each box score.
These descriptors are meant to be used as guides. The clinician should attempt to distinguish which is
the best representation of severity for that particular domain. In situations where the clinician cannot
decide between one and two severity levels, the standard rule is to rate a higher severity level. An
example would be if memory is between a mild and a moderate severity rating, between a 1 and a 2
box score, and the clinician cannot determine where the best representation is, the rule would be that
memory is rated as a 2.
To the degree that the informant is observant and their information is thought to be accurate, the
CDR information provides essential information in scoring. This is particularly true because three of
the six domains of the CDR (Community Affairs, Home and Hobbies, and Personal Care) are almost
entirely dependent upon the informant interview.
The Informant Interview (CDI) and the Subject Interview (CDP) should be completed within 90 days
of each other. If more than 90 days has passed between these interviews, it should be noted in
notelogs on both forms. Scoring on the CDS should be based primarily on the later form.

II. Detailed Instructions for Each Item

0a. Enter the date on which the participant was seen in the clinic.
0b. Enter the staff ID for the person who completed this form.
1. Memory: It may be difficult to make a distinction between CDR memory score of 2 or 3. CDR-
2 says essentially only highly learned material is recalled and new material is rapidly
forgotten, while for CDR-3 only fragments of memory remain. CDR-2 level should be
assigned to an individual that appears to have a fairly good recall of essential past personal
and historical items and may recall some portions of recent events but not the entire event.
Someone with CDR-3 level may recall only a few relatively minor items from the past such as
where they were born and whether or not they were married.

Instructions for the Clinical Dementia Rating – Summary QxQ 06/01/2011 Page 1 of 2
2. Items 2-5 are self-explanatory, in conjunction with the online CDR training that is required of
all individuals who administer this scale. In general, the items from the CDI and CDP are
labeled by section, to assist the examiner in estimating box scores.
6. Personal Care: Personal Care is unique among the six domains in that it does not have a
CDR-0.5 score. At the point where the participant requires some help, if only prompting to
change clothes, to shave or to groom their hair, that becomes CDR-1 score. If the participant
requires no help, is fully independent, then CDR score should be 0. It is important to
emphasize to the participant and the informant that we are asking about change in cognitive
ability from prior levels of functioning (sometime over the past year, sometimes compared to
10 years previous).

7-8. Item #7 will be auto-calculated by the DMS, which is simply a sum of the box scores from #1-
6. Item # 8 (Standard Global CDR) can be calculated at the following website:
http://www.biostat.wustl.edu/adrc/ which will be provided in a link from the DMS, based on the
individual box scores from the first 6 items.

11-12. Item #11 is simply a sum of #9 and 10 (auto-calculated by DMS), and #12 is the sum of item
7 and item 11.

Instructions for the Clinical Dementia Rating – Summary QxQ 06/01/2011 Page 2 of 2