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Dementia Rating Scale-2 (DRS-2)
Archives of Clinical Neuropsychology 19 (2004) 145–147
Test review Dementia Rating Scale-2 (DRS-2) By P.J. Jurica, C.L. Leitten, and S. Mattis: Psychological Assessment Resources, 2001 The Dementia Rating Scale-2 (Jurica, Leitten, & Mattis, 2001) provides a general measure of cognitive ability in patients with dementia aged 56–105 years. This test and its predecessor (DRS; Mattis, 1988) were designed specifically for assessment of low levels of cognitive functioning where other instruments tend to suffer from floor effects. Thus, the DRS-2 is particularly well adapted for longitudinal study and discrimination of differing levels of ability in patients with dementia. The authors state that revision of this test includes several refinements including: “(a) improved user-friendliness, (b) expanded age and education corrected normative data, (c) and a comprehensive review of the literature with additional validity information.” 1. Item content and test materials There have been no changes to the original 32 stimulus cards, 36 tasks, five subscales, or administration instructions from the original DRS. The five subscales are attention (8 items), initiation/perseveration (11 items), construction (6 items), conceptualization (6 items), and memory (5 items). There are some minor refinements to the scoring guidelines, which should serve to clarify ambiguous scoring situations. Similarly, the response booklet has some minor refinements that will likely simplify test administration and score tabulation. 2. Psychometric properties 2.1. Reliability Examination of the original DRS found a one-week test retest reliability between DRS Total Scores to be .97 and subscale correlations were between .61 and 94, the lowest reliability coefficient being found for the Attention subscale. Internal consistency has also been shown to be acceptable with a split half reliability coefficient of .90 and alpha coefficients ranging from .75 to .95 for four of the five subscales (Attention = .95; Initiation Perseveration = .87; Conceptualization = .95; and Memory = .75). 2.2. Construct validity Confirmatory factor analytic studies of the DRS have found at least partial support for the five subscales of the DRS with some studies showing a three-factor model comprised 0887-6177/$ – see front matter © 2003 National Academy of Neuropsychology. doi:10.1016/j.acn.2003.07.003
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Test review / Archives of Clinical Neuropsychology 19 (2004) 145–147
of conceptualization, construction, and memory with the attention-initiation-perseveration factor being the least reliable in a sample of 171 patients with Alzheimer’s disease (Woodard, Salthouse, Godsall, & Green, 1996). In comparison with other measures of cognitive status such as the Mini-Mental State Examination, the DRS had a significant correlation ranging from r = .78 to .82, though the DRS shows greater sensitivity to cognitive changes in patients with severe dementia. Lastly, Brown et al. (1999) have shown that most DRS subscales show moderate to strong correlations (range = .48–.85) with common neuropsychological tests including the Wechsler Adult Intelligence Scale—Revised (WAIS-R), Wechsler Memory Scale (WMS), and Wisconsin Card Sorting Test (WCST) with the exception of Construction subscale, indicating acceptable levels of covergent and divergent validity. A list of select literature is provided in the test manual for use of the DRS with various clinical populations.
3. Normative data Race and gender have not been found to significantly predict DRS performance (Marcopulos, McLain, & Giuliano, 1997). However, a relationship has been demonstrated between age, education, and performance on the DRS (Vangel & Lichtenberg, 1995). Consequently, the authors have included age and education conversion scores obtained from researchers associated with the Mayo Older American Normative Studies (MOANS; Lucas et al., 1998). The original DRS primarily used normative data collected by Coblentz et al. (1973) based on 30 patients with SDAT and 11 normal controls. In contrast, the new normative sample is significantly larger and is based on 623 community-dwelling elderly participants (199 men and 424 women) screened for medical and psychiatric history. As noted by the DRS-2 authors, the normative sample is predominantly comprised of Caucasian adults with higher than average education (M = 13.1 years; S.D. = 7.6 years). Therefore, scores for non-Caucasians and individuals with less than 8 years of education should be interpreted with caution or in conjunction with alternate normative data. In conclusion, the DRS-2 represents several advantages over its predecessor including improved ease of use, greatly enhanced normative data, and a comprehensive review of validity information. In this regard, it appears to have achieved its stated goals. While the DRS-2 still lacks normative information directly applicable to ethnic minorities or with persons who have less than 8 years of education, the inclusion of age and education corrected normative data is a welcome addition that will enhance its reputation as the instrument of choice for use with persons with lower levels of cognitive functioning. It should continue to provide an effective means for measuring cognitive functioning over time and differentiating cognitive skills among persons with dementia.
References Brown, G. G., Rahill, A. A., Gorell, J. M., McDonald, C., Brown, S. J., Sillanpaa, M., & Shultz, C. (1999). Validity of the Dementia Rating Scale in assessing cognitive function in Parkinson’s disease. Journal of Geriatric Psychiatry and Neurology, 12(4), 180–188.
Test review / Archives of Clinical Neuropsychology 19 (2004) 145–147
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Coblentz, J. M., Mattis, S., Zingesser, L. H., Kasoff, S. S., Wisniewski, H. M., & Katzman, R. (1973). Presenile dementia: Clinical aspects and evaluation of cerebrospinal fluid dynamics. Archives of Neurology, 29(5), 299–308. Jurica, S. J., Leitten, C. L., & Mattis, S. (2001). Dementia Rating Scale: Professional manual. Odessa, Fl: Psychological Assessment Resources. Lucas, J. A., Ivnik, R. J., Smith, G. E., Bohac, D. L., Tangalos, E. G., Kokmen, E., Graff-Radford, N. R., & Petersen, R. C. (1998). Normative data for the Mattis Dementia Rating Scale. Journal of Clinical and Experimental Neuropsychology, 20(4), 536–547. Marcopulos, B. A., McLain, C. A., & Giuliano, A. J. (1997). Cognitive impairment or inadequate norms? A study of healthy rural older adults with limited education. Clinical Neuropsychologist, 11(2), 111–131. Mattis, S. (1988). Dementia Rating Scale: Professional manual. Odessa, FL: Psychological Assessment Resources. Vangel, S. J., & Lichtenberg, P. A. (1995). Mattis Dementia Rating Scale: Clinical utility and relationship with demographic variables. Clinical Neuropsychologist, 9(3), 209–213. Woodard, L., Salthouse, T. A., Godsall, R. E., & Green, R. C. (1996). Confirmatory factor analysis of the Mattis Dementia Rating Scale in patients with Alzheimer’s disease. Psychological Assessment, 8(1), 85–91.
Doug Johnson-Greene Department of Physical Medicine and Rehabilitation Johns Hopkins School of Medicine, 5601 Loch Raven Blvd. Good Sam POB, Suite 406, Baltimore, MD 21239, USA 15 July 2003
Test review Dementia Rating Scale-2 (DRS-2) By P.J. Jurica, C.L. Leitten, and S. Mattis: Psychological Assessment Resources, 2001 The Dementia Rating Scale-2 (Jurica, Leitten, & Mattis, 2001) provides a general measure of cognitive ability in patients with dementia aged 56–105 years. This test and its predecessor (DRS; Mattis, 1988) were designed specifically for assessment of low levels of cognitive functioning where other instruments tend to suffer from floor effects. Thus, the DRS-2 is particularly well adapted for longitudinal study and discrimination of differing levels of ability in patients with dementia. The authors state that revision of this test includes several refinements including: “(a) improved user-friendliness, (b) expanded age and education corrected normative data, (c) and a comprehensive review of the literature with additional validity information.” 1. Item content and test materials There have been no changes to the original 32 stimulus cards, 36 tasks, five subscales, or administration instructions from the original DRS. The five subscales are attention (8 items), initiation/perseveration (11 items), construction (6 items), conceptualization (6 items), and memory (5 items). There are some minor refinements to the scoring guidelines, which should serve to clarify ambiguous scoring situations. Similarly, the response booklet has some minor refinements that will likely simplify test administration and score tabulation. 2. Psychometric properties 2.1. Reliability Examination of the original DRS found a one-week test retest reliability between DRS Total Scores to be .97 and subscale correlations were between .61 and 94, the lowest reliability coefficient being found for the Attention subscale. Internal consistency has also been shown to be acceptable with a split half reliability coefficient of .90 and alpha coefficients ranging from .75 to .95 for four of the five subscales (Attention = .95; Initiation Perseveration = .87; Conceptualization = .95; and Memory = .75). 2.2. Construct validity Confirmatory factor analytic studies of the DRS have found at least partial support for the five subscales of the DRS with some studies showing a three-factor model comprised 0887-6177/$ – see front matter © 2003 National Academy of Neuropsychology. doi:10.1016/j.acn.2003.07.003
146
Test review / Archives of Clinical Neuropsychology 19 (2004) 145–147
of conceptualization, construction, and memory with the attention-initiation-perseveration factor being the least reliable in a sample of 171 patients with Alzheimer’s disease (Woodard, Salthouse, Godsall, & Green, 1996). In comparison with other measures of cognitive status such as the Mini-Mental State Examination, the DRS had a significant correlation ranging from r = .78 to .82, though the DRS shows greater sensitivity to cognitive changes in patients with severe dementia. Lastly, Brown et al. (1999) have shown that most DRS subscales show moderate to strong correlations (range = .48–.85) with common neuropsychological tests including the Wechsler Adult Intelligence Scale—Revised (WAIS-R), Wechsler Memory Scale (WMS), and Wisconsin Card Sorting Test (WCST) with the exception of Construction subscale, indicating acceptable levels of covergent and divergent validity. A list of select literature is provided in the test manual for use of the DRS with various clinical populations.
3. Normative data Race and gender have not been found to significantly predict DRS performance (Marcopulos, McLain, & Giuliano, 1997). However, a relationship has been demonstrated between age, education, and performance on the DRS (Vangel & Lichtenberg, 1995). Consequently, the authors have included age and education conversion scores obtained from researchers associated with the Mayo Older American Normative Studies (MOANS; Lucas et al., 1998). The original DRS primarily used normative data collected by Coblentz et al. (1973) based on 30 patients with SDAT and 11 normal controls. In contrast, the new normative sample is significantly larger and is based on 623 community-dwelling elderly participants (199 men and 424 women) screened for medical and psychiatric history. As noted by the DRS-2 authors, the normative sample is predominantly comprised of Caucasian adults with higher than average education (M = 13.1 years; S.D. = 7.6 years). Therefore, scores for non-Caucasians and individuals with less than 8 years of education should be interpreted with caution or in conjunction with alternate normative data. In conclusion, the DRS-2 represents several advantages over its predecessor including improved ease of use, greatly enhanced normative data, and a comprehensive review of validity information. In this regard, it appears to have achieved its stated goals. While the DRS-2 still lacks normative information directly applicable to ethnic minorities or with persons who have less than 8 years of education, the inclusion of age and education corrected normative data is a welcome addition that will enhance its reputation as the instrument of choice for use with persons with lower levels of cognitive functioning. It should continue to provide an effective means for measuring cognitive functioning over time and differentiating cognitive skills among persons with dementia.
References Brown, G. G., Rahill, A. A., Gorell, J. M., McDonald, C., Brown, S. J., Sillanpaa, M., & Shultz, C. (1999). Validity of the Dementia Rating Scale in assessing cognitive function in Parkinson’s disease. Journal of Geriatric Psychiatry and Neurology, 12(4), 180–188.
Test review / Archives of Clinical Neuropsychology 19 (2004) 145–147
147
Coblentz, J. M., Mattis, S., Zingesser, L. H., Kasoff, S. S., Wisniewski, H. M., & Katzman, R. (1973). Presenile dementia: Clinical aspects and evaluation of cerebrospinal fluid dynamics. Archives of Neurology, 29(5), 299–308. Jurica, S. J., Leitten, C. L., & Mattis, S. (2001). Dementia Rating Scale: Professional manual. Odessa, Fl: Psychological Assessment Resources. Lucas, J. A., Ivnik, R. J., Smith, G. E., Bohac, D. L., Tangalos, E. G., Kokmen, E., Graff-Radford, N. R., & Petersen, R. C. (1998). Normative data for the Mattis Dementia Rating Scale. Journal of Clinical and Experimental Neuropsychology, 20(4), 536–547. Marcopulos, B. A., McLain, C. A., & Giuliano, A. J. (1997). Cognitive impairment or inadequate norms? A study of healthy rural older adults with limited education. Clinical Neuropsychologist, 11(2), 111–131. Mattis, S. (1988). Dementia Rating Scale: Professional manual. Odessa, FL: Psychological Assessment Resources. Vangel, S. J., & Lichtenberg, P. A. (1995). Mattis Dementia Rating Scale: Clinical utility and relationship with demographic variables. Clinical Neuropsychologist, 9(3), 209–213. Woodard, L., Salthouse, T. A., Godsall, R. E., & Green, R. C. (1996). Confirmatory factor analysis of the Mattis Dementia Rating Scale in patients with Alzheimer’s disease. Psychological Assessment, 8(1), 85–91.
Doug Johnson-Greene Department of Physical Medicine and Rehabilitation Johns Hopkins School of Medicine, 5601 Loch Raven Blvd. Good Sam POB, Suite 406, Baltimore, MD 21239, USA 15 July 2003