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A Double Cross-Validation and Application to a Community-Dwelling Sample

Andreas U. Monsch, PhD; Mark W. Bondi, PhD; David P. Salmon, PhD; Nelson Butters, PhD; Leon J. Thal, MD; Lawrence A. Hansen, MD; Wigbert C. Wiederholt, MD; Deborah A. Cahn, PhD; Melville R. Klauber, PhD

Arch Neurol. 1995;52(9):899-904.

Abstract
Objective
To assess the clinical validity of the Dementia Rating Scale (DRS) in detecting patients with dementia of the Alzheimer type (DAT).

Background
The DRS is widely used to evaluate cognitive functioning in older adults. Adequate normative data are unavailable; studies addressing the clinical validity of the DRS are limited by small sample sizes.

Design and Methods
Administered the DRS to 254 outpatients with DAT and 105 healthy elderly subjects. Performed (1) multiple regressions of demographic factors on the DRS and its subscales; (2) derivation of optimal DRS cutoff scores using receiver operating characteristic curves; (3) double cross-validation with stepwise logistic regressions; and (4) application of results to a community-dwelling sample.

Results
Age- and education-adjusted DRS scores were computed. The optimal DRS cutoff score for DAT of 129 or less revealed a sensitivity of 98% and a specificity of 97%. The logistic regressions resulted in a combination of the Memory and Initiation/Perseveration subscales that correctly classified 98% of all subjects, 92% of a subsample of 76 patients with mild DAT, and 100% of the 51 patients with autopsyconfirmed DAT. The resultant equation was then applied to a community-dwelling sample (238 healthy elderly subjects and 44 patients with DAT): 91% of patients and 93% of normal subjects were correctly classified. Of an additional 77 individuals with questionable DAT, 43 were classified as demented and 34 were classified as nondemented.

Conclusions
The DRS is a clinically valid psychometric test for the detection of DAT. The Memory and Initiation/Perseveration subscales are its best discriminative indexes for an abbreviated version.

Author Affiliations
From the Departments of Psychiatry (Drs Monsch, Bondi, Butters, and Cahn), Neurosciences (Drs Salmon, Thal, Hansen, and Wiederholt), and Family and Preventive Medicine (Dr Klauber), University of California, San Diego, School of Medicine, and the San Diego Department of Veterans Affairs Medical Center (Drs Bondi, Butters, Thal, and Cahn). Dr Monsch is now with the Memory Clinic of the Geriatric University Hospital, Basel, Switzerland.

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