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Parkinson's Disease - Cognitive Functional Rating Scale (PD-CFRS)
Please visit this website for more information about the instrument: Parkinson's Disease - Cognitive Functional Rating Scale
Available in the public domain.
License for the scale to be used in a study promoted by a pharmaceutical company has a fee. License for non-profit scientific research is free of charge.
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
Purpose: The PD-CFRS is a brief questionnaire to explore a wide range of functional aspects of cognitive impairment in PD (Kulisevsky et al., 2013).
Overview: The questionnaire includes 12 questions about activities of daily living (e.g., handling money, controlling medication regimen, using public transportation). When answering the questions, subjects are instructed to disregard the motor problems, instead focus on how the cognitive difficulties may affect these activities. The survey can be administered to the patient or a knowledgeable informant of the patient.
The questionnaire has no alternate versions. It is available in six non-English languages (Dutch, French, German, Hebrew, Italian, Spanish).
The administration takes about 5 min.
Comments/Special Instructions
The PD-CFRS is suitable for screening of functional status in daily living related to cognitive impairment in PD.
Scoring and Psychometric Properties
Scoring: The range of scores is 0-24. Higher score indicates worse function.
0: No trouble with the activity, 1: Trouble with the activity some of the time, 2: Trouble with the activity most of the time, 8: Never done the activity before.
To obtain the final score, the average of all the items rated from 0 to 2 is calculated and turned to the nearest integer value (0-1-2) (e.g., 1.52 = 2). This average value must replace all those items answered with 8. The total score is the sum of the 12 items once every 8 has been replaced.
A cut-off score of > 2 shows good sensitivity (0.84) and a score of > 3 shows good specificity (0.91) to detect functional impairment in PD with mild cognitive impairment (MCI). A cut-off score of = 3 is considered optimal to detect functional impairment in PD-MCI. A cut-off score of > 6 shows good sensitivity (0.83) and specificity (0.83) to detect functional impairment in PD patients with dementia (Kulisevsky et al., 2013).
An increase of 2 points in the PD-CFRS after 6 months was associated with a clinically significant worsening of the cognitive functional status (Kulisevsky et al., 2013).
Psychometric Properties: In the original clinimetric study, the PD-CFRS was validated against the Old Americans Resource Survey-Instrumental Activities of Daily Living (Kulisevsky et al., 2013).
-Good internal consistency (Cronbach's alpha 0.79)
-Good test-retest reliability (0.82)
-Good inter-rater reliability (0.80)
-Intermediate concurrent validity (0.50)
-Strong correlation with the global cognitive status determined with the PD-Cognitive Rating Scale (r = 0.72, p < 0.0001).
The psychometric properties of the PD-CFRS have also been demonstrated to be acceptable in patients with MCI and dementia other than associated with PD (Alzheimer's, vascular) (Ruzafa-Valiente et al., 2016).
-Easy to administer  
-Acceptable properties for detecting functional changes related to early and mild cognitive impairment in PD
-Confirmation with larger samples is needed
Key Reference:
Kulisevsky J, Fernández de Bobadilla R, Pagonabarraga J, Martínez-Horta S, Campolongo A, García-Sánchez C, Pascual-Sedano B, Ribosa-NoguÉ R, Villa-Bonomo C. Measuring functional impact of cognitive impairment: validation of the Parkinson's disease cognitive functional rating scale. Parkinsonism Relat Disord. 2013 Sep;19(9):812-7.
Additional Reference:
Ruzafa-Valiente E, Fernández-Bobadilla R, García-Sánchez C, Pagonabarraga J, Martínez-Horta S, Kulisevsky J. Parkinson's Disease--Cognitive Functional Rating Scale across different conditions and degrees of cognitive impairment. J Neurol Sci. 2016 Feb 15;361:66-71.
Document last updated August 2022