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Alzheimer's Disease Assessment Scale-Cognition (ADAS-cog)
Please visit this website for more information about the instrument: Alzheimer's Disease Assessment Scale-Cognition
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
The Alzheimer's Disease Assessment Scale- Cognition (ADAS-cog) was developed specifically to address selected aspects of cognitive function in Alzheimer's Disease (AD).
Overview: The 11-item scale is designed to address language and memory skills in AD patients. Several variants exist, including a 13-item measure and an item response theory (IRT) measure used for mild cognitive impairment (MCI). The administration takes approximately 35-45 minutes.

Languages: eProvide indicates that the scale has been translated into 81 languages as of November 2021. However, the extent to which these versions have been used, harmonized or validated is unclear.


Construct measured: Cognition (specific for: memory, language, praxis).
Generic vs. disease specific: Designed specific to Alzheimer's disease.
Means of administration: Rater administered paper and pencil. Training required.
Intended respondent (e.g., patient, caregiver, etc.): Patient.
Scoring and Psychometric Properties
Scoring: maximum: 70 (for 11-item version); higher = worse cognition. There are up to 25 points for language, 27 points for memory, 10 points for praxis, 8 points for orientation.


Psychometric Properties: The test is not normed and thus no adjustments are made for demographics. No unique cutoff scores are provided for Parkinson's disease dementia (PDD) or PD-MCI.

Parkinson's Disease-specific:

Although recommended as a cognitive outcome measure in PDD by Holden et al. (2016), the ADAS-Cog was only "suggested" for use as a cognition rating scale in PD by a Movement Disorder Society (MDS) task force (Skorvanek et al., 2018). The ADAS-Cog yields significantly different mean scores in Parkinson's disease groups with mild vs moderately severe dementia (defined per Mini-Mental State Examination (MMSE)) (Harvey et al., 2010). 4-week test-retest reliability was good: Spearman correlations were 0.652 for mild PDD and 0.714 for moderate PDD (Harvey et al 2010). PDD is more impaired than AD on language and praxis, while AD is more impaired than PDD in memory (Farlow et al., 2013). ADAS-Cog Total score is sensitive to treatment change in PD as seen in a 7-month cognitive rehabilitation program (Reuter et al., 2012) and sometimes (Weintraub et al., 2011) but not always after cholinesterase inhibitor treatment in PDD (Dubois et al., 2012).


It is not known whether ADAS-Cog is sensitive to progression to dementia, i.e., from PD to PD-MCI to PDD, but it is unlikely to be given its lack of sensitivity to change in MCI (Podhorna et al., 2016).
Strengths: A copyright-free alternative to MMSE. Brief screening, provides subdomain scores, easy to administer, supported by clinimetrics.

Weaknesses: Not often used in PD; as a screening test provides only superficial neuropsychological evidence, and not adequate to identify MCI.
Key References:
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984 Nov;141(11):1356-64.
Mohs RC, Knopman D, Petersen RC, Ferris SH, Ernesto C, Grundman M, Sano M, Bieliauskas L, Geldmacher D, Clark C, Thal LJ. Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer's Disease Assessment Scale that broaden its scope. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11 Suppl 2:S13-21.
Additional References:
Balsis S, Unger AA, Benge JF, Geraci L, Doody RS. Gaining precision on the Alzheimer's Disease Assessment Scale-cognitive: a comparison of item response theory-based scores and total scores. Alzheimers Dement. 2012 Jul;8(4):288-94.
Baron M, Jimenez Escrig A, Orensanz L, Gobernado JM. The Alzheimer's disease assessment scale. Neurology. 1998 May;50(5):1516.
Chu LW, Chiu KC, Hui SL, Yu GK, Tsui WJ, Lee PW. The reliability and validity of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the elderly Chinese in Hong Kong. Ann Acad Med Singap. 2000 Jul;29(4):474-85.
Doraiswamy PM, Bieber F, Kaiser L, Krishnan KR, Reuning-Scherer J, Gulanski B. The Alzheimer's Disease Assessment Scale: patterns and predictors of baseline cognitive performance in multicenter Alzheimer's disease trials. Neurology. 1997 Jun;48(6):1511-7.
Doraiswamy PM, Kaiser L, Bieber F, Garman RL. The Alzheimer's Disease Assessment Scale: evaluation of psychometric properties and patterns of cognitive decline in multicenter clinical trials of mild to moderate Alzheimer's disease. Alzheimer Dis Assoc Disord. 2001 Oct-Dec;15(4):174-83.
Dubois B, Tolosa E, Katzenschlager R, Emre M, Lees AJ, Schumann G, Pourcher E, Gray J, Thomas G, Swartz J, Hsu T, Moline ML. Donepezil in Parkinson's disease dementia: a randomized, double-blind efficacy and safety study. Mov Disord. 2012 Sep 1;27(10):1230-8.
Farlow MR, Schmitt F, Aarsland D, Grossberg GT, Somogyi M, Meng X. Comparing clinical profiles in Alzheimer's disease and Parkinson's disease dementia. Dement Geriatr Cogn Dis Extra. 2013 Sep 11;3(1):281-90.
Graham DP, Cully JA, Snow AL, Massman P, Doody R. The Alzheimer's Disease Assessment Scale-Cognitive subscale: normative data for older adult controls. Alzheimer Dis Assoc Disord. 2004 Oct-Dec;18(4):236-40.
Gillen TE, Gregg KM, Yuan H, Kurth MC, Krishnan KR. Clinical trials in Alzheimer's disease. Calculating Alzheimer's Disease Assessment Scale-cognitive subsection with the data from the consortium to establish a registry for Alzheimer's disease. Psychopharmacol Bull. 2001 Spring;35(2):83-96.
Harvey PD, Ferris SH, Cummings JL, Wesnes KA, Hsu C, Lane RM, Tekin S. Evaluation of dementia rating scales in Parkinson's disease dementia. Am J Alzheimers Dis Other Demen. 2010 Mar;25(2):142-8.
Holden SK, Jones WE, Baker KA, Boersma IM, Kluger BM. Outcome measures for Parkinson's disease dementia: a systematic review. Mov Disord Clin Pract. 2016 Jan-Feb;3(1):9-18.
Khan A, Yavorsky C, DiClemente G, Opler M, Liechti S, Rothman B, Jovic S. Reliability of the Alzheimer's disease assessment scale (ADAS-Cog) in longitudinal studies. Curr Alzheimer Res. 2013 Nov;10(9):952-63.
Kueper JK, Speechley M, Montero-Odasso M. The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog): Modifications and Responsiveness in Pre-Dementia Populations. A Narrative Review. J Alzheimers Dis. 2018;63(2):423-444.
Liu HC, Teng EL, Chuang YY, Lin KN, Fuh JL, Wang PN. The Alzheimer's Disease Assessment Scale: findings from a low-education population. Dement Geriatr Cogn Disord. 2002;13(1):21-6.
Pena-Casanova J. Alzheimer's Disease Assessment Scale--cognitive in clinical practice. Int Psychogeriatr. 1997;9 Suppl 1:105-14.
Podhorna J, Krahnke T, Shear M, Harrison JE; Alzheimer's Disease Neuroimaging Initiative. Alzheimer's Disease Assessment Scale-Cognitive subscale variants in mild cognitive impairment and mild Alzheimer's disease: change over time and the effect of enrichment strategies. Alzheimers Res Ther. 2016 Feb 12;8:8.
Reuter I, Mehnert S, Sammer G, Oechsner M, Engelhardt M. Efficacy of a multimodal cognitive rehabilitation including psychomotor and endurance training in Parkinson's disease. J Aging Res. 2012;2012:235765.
Rozzini L, Vicini Chilovi B, Bertoletti E, Conti M, Delrio I, Trabucchi M, Padovani A. The importance of Alzheimer disease assessment scale-cognitive part in predicting progress for amnestic mild cognitive impairment to Alzheimer disease. J Geriatr Psychiatry Neurol. 2008 Dec;21(4):261-7.
Skorvanek M, Goldman JG, Jahanshahi M, Marras C, Rektorova I, Schmand B, van Duijn E, Goetz CG, Weintraub D, Stebbins GT, Martinez-Martin P; members of the MDS Rating Scales Review Committee. Global scales for cognitive screening in Parkinson's disease: Critique and recommendations. Mov Disord. 2018 Feb;33(2):208-218.
Weintraub D, Somogyi M, Meng X. Rivastigmine in Alzheimer's disease and Parkinson's disease dementia: an ADAS-cog factor analysis. Am J Alzheimers Dis Other Demen. 2011 Sep;26(6):443-9.
Document last updated August 2022