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Parkinson's Disease-Cognitive Rating Scale (PD-CRS)
Please visit this website for more information about the instrument: Parkinson's Disease - Cognitive Rating Scale
Available in public domain.
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
Purpose: The PD-CRS is a global cognitive scale developed to assess the whole spectrum of cognitive impairments over the course of PD. It can be used to detect PD dementia and mild cognitive impairment. An alternate version is available (Pagonabarraga et al, 2008), (Fernández-Bobadilla et al., 2017). It is also available in other languages (e.g., Spanish, Italian). A validated Persian version is also available (Mahmoudi et al., 2020)
Overview: There are nine items assessing subcortical-type and cortical-type cognitive functions:
-Immediate free verbal recall (12 words)
-Confrontation naming* (name 20 line-drawings)
-Sustained attention (report the number of letters in a sequence of letters and numbers, 10 sets)
-Working memory (repeat first the numbers, then the letters in randomized lists of numbers and letters)
-Clock drawing
-Clock copying*
-Delayed free verbal recall (previous 12 words)
-Alternating verbal fluency (alternate between generating words starting with "S" and describing articles of clothing for 60 s)
-Action verbal fluency (name things people do)
*Cortical-type cognitive items
The administration (paper-pencil) takes approximately 20 min.
Comments/Special Instructions
The PD-CRS is appropriate for screening, prevalence and correlation studies, and treatment trials.  
Scoring and Psychometric Properties
Scoring: The maximum score is 134 (higher score indicates better performance). Subcortical (0 -114) and cortical scores (0 -20) are obtained by adding the raw scores of the items within each group. The total score (134) is calculated by adding the subcortical and cortical scores: Immediate free verbal recall (12), confrontation naming (20), sustained attention (10),
working memory (10), clock drawing (10), clock copying (10), delayed free verbal recall (12), alternating verbal fluency (20), action verbal fluency (30).
Psychometric Properties:
-Good construct validity supported by correlations with other global scales (Pagonabarraga et al., 2008),
Good internal consistency (Cronbach's alpha ? 0.82) (Pagonabarraga et al., 2008), (Skorvanek et al., 2018)
-Good test-retest reliability (0.75-0.94) (Pagonabarraga et al, 2008)
-Good inter-rater reliability (0.75-0.94) (Pagonabarraga et al., 2008)
-Very good discrimination between PD patients with and without dementia with a cutoff score of 62/134 (Serrano-Dueñas et al., 2016)
-Good discrimination between PD patients with mild cognitive impairment (MCI) and those with normal cognition with a cutoff score of 81/134 (Fernández de Bobadilla et al., 2013). But see Koevoets et al. (2018) who found that optimal cutoff for detecting PD-MCI vs PD with normal cognition was (<102), and this cutoff had sensitivity 0.88 and specificity 0.64.
-A change between 10-13 points in the PD-CRS total score is indicative of a clinically significant change (Fernández de Bobadilla et al., 2013).
-Normative values are available from an Italian cohort (Santangelo et al., 2017).
-Normative data available for healthy Greek persons (Aretouli et al., 2021).
-An alternate version is available.
-Provides broad coverage of several cognitive domains.
-Sensitive to change.
-Very sensitive and specific for detection of PD-dementia.
-Reasonably sensitive and specific for detection of PD-MCI.
Key References:
Pagonabarraga J, Kulisevsky J, Llebaria G, García-Sánchez C, Pascual-Sedano B, Gironell A. Parkinson's disease-cognitive rating scale: a new cognitive scale specific for Parkinson's disease. Mov Disord. 2008 May 15;23(7):998-1005.
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.
Additional References:
Aretouli E, Chondrogiorgi M, Dede O, Koutsonida M, Lafi C, Konstantinopoulou E, Kulisevsky J, Kosmidis MH, Konitsiotis S. The Parkinson's Disease-Cognitive Rating Scale: Greek Normative Data, Clinical Utility and Cultural Considerations. J Geriatr Psychiatry Neurol. 2021 Oct 18:8919887211049110.
Fernández de Bobadilla R, Pagonabarraga J, Martínez-Horta S, Pascual-Sedano B, Campolongo A, Kulisevsky J. Parkinson's disease-cognitive rating scale: psychometrics for mild cognitive impairment. Mov Disord. 2013 Sep;28(10):1376-83.
Koevoets EW, Schmand B, Geurtsen GJ. Accuracy of Two Cognitive Screening Tools to Detect Mild Cognitive Impairment in Parkinson's Disease. Mov Disord Clin Pract. 2018 Mar 23;5(3):259-264.
Mahmoudi Asl A, Mehdizadeh M, Kulisevsky J, Sabet A, Taghavi Azar Sharabiani P, Mehdizadeh H, Ashayeri H, Taghizadeh G. Reliability, validity, and diagnostic accuracy of Parkinson's Disease-Cognitive Rating Scale in Iranian patients with idiopathic Parkinson's disease. Disabil Rehabil. 2020 Sep 14:1-8.
Santangelo G, Lagravinese G, Battini V, Chiorri C, Siciliano M, Abbruzzese G, Vitale C, Barone P. The Parkinson's Disease-Cognitive Rating Scale (PD-CRS): normative values from 268 healthy Italian individuals. Neurol Sci. 2017 May;38(5):845-853.
Serrano-Dueñas M, Serrano M, Villena D, Granda D. Validation of the Parkinson's Disease-Cognitive Rating Scale Applying the Movement Disorder Society Task Force Criteria for Dementia Associated with Parkinson's Disease. Mov Disord Clin Pract. 2016 Mar 1;4(1):51-57.
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.
Document last updated August 2022