The Consortium to

Establish a Registry for

Alzheimer’s Disease (CERAD).
Part V.A normative study of the neuropsychological battery
K.A. Welsh, PhD; N. Butters, PhD; R.C. Mohs, PhD; D. Beekly, BS;
S. Edland, MS; G. Fillenbaum, PhD; and A. Heyman, MD

Article abstract-The neuropsychological tests developed for the Consortium to Establish a Registry for Alzheimer’s
Disease (CERAD) are currently used to measure cognitive impairments of Alzheimer’s disease (AD) in clinical investi-
gations of this disorder. This report presents the normative information for the CERAD battery, obtained in a large
sample (n = 413) of control subjects (ages 50 to 89) who were enrolled in 23 university medical centers in the United
States participating in the CERAD study from 1987 to 1992. We compared separately the performance of subjects with
high (212) and low ( d 2 ) years of formal education. For many of the individual cognitive measures in the highly edu-
cated group, we observed significant age and gender effects. Only the praxis measure showed a significant age effect in
the low-education group. Delayed recall, when adjusted for amount of material acquired (savings), was relatively unaf-
fected by age, gender, and level of education. Our findings suggest that the savings scores, in particular, may be useful
in distinguishing between AD and normal aging.
NEUROLOGY 1994;44:609-614

There are many brief mental status instruments
used to measure the degree and types of cognitive
impairments in the Most of these instru-
ments were validated on institutionalized patients
and differentiate definite cases of dementia from
normal controls. Because many mental status tests
have a restricted range of values in normal elderly
subjects (ie, ceiling effects), they have limited sensi-
tivity and specificity in detecting mild cognitive syn-
d r o m e ~ .In
~ ,addition,
~~ there are high false-positive
tendencies for many of these measures when used
in community samples of normal elderly subjects
with less education and of lower socioeconomic sta-
tus.11
The Consortium to Establish a Registry for Alz-
heimer’s Disease (CERAD) developed a neuropsy-
chological battery that is more extensive than a
simple mental status screen, is sensitive to early-
stage dementia,12J3and has substantial interrater
agreement (0.92 to L O ) , high test-retest reliability,
and longitudinal validity.14J5These findings, along
with the instrument’s brevity (20 to 30 minutes,
approximately) and relative ease of administration
and scoring, have suggested a broader clinical ap-
plicability than its original intended use in re-
search. In clinical settings where factors such as
patient fatigue, motivation, or incapacity prohibit
more extensive neuropsychological examination of
cognitive capacities, the CERAD battery would ap-
pear to be a favorable alternative. However, in clin-
ical settings, as well as in research studies de-
signed to detect dementia, use of the CERAD bat-
tery has been limited by the lack of normative val-
ues needed for clinical interpretation.
Normative information is critically important for
deciding who, on the basis of performance on the
battery, may be demented and who is not. Without
a clear indication of the normal range of perfor-
mance on the CERAD measures and the effects of
age and education on performance, interpretation
is subjective and prone to error. For patients with
early-stage dementia or those who are very old or
who have limited formal education, the need for ob-
jective information on the normal range of perfor-

From the Duke University Medical Center (Drs. Welsh, Fillenbanm, and Heyman), Durham, NC; Veterans Administration Medical Center and Univer-
sity of California at San Diego (Dr. Butters), La Jolla, CA; Mount Sinai School of Medicine (Dr. Mohs), New York, NY;and University of Washington (D.
Beekly and S. Edlandf, Seattle, WA.
Supported by NIA grants AGO6790 and AGO5128 to Duke University Medical Center by funds from the Veterans Administration, Washington, DC, and
NIA grants AGO8024 and AGO5131 to the University of California at San Diego, CA.
Received August 4, 1993. Accepted for publication in final form September 15, 1993.
Address correspondence and reprint requests to Dr. Kathleen Welsh, Bryan Alzheimer’s Disease Research Center, Duke University Medical Center,
2200 West Main Street, Suite A-230, Durham, NC 27705.

April 1994 NEUROLOGY 44 609

mance on the CERAD battery is essential.
This study reports performance on the CERAD
neuropsychological battery by 413 normal white
adults, 50 to 89 years of age, enrolled in the large
multicenter CERAD study. All subjects were exam-
ined by physicians to assess their neurologic and
functional status independent of the results of the
neuropsychological examination. Thus, this study
provides the normative data on the CERAD battery
needed for clinical diagnosis. Information from
other important demographic groups (blacks and
Hispanics) are not included here but are the subject
of the expanded enrollment in the CERAD project.
Methods. Subjects. Control subjects were recruited from
23 participating US C E W sites. The sample of 413 in-
dividuals included in these analyses consists of approxi-
mately e q u a l n u m b e r s of spouses of p a t i e n t s w i t h
Alzheimer’s disease (AD) enrolled in the CERAD study
and community volunteers. Because the number of en-
rolled black and Hispanic subjects was too small at the
time of data analysis to support normative inferences,
only the normative data for the white participants are
presented here. All subjects satisfied strict entry criteria
excluding serious neurologic, medical, and psychiatric dis-
orders that could affect mentation. All were 50 years of
age or older at entry into the study, and their first lan-
guage was English. Informed consent was obtained from
each subject by methods approved by the institutional re-
view board at each center.
Clinical assessment. Each of the control subjects en-
rolled in the CERAD project was examined by physicians
participating in CERAD. The clinical assessment, de-
scribed elsewhere,14 consists of a semistructured inter-
view of cognitive and functional status, drug inventory,
depression a n d medical history, t h e six-item S h o r t
Blessed test,16 and a general physical and neurologic ex-
amination, usually carried out by a neurologist or psychi-
atrist. Stage of disease was measured by the Clinical De-
mentia Rating ~ c a 1 e . l ~
Neuropsychologicat testing. The CERAD neuropsycho-
logical assessment battery was administered at each of
the participating sites by trained, certified psychometri-
cians, independent of the physician’s clinical evaluation.
The battery was designed to assess the basic cognitive
functions affected in AD and includes the various mea-
sures listed below, presented in the order of administra-
tion within the battery. The subtest abbreviations that
will be used throughout the text are also provided.
Verbal Fluencv Test (Fluencv). This test measures
verbal production, semantic memory, and language.18 It
requires the subject to name as many examples of the
category “animal” as possible in 1minute.
Boston Naming Test-modified (Naming). This test
measures visual naming and presents 15 line drawings
of common objects from the Boston Naming Test.lg These
items are stratified into three groups of five items each,
representing objects of high (easy to name), medium, and
low (hard to name) frequency of occurrence in the En-
glish language. The maximum score is 15.
Mini-Mental State Examination (MMSE). This is a
slightly modified version of the well-known screen of cog-
nitive function3 t h a t measures orientation, language,
concentration, constructional praxis, and memory. The
serial subtraction subtest has been replaced by the alter-
native test procedure, ie, spelling “world” backwards.
610 NEUROLOGY 44 April 1994
The maximum score on the test remains 30.
Word-list memory (Trial 1, Trial 2. Trial 3 learning).
This is a free-recall memory test that is also included in
the Alzheimer’s Disease Assessment Scale (ADAS; 20)
and assesses learning ability for new verbal information.
Three trials of a 10-item word list are presented. On each
trial, the 10 words are presented in a different order. The
subject is instructed to read aloud each word as it is pre-
sented. Immediately following each trial, the subject is
asked to recall as many items as possible. The maximum
score on each trial is 10.
Constructional praxis (Praxis). This task is also de-
rived from t h e ADAS.20 It measures visuospatial and
constructional abilities and requires the subject to copy
four line drawings presented in order of increasing com-
plexity (circle, diamond, overlapping rectangles, cube).
The total possible score is 11.
Word-list recall (Delav). This test assesses the ability
to recall, after a 5-minute delay, the 10 words given in
the word-list memory test. The maximum number of cor-
rect responses is 10. For each subject, a savings score
(Savings) is computed and is presented as a percentage,
reflecting the relative amount of verbal information re-
tained over the delay interval ([DelayPTrial 31 X 100 =
Savings).
Word-list recomition. The last test in the battery as-
sesses recognition of the words presented in the word-list
memory task (Rec-Yes) when presented among 10 dis-
tractor words (Rec-No). The maximum score for correct
recognition of the targets is 10. The maximum score for
correct discrimination of the distractors is also 10.
Procedures. The CERAD control subjects tended to
have high levels of education, similar to other research
studies of this nature.21v22For this reason, the sample
was subdivided into two groups, those with less than a
high school education and those with 12 years of school-
ing or more. Although the number of lower-education in-
dividuals was small, it was nevertheless retained to
allow exploratory analyses of the effects of educational
level on t h e various cognitive measures. These two
groups were further subdivided by age (50 to 69 years
and 70+ years) for an evaluation of the effects of age on
performance. The sample of control subjects with high
education was further divided into two groups by gender.
The number of subjects in the lower education sample,
however, was too small to allow further subdivision by
gender. This would have resulted i n cell sizes of fewer
t h a n five individuals i n some cases, which could give
misleading findings. Thus, analyses of performance on
t h e various cognitive measures in t h e low-education
groups were collapsed across gender.
Statistical analysis. Means and SDs were computed
for each of the above subdivided groups in the high- and
low-education strata. Comparisons of performance on
each of the cognitive measures were made with ANOVA
and post hoc t tests. Some cognitive measures proved
limited in range (eg, Naming). In these situations, equiv-
a l e n t nonparametric statistical t e s t s were used (eg,
Wilcoxon’s). To better define performance on the various
measures, the groups were collapsed and the distribution
of scores was determined. All statistical analyses were
carried out by the CERAD Methodology and Data Man-
agement Center using SAS (SAS, version 6.07, SAS In-
stitute, Cary, NC, 1991).
Results. Characteristics o f the sample. Demo-
graphic data for the high and low education groups
are presented in table 1.The average level of educa- tend t o do better than older subjects), the differ-
tion for men and women was similar within each of ences in the high-education group suggest that
the education strata (212 years, <12 years). How- women might be expected t o slightly outperform
ever, the ages of the men and women in the educa- men (who are older) on the various neuropsychologi-
tion groups differed significantly. In the highly edu- cal measures. In the low-education sample, in which
cated group, the men were significantly older than the groups are collapsed across gender, differences
the women, i n contrast with the low-education between men and women need t o be considered
group, in which the women were older than the men when interpreting the data. Normative results in
(p’s <0.001). Because age is often a significant modi- the low-education group may be largely driven by
fier of cognitive performance (ie, younger subjects the performance of elderly women.
Distribution of scores. The distribution of scores
on each measure for the entire sample is presented
Table 1. Demographic variables for total sample in table 2. In some instances, particularly on the
(N = 413) Naming, Rec-Yes, and Rec-No tasks, the distribu-
tion of scores clustered close t o the ceiling score.
212 Years education <12 Years education These limitations in range should be considered in
Men Women Men Women interpreting the data because the clinical implica-
(N= 127) (N= 240) (N= 16) (N= 30) tions of very small, albeit statistically significant,
Age (years) differences are likely to be minor. Use of cut-scores
Mean (SD) 70.5 (6.5) 67.0 (7.9) 67.4 (7.5) 71.6 (8.8) or percentile ranks may facilitate interpretation of
Range 55.6-84.9 50.5-88.3 55.5-80.5 53.5-86.8 individual performance outcomes.
Education (years) High-education group. The neuropsychological
Mean (SD) 14.9 (2.6) 14.5 (2.4) 9.1 (1.9) 9.1 (1.4) performance in the sample with 212 years of educa-
Range 12.0-21.0 12.0-21.0 5.0-11.0 6.0-11.0 tion (presented in table 3) should be considered
with the above caveats in mind. The analyses indi-

Table 2. Raw scores and cumulative percentages on CERAD measures:Distribution for total population
T = 413)

Raw
score MMSE Naming Fluency Praxis Trial 1 Trial2 Trial3 Delay Rec-Yes Rec-No

231 5 (100%)
30 169(100%) 4 (99%)
29 127(61%) 3 (99%)
28 66(30%) 6 (99%)
27 32(14%) 6 (98%)
26 14(6%) 7 (97%)
25 2(<3%) 7 (95%)
24 2(<2%) 15 (93%)
23 1(<1%) 16 (89%)
22 26 (85%)
21 19 (79%)
20 28 (74%)
19 28 (67%)
18 34 (60%)
17 32 (52%)
16 48 (44%)
15 284 (100%) 36 (32%)
14 100 (32%) 23 (23%)
13 22 (8%) 20 (17%)
12 4 (3%) 22 (12%)
11 2 (<2%) 15 (6%) 221 (54%)
10 1(<1%) 6(2%) 94 (23%) 3 (100%) 34 (100%) 86 (100%) 41 (100%) 323 (100%) 381 (100%)
9 6 (1%) 55 (13%) 9 (99%) 52 (92%) 105 (78%) 54 (89%) 64 (21%) 24 (8%)
8 - 24 (6%) 30 (97%) 111 (79%) 112 (53%) 105 (76%) 14 (6%) 8 (2%)
7 1(<l%) 14 (3%) 47 (90%) 104 (52%) 66 (26%) 81 (51%) 7 (3%)
6 5 (1%) 85 (79%) 66 (26%) 29 (10%) 62 (31%) 4 (1%)
5 109 (58%) 32 (11%) 11(3%) 39 (16%) 1 (<l%)
4 75 (31%) 8 (3%) 4 (<l%) 14 (7%)
3 39 (13%) 4 (1%) - 12 (4%)
2 13 (3%) 2 (<1%) - 2 (1%)
1 3 (<l%) - - 1 (<l%)
0 2 (<1%)

The number of individuals scoring a t each level of the various psychometric measures is indicated. Values in parentheses indicate the percentage
of subjects in the sample scoring a t that level or lower.

April 1994 NEUROLOGY 44 611

Table 3. Means and SDs on the CERAD measures by age and gender (N = 413)
I 1

n=61 n=151 n = 66 n=89 factors n = 23 n = 23 factors

MMSE 28.9 (1.1) 29.4 (0.8) 28.6 (1.3) 28.9 (1.3) 28.4 (1.3) 27.6 (2.2) ED*
Fluency 18.4 (5.8) 19.0 (4.8) 18.3 (4.5) 17.2 (4.2) 16.6 (4.4) 14.4 (3.7)
Naming 14.7 (0.7) 14.7 (0.6) 14.6 (0.7) 14.5 (0.7) 14.4(1.1) 14.3 (1.1) ED**
Praxis 10.3 (0.9) 10.3 (1.0) 10.3 (1.0) 10.0 (1.3) 9.9 (1.2) 8.8 (1.9) A*, ED**
Trial 1 5.1 (1.5) 6.1 (1.5) 4.6 (1.5) 5.1 (1.6) 4.1 (1.2) 4.8 (1.6)
learning
Trial 2 7.1 (1.5) 8.0 (1.4) 6.6 (1.5) 7.3 (1.2) 6.4 (1.7) 6.6 (1.7)
learning
Trial 3 8.0 (1.3) 8.8 (1.0) 7.7 (1.5) 8.2 11.4) 8.1 (1.3) 7.6 (1.9) ED*
learning
Delay 7.0 (2.1) 7.9 (1.6) 6.3 (1.8) 6.9 (1.7) 7.0 (1.9) 6.7 (1.9)
recall
Savings 86.7 (21.7) 89.9 (15.5) 81.5 (19.6) 85.3 (18.9) 86.8 (17.8) 89.7 (17.3)
Rec-Yes 9.7 (0.8) 9.8 10.5) 9.5 (0.8) 9.7 (0.7) 9.3 (1.0) 9.3 (1.2) ED**
Rec-No 9.9 (0.5) 9.9 (0.2) 9.8 (0.5) 9.9 (0.3) 9.9 (0.3) 9.9 (0.3)
Means and SDs (presented in parentheses) for each of the CERAD measures in the high- (N = 367) and low- ( N = 46) education groups. For the
high-education strata (left side of table), the data for men and women are presented separately, and age, gender, and age X gender effects were
explored. In the low-education strata (right side of table), only age effects could be explored because of limited sample size. Overall education
effects were examined in the entire sample, composed of both high- and low-educated subjects.
A = age factor. G = gender factor. ED = education factor. Statistically significant overall group differences (ANOVA) are indicated (*I for each
factor. * p < 0.05, * * p < 0.01, ***p < 0.001.

cated significant age and gender effects on some
measures where no serious restrictions in range
were present (MMSE, p < 0.01; each of the three
learning trials and the Delay measure, p's < 0.001).
In each of these instances, the younger groups out-
performed the older groups and women tended to
score higher than men did. Similar but milder de-
clines with age were noted on the Savings measure
and on the Naming test and one of the recognition
memory measures (Rec-Yes);no gender differences,
however, were seen on any of these measures. Fi-
nally, performance on the Fluency and Praxis mea-
sures were not influenced by age or gender in this
highly educated group.
Low-education group. The neuropsychological
performance of individuals with <12 years of edu-
cation is presented in the far-right columns of table
3. Because of the small size of this sample, the ef-
fects of gender were not analyzed. Unlike the re-
sults in the highly educated group, no significant
differences emerged between the age groups on
tests of learning or memory. The only measure af-
fected by age in this sample was Praxis ( p < 0.05).
Education effects. To explore the effects of educa-
tion on the various neuropsychological measures,
each education stratum (<12 years, 212 years) was
collapsed across age and gender, and performance
on the measures was then compared between the
two education groups. The results of these analyses
are presented in the far-right column of table 3.
Analysis of MMSE scores across groups revealed
significant differences ( p < 0.051, and highly signifi-
cant differences were also seen on Naming and
Praxis (p's < 0.01). In each instance, whenever edu-
612 NEUROLOGY 44 April 1994
cation effects emerged, the more highly educated
group, as expected, outperformed the lower-edu-
cated group. In contrast with these measures, there
were no significant differences between the low-
and high-education groups on the Fluency measure
or on most of the learning and memory measures,
including Trial 1 and Trial 2 learning, Delay, Sav-
ings, and recognition of distractors (Rec-No). The
only memory measures affected by education were
Trial 3 learning and Rec-Yes.
Discussion. The results of these analyses indicate
that the neuropsychology measures in the CERAD
battery are differentially affected by age, education,
and gender. This is particularly evident in the sub-
jects with 12 years' or more education, of whom
there are sufficient numbers to evaluate all the fac-
tors. In this group, tests of verbal learning and
memory were most affected by age, education, and
gender. Performance scores on the memory mea-
s u r e s decreased with age a n d were higher in
women. The memory measures were largely unaf-
fected by education, a finding consistent with other
reports.23There were similar results with the
MMSE, confirming many previous s t ~ d i e s . ~ ~ In- ~ O
contrast to these results, several measures of cogni-
tive function were affected by some but not all de-
mographic factors. For example, Praxis was affected
by education but not by age or gender; Naming was
affected by age and education but not gender; and
Savings, although slightly vulnerable to age, was
not affected by either education or gender. In the
subjects with fewer than 12 years' education, of
whom the sample size is small, we did not analyze
gender. The Praxis measure was the only measure
affected by age in this group.
The lack of an age effect in either the high- or
low-education groups on the Fluency measure was
somewhat surprising and appears to conflict with
other reports that indicate age-related declines in
verbal p r o d u ~ t i o n .Those
~ ~ , ~ studies,
~ however, in-
cluded a broader range of ages. Thus, the apparent
conflict between studies may actually indicate that
little additional age-related change in fluency oc-
curs after age 67 or so (the average age of our
youngest subgroup), an interpretation supported by
other studies using similar fluency procedure^.^^-^^
Of special importance in this study are the find-
ings obtained with the Savings scores. Unlike the
other learning and memory measures, including
Delay, the Savings scores showed only minimal ef-
fects of age, and then only in the highly educated
group. This finding is consistent with other reports
u s i n g s i m i l a r memory m e a s u r e s i n t h e el-
derly,23,31,36-38 which indicate that Delay, particu-
larly when adjusted for acquisition, is fairly resis-
tant to decline with age. This measure, which is
very sensitive to early AD12J3fortunately is rela-
tively unaffected by age, education, and gender.
Since the learning and Delay measures are some-
what depressed as a function of normal aging (and
to a greater extent as a function of AD), the pres-
ence of ambiguous performance, such as partial for-
getting, poses a difficult diagnostic dilemma. How-
ever, since the ratio of the measures (Savings) de-
creases only slightly with age and is unaffected by
gender and education, which often confound inter-
pretation, the decrease in Savings may be particu-
larly helpful in diagnosing cognitive impairment.
Performance on both Delay and Savings should be
impaired in cases of AD. Thus, considering both
measures together should increase the likelihood of
detecting and differentiating this disorder from the
benign cognitive impairment in aging.
Some caveats are necessary, however, when ap-
plying the above findings to clinical practice. The
present sample consists entirely of white subjects
who are, for the most part, well educated. The
number of subjects with lower educational attain-
ment was very small, and for this reason, the
norms for this subgroup must be considered only
preliminary. Because of these small numbers, the
power to detect education effects was reduced, and
the influence of low education on the individual
measures in the CERAD battery may not be sub-
stantive. Moreover, extrapolation of our findings t o
populations with different culturaVethnic groups35
may be inadvisable.
In summary, the use of the CERAD battery in
this sample of normal individuals ages 50 to 89
shows that older persons perform less well on many
of the subtests. The CERAD word list learning test
and the Delay measure particularly appear affected
by age. Importantly, however, age had only a mini-
mal effect on delayed recall when initial learning
was taken into consideration (ie, the Savings mea-
sure). The level of education did not affect the Delay
or Savings memory measures. The amount of edu-
cation did affect performance on the Naming and
the Praxis procedures. When applying these find-
ings to the clinical evaluation of the elderly, particu-
lar attention should be directed to the Delay mea-
sure and the Savings scores. In the early stages of
dementia (such as AD), cognitive loss caused by this
disorder should be suspected if both the Delay score
and the Savings score are significantly decreased.
Modest impairments in delayed recall, when associ-
ated with adequate Savings scores, would be less di-
agnostic. These considerations, however, should de-
pend on the results of the clinical examination and
other neuropsychological findings.
Acknowledgments
We would like to acknowledge the various CERAD centers and
the many investigators (neurologists, psychiatrists, neuropsy-
chologists, and clinical coordinators) a t each site who con-
tributed data to this work. The centers include Burke Rehabili-
tation Center, White Plains, Ny, Baylor University College of
Medicine, Houston, TX; Case Western Reserve University,
Cleveland, OH; Columbia University, New York, Ny, Duke Uni-
versity Medical Center, Durham, NC; Emory University School
of Medicine, Atlanta, GA; Graduate Hospital, Philadelphia, PA,
Johns Hopkins University, Baltimore, MD; Massachusetts Gen-
eral Hospital, Boston, M A Mount Sinai Medical Center, New
York, Ny; University of Alabama, Birmingham, AL; University
of Kentucky Medical Center, Lexington, Ky; University of Pitts-
burgh Medical School, Pittsburgh, PA; University of Rochester
Medical Center, Rochester, Ny, University of Southern Califor-
nia, Los Angeles, CA; University of Texas, Southwestern Medi-
cal Center, Dallas, Tx; University of Washington, Seattle, WA;
Veterans Administration Medical Center and University of Cali-
fornia at S a n Diego, La Jolla, CA, Veterans Administration
Medical Center, Minneapolis, MN; and Washington University
School of Medicine, St. Louis, MO. We also wish to acknowledge
the contributions to this work of the various members of the
CERAD steering committee: Leonard Berg, MD, coprincipal in-
vestigator of the CERAD study, and Mokhtar Gado, MD (Wash-
ington University School of Medicine, St. Louis, MO); Patricia
Davis, MD, and Suzanne Mirra, MD (Emory University School
of Medicine, Atlanta, GA); Gerald van Belle, PhD (University of
Washington, Seattle, WA); and Marilyn Albert, PhD (Harvard
Medical School, Boston, MA). We appreciate the helpful com-
ments of Florence Nash and William Wilkinson, PhD, and the
technical assistance of Kathleen Keating and Ron Nelson of the
Bryan Alzheimer's Disease Research Center.
References
1. Blessed G, Tomlinson BE, Roth M. The association between
quantitative measures of dementia and of senile change in
* the cerebral erev matter of elderlv subiects. Br J Psvchiatrv
1968;114:79fSl"l.
" . I
2. Eslinger PJ, Damasio AR, Benton AL,Van Allen M. Neu-
ropsychological detection of abnormal mental decline i n
older persons. JAMA 1985;253:670-674.
3. Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State":
a practical method for grading the cognitive state of patients
for the clinician. J Psychiatr Res 1975;12:189-198.
4. Jacobs JW,Bernhard MR, Delgado A, Strain JJ. Screening
for organic mental syndromes in the medically ill. Ann In-
tern Med 1977;86:40-46.
5. Kahn RL, Goldfarb AL,Pollack M, Peck A. Brief objective
measures for t h e determination of mental status in t h e
aged. Am J Psychiatry 1960;117:326-328.
6. Kendrick DC, Gibson AJ, Moyes IC. The Revised Kendrick
battery: clinical studies. Br J SOCClin Psycho1 1979;18:329-
April 1994 NEUROLOGY 44 613
 340.
7. Mattis S. Mental status examination for organic syndromes
in the elderly patient. In: Bellak L, Karasu TE, eds. Geri-
atric psychiatry. New York Grune and Stratton, 1976.
8. Pfeiffer E. A short portable mental status questionnaire for
the assessment of organic brain deficit in elderly patients. J
Am Geriatr SOC1975;23:433-441.
9. Anthony JC, LeResche L, Niaz U, Von Korff MR, Folstein
MF. Limits of the “Mini-Mental State” as a screening test
for dementia and delirium among hospital patients. Psychol
Med 1982;12:397-408.
10. Nelson A, Fogel BS, Faust D. Bedside cognitive screening in-
s t r u m e n t s : a critical a s s e s s m e n t . J N e r v M e n t D i s
1986;174:73-83.
11. Fillenbaum G, Heyman A, Williams K, Prosnitz B, Burchett
B. Sensitivity and specificity of standardized screens of cogni-
tive impairment and dementia among elderly black and
white community residents. J Clin Epidemiol 1990;43:651-
660.
12. Welsh KA, Butters N, Hughes J, Mohs R, Heyman A. Detec-
tion of abnormal memory in mild cases of Alzheimer’s dis-
ease using CERAD neuropsychological measures. Arch Neu-
rol 1991;48:278-281.
13. Welsh KA, Butters N, Hughes JP, Mohs RC, Heyman A. De-
tection and staging of dementia in Alzheimer’s disease: use
of the neuropsychological measures developed for the Con-
sortium t o Establish a Registry for Alzheimer’s disease
(CERAD). Arch Neurol 1992;49:448-452.
14. Morris JC, Heyman A, Mohs RC, et al. The Consortium to
Establish a Registry for Alzheimer’s Disease (CERAD). Part
I. Clinical and neuropsychological assessment of Alzheimer’s
disease. Neurology 1989;39:1159-1165.
15. Morris JC, Edland S, Clark C, et al. The Consortium to Es-
tablish a Registry for Alzheimer’s Disease (CERAD). Part
IV. Ratings of cognitive change in the longitudinal assess-
m e n t of probable Alzheimer’s d i s e a s e . Neurology
1993;43:2457-2465.
16. Katzman R, Brown T, Fuld P, et al. Validation of a short ori-
entation-memory-concentration test of cognitive impair-
ment. Am J Psychiatry 1983;140:734-739.
17. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A
new clinical scale for the staging of dementia. Br J Psychia-
try 1982;140:566-572.
18. Rosen WG. Verbal fluency in aging and dementia. J Clin
Neuropsychol1980;2: 135-146.
19. Kaplan EF, Goodglass H, Weintraub S. The Boston naming
test. Boston, MA Veterans Administration Medical Center,
1978.
20. Rosen WG, Mohs RC, Davis KL. A new rating scale for
Alzheimer’s disease. Am J Psychiatry 1984;141:1356-1364.
21. Ivnik RJ, Malec JF, Tangalos EG, Petersen RC, Kokmen E,
Kurland LT. Mayo’s Older Americans Normative Studies:
WMS-R n o r m s for a g e s 5 6 t o 94. Clin Neuropsychol
1992;6:49-82.
614 NEUROLOGY 44 April 1994
22. Ivnik RT, Malec J F , Tangalos EG, Petersen RC, Kokmen E,
Kurland LT. Mayo’s Older Americans Normative Studies:
updated AVLT norms for ages 56 to 97. Clin Neuropsychol
1992;6:83-104.
23. Inouye SK, Albert MS, Mohs R, Sun K, B e r h a n LF. Cogni-
tive performance in a high functioning community-dwelling
elderly population. J Gerontol 1993;48:M146-M151.
24. Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J . Age-spe-
cific norms for the Mini-Mental S t a t e Exam. Neurology
1988;38:1565-1568.
25. Crum RM, Anthony JC, Bassett SS, Folstein MF. Popula-
tion-based norms for the Mini-Mental State Examination by
age and educational level. JAMA 1993;2692386-2391.
26. Cummings JL. Mini-Mental State Examination: norms, nor-
mals, and numbers. JAMA 1993;269:2420-2421.
27. Fillenbaum GG, Hughes DC, Heyman A, George LK, Blazer
DG. Relationship of health and demographic characteristics
to Mini-Mental State Examination score among community
residents. Psychol Med 1988;18:719-726.
28. Jorm AF, Scott R, Henderson AS, Kay DWK. Educational
level differences on the Mini-Mental State: the role of test
bias. Psychol Med 1988;18:727-731.
29. O’Connor DW, Pollitt PA, Treasure FP, Brook CPB, Reiss
BB. The influence of education, social class and sex on Mini-
Mental State scores. Psychol Med 1989;19:771-776.
30. Tombaugh TN, McIntyre NJ. The Mini-Mental State Exami-
n a t i o n : a comprehensive review. J Am G e r i a t r S O C
1992;40:922-935.
31. Wiederholt WC, Cahn D, Butters NM, Salmon DP, Kritz-Sil-
verstein D, Barrett-Connor E. Effects of age, gender and ed-
ucation on selected neuropsychological tests in an elderly
community cohort. J Am Geriatr SOC1993;41:639-647.
32. Spreen 0, Strauss E. A compendium of neuropsychological
tests: administration, norms and commentary. New York:
Oxford University Press, 1991.
33. Bolla KI, Lindgren KN, Bonaccorsy C, Bleecker ML. Predic-
tors of verbal fluency (FAS) in the healthy elderly. J Clin
Psycho1 1990;46:623-628.
34. Cauthen NR. Verbal fluency: normative data. J Clin Psychol
1978;34:126-129.
35. Ganguli M, Ratcliff G, Huff FJ, e t al. Effects of age, gender,
and education on cognitive tests in a rural elderly commu-
nity sample: norms from the Monongahela Valley Indepen-
dent Elders Survey. Neuroepidemiology 1991;10:42-52.
36. Haaland KY, Linn RT, Hunt WC, Goodwin JS. A normative
study of Russell’s variant of the Wechsler Memory Scale in a
h e a l t h y e l d e r l y population. J Consult Clin Psychol
1983;51:878-881.
37. Ivnik R J , Smith GE, Tangalos EG, Petersen RC, Kokmen E ,
Kurland LT. Wechsler Memory Scale: I& dependent norms
for persons ages 65 to 97 years. Psychol Assess 1991;3:156-
161.
38. Petersen RC, Smith G, Kokmen E, Ivnik RJ, Tangalos EG.
Memory function in normal aging. Neurology 1992;42:396-401.
The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V.
A normative study of the neuropsychological battery
K. A. Welsh, N. Butters, R. C. Mohs, et al.
Neurology 1994;44;609
DOI 10.1212/WNL.44.4.609

This information is current as of April 1, 1994

Updated Information & including high resolution figures, can be found at:
Services http://www.neurology.org/content/44/4/609.full.html

Citations This article has been cited by 91 HighWire-hosted articles:

http://www.neurology.org/content/44/4/609.full.html##otherarticle
s
Permissions & Licensing Information about reproducing this article in parts (figures,tables)
or in its entirety can be found online at:
http://www.neurology.org/misc/about.xhtml#permissions
Reprints Information about ordering reprints can be found online:
http://www.neurology.org/misc/addir.xhtml#reprintsus

Neurology ® is the official journal of the American Academy of Neurology. Published continuously
since 1951, it is now a weekly with 48 issues per year. Copyright © 1994 by AAN Enterprises, Inc.. All
rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.