[BRIEF COGNITIVE RATING SCALE (BCRS) udetines for Using the BCRS CRS is an assessment too! to be used with the Global Deterioration Scale (GDS) to help stage a person suffering from primary degenerative dementia such as Alzheimer’s disease, Developed by Dr. Barry Reisberg, this assessment tool tests $ tferentarcas known as Axis (4 cognitive and | functional) For the first 4 axis, the tester will ask a variety of questions to termine the level of impairment (see Guidelines for Scoring BCRS at the bottom of this page). The results of the Sth axis ‘unctioning) are determined primarily by observation. Tester can use the Functional Assessment Staging test (FAST) for a re accurate assessment, After a score is determined for each Axis, total the results and divide by 5. This answer will result lina stage corresponding on the GDS. Assessment Date | Date | Date _| Date 1 Date Brief Cognitive Rating Seale (BCRS)* Rating | Rating | Rating [Rating | Rating (Cizcle the Highest Rating Attained) ‘Axis I: Concentration T 1 1 1 T= No objective or subjective evidence of deficit im -oncentration. 2 2 2 2 subjective deerement in concentration ability. 3 3 3 3 inor objective signs of poor concentration (e.&., ibtraction of serial 7's from 100). 4 4 4 4 DPefinte concentration deficit for persons of theit -kgrounds (eg. marked deficit on serial 75; frequent efi: in subtraction of serials 4's from 40). 3 5 3 5 arked concentration deficit (2, giving months ickwards or serials 2's from 20) 6 6 6 6 6= Forges the concentration task, Frequently begins to count, fiorwacd when asked to count backwards from 10 by I's. farked difficulty counting forward to 10 by I's. 1 2 1 1 z ‘Axis Ii Recent Memory t 7 7 T fo cbjective or subjective evidence of deficit in recent fremary 2 2 2 2 Subjective impairment only (e.g. forgetting names more an formerly). 3 3 3 3 3= Deficit in eval of specific events evident upon detailed stoning. No deficit in recall of major recent events. 4 4 4 4 4 |Cannet recall major events of previous weekend or week, canty knowledge (not detailed) of current events, favorisTV shows, etc. 5 5 3 8 ‘Se [Unsure of weather; may not know current President or feurrent adress. 6 6 6 6 ecasional knowledge of some events, Little or no idea of surrent address, weather, et. 1 Ga 4 7_No knowledge of any recent eventsAxis II: Past Memory 6 a» Be 6 to. fo subjective or objective impairment in past memory.) subjective impairment only. Can recall two or more imary school teachers. some gaps in past memory upon detailed questioning. ‘le to recall at least one childhood teacher and/or one {childhood friend. ‘ear-cut deficit. The spouse recalls more of the patient's. | than the patient. Cannot recall childhood friends fand/or teachers but knows the names of most schools tended. Confuses chronotogy in reciting personal history fajor past events sometimes not recalled (e.g, names of chools attended) ome residual memory of past (e.g, may recall county of| nth o Former occupation. fo memory of past. ‘Axis IV: Orientation a o 1 io deficit in memory for time, place, identify of self or er. subjective impairment only. Knows time to nearest hour, location. ny mistakes in time >2.hours: day of week> | day; date 3 days. jtakes in month > 10 days or year > 1 month. insure of month and/or year and/or season; unsure of | local, | (0 idea of date. Identifies spouse but may not recall name. ‘mows own name. annct identify spouse. May be unsure of personal ldentiy‘Axis V: Functioning and Self-Care 1 1 T 1 I= No dificuity, either subjectively or objectively. 2 2 2 2 | 2 [Complains of forgetting location of objects. Subjective vk difficulties 3 3 3 3 ccreesed job functioning evident to coworkers. Difficulty veling to new locations. 4 4 4 4 de -crezsed ability to perform complex tasks (¢.g., planning liner for guests, handling Gnances, marketing, ee) cequites assistance in choosing proper clothing. 5 5 5 5 equives assistance in feeding, and/or toileting, and/or 6 6 6 6 fbathing, and/or ambulating. ites constant assistance in al activities of daily life. z 1 2 7 ie =Total Sore B= | = [=| 7= | TS= _ Stage on Global Deterioration Seale (GDS) Relsberg, 1983 |'Use with Global Deterioration Seale (GDS) UIDELINES FOR SCORING BCRS tings: Taking into account the subjects level of education, cultural background, e., the interviewer rates ach clinical axis on the BCRS on a scale ranging from | to 7. These scale points define the degree of airment on each axis as follows: T= Normal, no cogillive decline present. Average or beter performance. 2 Very mild, subjective impairment in comparison with 5 or 10 years previous. 3 = Mild. Minimal impaitment which is clinially verifiable with detailed questioning. ‘4 = Moderate, Marked impairment which is realty evidenced clinically. 5 = Moderately severe, Severe impairment on assessment, 6= Severe. Very severe impairment; some residual capacity in some assessment areas, ‘L= Very severe, Very severe impairment; litle residual capacity elicited in assessments Taxis fe Concentration - Assessing concentration and ailentiveness. Taking into account educational level, ask ‘How far did you go in school?" "How are you at subtraction?" "What is 7 from 1002 7 from 935 7 from 86° (if "do ask 4s; if cant do ask 23), laxis If: Impairment of Revent Memory ~ Ask "What did you do Inst weekend? What did you have for breakfast? /atis the weather like today? Who isthe president, tue governor, ec." xis II: Impaitment of Past Memory - Ask "What primary sczools did you attend? Where was it located?” Who fee your primary teachers? Where were you born? Who were your childhood friends? What kinds of things dic ‘ou do with your childhood ftiends?" \Axis IV: Orientation - Ask hour, day of week, date, place, idewity of self, [Axis V: Functioning and Self-Carefile Global Deterioration Seale (GDS), doveloped by Dr. , provides caregivers an overview off he stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. Its broken down into 7 different stages. Stages 1-3 re the pre- jementia stages. Stages 4-7 are the dementia stages. Beginning in stage S, an individual can 10 longer survive without assistance, Within the GDS, each stage is numbered (1-7), given a ‘hort title (i, Forgetfulness, Early Confusional, etc. followed by a brief listing of the sharacterstcs for that stage. Caregivers can get a rough idea of where an individual i at in he disease process by observing that individual's behavioral characteristics and comparing hem to the GDS. For more specific assessments, use the accompanying Brief Cognitive mating Scale (BCRS) and the Functional Assessment Staging (FAST) measures. I “The Global Deterioration Scale for Assessment of Primary Degenerative Dementia Level ‘Clinical Characteristies No cogative ee complaints of memory deficit. No memory deficit evident on clinica decline E 2 Subjective complaints of memory defi, most frequently in following areas: (a) Very mild cognitive forgetting where one has placed ‘amiliar objects; (b) forgetting names one former dectine new well, No objective evidence of memory deficit on clinical interview. N¢ (Age Associated piective deficits in employment or social situations. Appropriate concern wit Memory Impairment) _fespect to symptomatology. TEariest clearcut deficits. Manifestations in more than one of the following areas (4) patient may have gotten lost when traveling to an unfamiliar location; (b)o crkers become aware of patient's relatively poor performance; (e) word and nam Finding deficit becomes evident to intimates; (A) patient may reed a passage oF cane ok and retain relatively litle material; e) patient may demonstrate decreased ee city in remembering names upon introduction to new people; (f) patient m have fost or misplaced an object of value; (g) concentration deficit may be evident clinical testing, Objective evidence of memory deficit obtained only with lintensive interview. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate ‘anxiety xccompanies symptoms. lear-cut deficit on careful clinal Interview. Deficit manifest in following areas (Mild Cognitive Impairment (a) decreased knowledge of current and recent events; (b) may exhibit some dofici 4 fin memory of ones personal history; (c) concentration deficit elicited on serial Moderate cognitive bubtractions; (4) decreased ability to travel, handle finances, etc. Frequently 1 decline cit in following arcas: (a) orientation to time and place; (b) recognition o! (Mild Dementia) familiar persons and faces; to travel to familiar locations. Inability t erform complex tasks, Denial is dominant defense mechanism, Flattening of affec ind withdrawal from challenging situations frequently occur atient can no Tonger survive without some assistance, Patient is unable during erview to recall a major relevant aspect of their current lives, eg, an address 0 Jephone number of many yess, the names of close family members (such a 8 randchildren), the name of the high school or college from which they graduated| ‘Moderately severe ‘Frequently some disorientation to time (date, day of week, season, ete.) of to place: cognitive decline ‘edlucated person may have difficulty counting back from 40 by 4s or from 20 by} (Moderate Dementia) Bs. Persons at this stage retain knowledge of many major facts regarding themselves if others. They invariably kxow their own names and generally know thel ouses! and children's names. They require no assistance with toileting and eating ut may have some difficulty choosing the proper clothing to wear.6 Severe cognitive decline (Moderately Severe Dementia) 7 Very severe cognitive decline (Severe Dementia) [May occasionally forget the name of the spouse upon whom they are entre] fependent for survival, Will be largely unaware of all ecent events and experience in thei fives, Retain some knowledge of their past lives but this is very sketchy jenerslly unaware of their surroundings, the year, the season, ete. May ha litficulty counting from 10, both backward and, sometimes, forward. Will requird ome assistance With activities of daily living, e.g, may become incontinent, wil quire travel assistance but occasionally will be able to travel to familiar locations [Diurnal rhythm fiequently disturbed. Almost always recall their own name requently continue to be able to distinguish familiar fom unfamiliar persons in) fei environment. Personality and emotional changes oceur. These are quit ariable and include: (a) deltsional behavior, eg, patents may accuse thei spo 9f being an impostor, may talk to imaginary figures in the environment, oto thet »wn reflection in the mirror; (b) obsessive symptoms, e.., person may continual peat simple cleaning actvities; (€) anxiety symptoms, agitation, and even! jreviously nonexistent violet behavior may occur; (d) cognitive abulla Lc, oss of illpower because an individual cannot carry @ thought long enough to determine urposefil course of action. I verbal abilities are lost over the course Of this sage. Frequently there is hi peech at all -only unintelligible utterances and rare emergence of seemingly Forgotten words and phrases. Incontinent of urine, requires assistance toileting ani feeding. Basic psychomotor skills, eg, ability to walk, are Jost with the progressio this stage. The brain appears to n0 longer be able to tell the body what to do| jeneralized rigidity and developmental neurologic reflexes are frequently present, Bary Relsberg, MD. All Rights reserved. Reprocced with remission,