Dementia Rating Scale (DRS) – Sample

Abstract

The Dementia Rating Scale (DRS), originally developed by Steven Mattis in 1973, is a widely utilized clinical and research instrument designed for the quantitative assessment of cognitive impairment, particularly in diagnosing and tracking the progression of dementia. It is recognized as a more comprehensive and sensitive neuropsychological assessment tool than simpler screening measures, especially in detecting subcortical deficits and differentiating between various types of dementia. The DRS evaluates performance across five primary cognitive domains: Attention, Initiation/Perseveration, Construction, Conceptualization, and Memory. The scale’s later revision, the DRS-2, provides detailed scoring across these subscales, contributing to a robust total score used for severity classification.

Keywords

Dementia Rating Scale (DRS), Mattis Dementia Rating Scale (MDRS), Steven Mattis, cognitive impairment, dementia, neuropsychological assessment, Attention, Memory, Conceptualization, Geriatric psychiatry, DRS-2.

Authors

Steven Mattis

Purpose

The primary purpose of the DRS is to provide a standardized, quantitative measure of cognitive function across multiple domains for individuals suspected of having or diagnosed with organic mental syndrome or dementia. It is specifically valuable for clinical differential diagnosis, helping to distinguish between neurological disorders that cause cognitive decline, such as Alzheimer Type dementia, vascular dementia, and other forms of cognitive impairment, due to its detailed subscale analysis.

In addition to clinical diagnosis, the scale is frequently employed in research settings to measure the severity of cognitive deficits, monitor disease progression over time, and evaluate the efficacy of pharmacological or behavioral interventions. The scale’s structured nature allows clinicians to identify specific patterns of deficits, which is essential for targeted intervention strategies and prognostication.

Construct

The DRS is constructed to measure overall cognitive functioning by breaking down complex cognitive abilities into five distinct, yet interrelated, subscales, ensuring comprehensive coverage of domains often affected early in the dementing process. These subscales provide specific scores that contribute to a total score, typically ranging up to 144 points in the DRS-2 version.

The five core constructs evaluated by the DRS include: Attention (measuring focus, concentration, and working memory through tasks like digit span and visual scanning); Initiation/Perseveration (assessing the ability to start a new task, generate novel responses, and avoid repetitive or inappropriate behavior); Construction (evaluating visuospatial and motor praxis abilities, often through reproduction of geometric figures); Conceptualization (measuring abstract reasoning, inductive thinking, and problem-solving through similarity and difference tasks); and Memory (testing immediate and delayed verbal and visual recall and recognition, as well as orientation).

Validity

The DRS demonstrates strong clinical validity, particularly in differentiating between cognitively healthy individuals and those with dementia. Studies, such as those focusing on the detection of Alzheimer Type dementia (Monsch et al., 1995), confirm its high utility. The scale exhibits high concurrent validity with other established measures of cognitive function, often proving more sensitive than simpler screening tools in capturing the nuanced spectrum of cognitive decline.

Content validity is robust, given the comprehensive coverage of cognitive domains known to be affected by degenerative neurological conditions. Furthermore, the scale has been shown to be sensitive to longitudinal change, providing excellent criterion validity for measuring disease progression over time, which makes it a preferred outcome measure in clinical trials and long-term monitoring.

Reliability

The Psychometric properties of the DRS are well-established across numerous studies. The scale consistently demonstrates high internal consistency, indicating that the items reliably measure the underlying cognitive construct. Excellent inter-rater reliability is also reported, ensuring that scores remain consistent regardless of the administering clinician, due to the highly structured and objective scoring rules. Studies providing extensive normative data (Schmidt et al., 1994; Lucas et al., 1998) further confirm the scale’s stability and robust measurement capabilities across diverse populations.

Factor Analysis

Factor analytic studies of the DRS generally support the scale’s underlying structure of five clinical subscales, although the factors are often highly correlated. This high correlation suggests that while the subscales measure distinct aspects of cognition (e.g., Attention versus Construction), they are all reflective of a single, global factor representing overall dementia severity or cognitive efficiency. However, the retention of the five subscales remains clinically valuable as it allows practitioners to identify specific patterns of deficits that may aid in differentiating various etiologies of dementia, such as identifying prominent executive dysfunction (Initiation/Perseveration) or posterior cortical deficits (Construction).

Instrument

Test Type: Performance-based neuropsychological assessment scale

Format: Structured clinical interview and performance tasks (involving verbal responses, motoric actions, and paper-and-pencil tasks)

Language Available: Primarily English; translated versions are used internationally and require specific validation studies.

Population Group: Clinical populations with suspected or confirmed cognitive impairment, typically due to neurological disease or age-related decline.

Age Group: Adults and elderly individuals, particularly those evaluated in Geriatric psychiatry and neurology settings.

Population Details: Extensive normative data are available for healthy volunteers (Schmidt et al., 1994), including specific norms tailored for diverse demographic groups, such as older African Americans (Rilling et al., 2005).

Test Methodology: Administration requires a trained clinician to present standardized verbal commands and visual stimuli. Scoring is objective based on performance accuracy across the five subscales. The original PDF describing the instrument can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

Keywords

Cognitive decline, Mattis, DRS-2, memory assessment, neuropsychology, subcortical dementia, executive function, psychometric properties, normative data.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Correspondence related to the DRS-2 is typically directed to the publisher, Psychological Assessment Resources (PAR, Inc.).

Permissions & Fee and Test Year

The original scale was introduced by Steven Mattis in 1973. The revised version, DRS-2, is a proprietary instrument published by Psychological Assessment Resources (PAR, Inc.), requiring purchase of the professional manual and test forms for standardized use. Permissions for clinical and commercial use must be obtained directly from the publisher. The scale remains highly relevant and is a widely cited tool in health measurement and neurology.

Reference’s

Coblentz, M., Mattis, S., Zingesser, L.H., et al. (1979). Presenile dementia: clinical aspects and evaluation of cerebrospinal fluid dynamics. Arch Neurol, 29:299–308.

Lucas, J.A., Ivnik, R.J., Smith, G.E, et al. (1998). Normative data for the Mattis Dementia Rating Scale. Journal of Clinical and Experimental Neuropsychology, 20:536–547.

Mattis, S. (1988). Dementia Rating Scale: professional manual. Odessa, Florida: Psychological Assessment Resources, 1988.

Mattis, S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, eds. Geriatric psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune and Stratton, 1976:77–121.

McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS

Monsch, Andreas U., Bondi, Mark W., Salmon, David P., et al (1995). Clinical Validity of the Mattis Dementia Rating Scale in Detecting Dementia of the Alzheimer Type: A Double Cross-Validation and Application to a Community-Dwelling Sample. Arch Neurol, 52(9):899-904.

Rilling, L.M., Lucas, J.A., Ivnik, R.J, et al. (2005). Mayo’s older African American normative studies: norms for the Mattis Dementia Rating Scale. Clin Neuropsychologist, 19:229–242.

Schmidt, R., Freidl, W., Fazekas F., et al. (1994). The Mattis Dementia Rating Scale: normative data for 1,001 healthy volunteers. Neurology, 44(5):964–966.

Smith, G.E., Ivnik, R.J., Malec, J.F, et al. (1994). Psychometric properties of the Mattis Dementia Rating Scale. Assessment, 1:123–131.

Items of the Dementia Rating Scale (DRS) – Sample

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

I. Attention

• Digit span (Repeat three random digit strings forwards and backwards)
• Respond to successive commands (Open your mouth and close your eyes)
• Respond to single command (Stick out tongue)
• Imitate movement (Raise your right hand)
• Counting (Count A’s in matrix of letters‚ and in scrambled letter pattern)
• Reading (Lists of words)

II. Initiation and perseveration

• Verbal (Name things a person can buy at the supermarket; naming articles of clothing; Say “Bee‚ Key‚ Gee” four times.)
• Motor—double alternating (movement Left palm up‚ right palm down‚ then switch simultaneously several times)
• Graphomotor functions (Copy four geometric figures)

III. Construction

• Geometric figures (Copy five figures)

IV. Conceptualization

• Multiple choice:
• Similarities—verbal (In what way are an apple and a banana alike?)
• Primary inductive (Name three things people eat.)
• Differences (Which does not belong: dog‚ cat‚ car?)
• Similarities (Apple‚ banana. Are they both animals‚ fruit‚ or green?)
• Identities and oddities (Which two figures are the same? Which one is different?)
• cr‎eate sentence (Make up a sentence using the words man and car.)

V. Memory

• Verbal recall (Recall a simple sentence after distraction.)
• Orientation (Awareness of time‚ place‚ president)
• VI. Sentence recall (Repeat the simple sentence and the sentence involving man and car
• Verbal recognition (Forced choice format: se‎lect which word in a pair you have read on previous page.)
• Design recognition (Forced choice format: se‎lect which design in a pair you saw on the previous page.)

DRS-2™ Item Responses

Attention

• A. Digit Span (Recalling digits forward and backward)
• B. Two Successive Commands (Following two-part verbal commands)
• C. Single Command (Following one-part verbal commands)
• D. Imitation (Imitating motoric gestures)
• AD. Counting Distraction 1 (Visual scanning and target number identification)
• AE. Counting Distraction 2 (Visual scanning and target number identification)
• AH. Verbal Recognition-Presentation (Reading a list of words aloud)
• AJ. Visual Matching (Identifying visual design)

Initiation/Perseveration

• E. Complex Verbal Initiation/Perseveration (Naming U. S. States)
• F. Simple Verbal Initiation/Perseveration (Naming colors found in the room)
• G. Consonant Perseveration (“Say‚ ‘gee-key-bee’ four times.” )
• H. Vowel Perseveration (“Say‚ ‘boh-bah-bee’ four times.”)
• I. Double Alternating Movements 1 (Palm up/palm down — five repetitions)
• J. Double Alternating Movements 2 (Clenched/extended — five repetitions)
• K. Alternate Tapping (Tap left/tap right — 10 repetitions)
• L. Graphomotor Design 1 (Reproduction ramparts — five consecutive alternating “square-semi circle waves”)
• M. Graphomotor Design 2 (Reproduction of “semi circle”)
• N. Graphomotor Design 3 (Reproduction of “cross”)
• O. Graphomotor Design 4 (Reproduction of at least five consecutive alternating “cross and semi circle” pairs)

Construction

• P. Construction Design 1 (Reproduction of horizontal lines)
• Q. Construction Design 2 (Reproduction of circle in a triangle)
• R. Construction Design 3 (Reproduction of triangle and circle)
• S. Construction Design 4 (Reproduction of circle)
• T. Construction Design 5 (Reproduction of triangle)
• U. Construction Design 6 (Production of recognizable) name/signature

Conceptualization

• V. Identities and Oddities (Identifying similar and dissimilar visual designs)
• W. Similarities (Identifying how objects are alike; abstract concept formation)
• X. Priming Inductive Reasoning (Generating similar objects)
• Y. Differences (Identifying dissimilar verbal objects)
• Z. Similarities – Multiple Choice (Identifying how objects are alike in a multiple-choice format)
• AB. Verbal Recall – Sentence Initiation (Generate sentence using “child” and “ball”)

Memory

• AC. Orientation (Orientation to time‚ day‚ date‚ and situation)
• AF. Verbal Recall – Reading (Recall of sentence presented orally)
• AG. Verbal Recall – Sentence Initiation (Recall of sentence that was generated by the client)
• AI. Verbal Recognition (Verbal forced-choice recognition memory)
• AK. Visual Memory (Visual forced-choice recognition memory)