Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening
Authors: Nosheny Rachel L. , Yen Daniel , Howell Taylor , Camacho Monica , Moulder Krista , Gummadi Shilpa , Bui Chau , Kannan Sandhya , Ashford Miriam T. , Knight Kristen , Mayo Connie , McMillan Maureen , Petersen Ronald C. , Stricker Nikki H. , Roberson Erik D. , Chambless Carol , Gersteneker Adam , Martin Roy , Kennedy Richard , Zhang Yue , Kukull Walter , Flenniken Derek , Fockler Juliet , Truran Diana , Mackin R. Scott , Weiner Michael W. , Morris John C. , Li Yan 
Published: September 2023

ImportanceThe Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging.ObjectiveTo evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment.Design, Setting, and ParticipantsThis multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails.ExposuresParticipants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device.Main Outcomes and MeasuresThe primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions.ResultsA total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments.Conclusions and RelevanceThese findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings.