ALZHEIMER CLINICAL EVALUATION
FORMS AVAILABLE to download, complete,
print. These forms are provided in various states of utility.
There are potential copyright issues with all such forms,
but many have been widely used without regard to intellectual property concerns.
Click here for forms developed for the Alzheimer's Foundation of America to evaluate
cognitive and functional domains associated with the cognitive impairment of Alzheimer's disease.
Additional issues are mood, behavioral problems, and personaltiy changes.
DEPRESSION RATING SCALES
Geriatric Depression Depression Scale
Hamilton Depression Rating Scale - 24 item version - HDRS-24
Depression and Mood
Assessment Scale - DMAS
(Use caution with the PHQ-9 because of the direct query of suicidal ideation in item 9.
AGITATED BEHAVIOR RATING SCALES
Neuropsychiatric Inventory - Nursing Home - NPINH
Scales for other neurodegenerative, neuropsychiatric, somatic conditions:
Cohen-Mansfied Agitation Index - CMAI
Brief Psychiatric Rating Scale - BPRS
Rating Scale for Aggressive
Behavior in the Elderly - RAGE
Unified Parkinson's Disease
Rating Scale - UPDRS
Simpson-Angus Movement Scale
Barnes Akathisia Rating
Scale - Barnes
PainInventory-21 - by Ashford, Perlow, Wentt, for pain reported by Veterans
Brief Pain Inventory (BPI)
Defense and Veterans Pain Rating Scale
See this link for descriptions of 8 additional pain scales.
McGill Pain Questionnaire (MPQ-SF)
- see here for 2009 paper
Pain Catastrophizing Scale
Treatment Outcome of Pain States (TOPS)
VA Common Data Elements - GWI - 2021 - see Pain Section
The Brief Alzheimer Screen (BAS) is a test that is recommended for
primary care practitioners to screen patients over the age of
60 years for possible cognitive impairment. The MMSEs,
as a group of items to be arithmetically summed, is no longer
recommended by this site. One alternative is to complete
the form provided here and allow this form to calculate an
estimate of the relative number of years into Alzheimer's
disease suggested by the performance on the individual
items. The extended version, MMSEx, which provides a
broader picture, is recommended for assessment of patients
that do not pass the A-Screen.
Site constructed and maintained
by: J. Wesson
Ashford, M.D., Ph.D.
mail address: email@example.com - or - mailto:firstname.lastname@example.org
Forms and papers provided on this site may be
copyrighted by their authors or the publishers.
copyright by J. Wesson Ashford, M.D., Ph.D., to retain rights for
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