Alzheimer's Disease Assessment Scale Late (ADAS-L)
1. Word learning: (Record # of correct responses. If pt. is completely right on
trials one and two, trial three may be omitted. The patient's error score is the number
of items missed or recalled incorrectly.)
2. Remote memory
year you were born?
who was first President?
two presidents you remember?
what letter comes after a,b,c,?
your name? (first/last)
how old are you? (within 1 yr)
what is the year?
what is the month?
what country are we in?
name of this place?
4. Naming: If no answer after "What is this called?", give cue listed after
the object. Six errors are possible.
flower; (cue) grows in
bed; (cue) used
(cue) it makes a sound when blown
(cue) used for writing
(cue) a kind of building
you drink from it
5. Commands: An error on each counts one point. Instructions are: "I want you to
do some simple things for me." Each command can be repeated twice if necessary.
Point to the floor.
Put your hand together, then pull them apart.
6. Expressive language: Assessed by asking pt. to generate a sentence. Instructions
are: "I want you to say something for me that begins with ' I wish...'. Instructions
can be repeated if necessary. Response is scored as follows:
3 = no response
2 = response does not begin
1 = response begins with
"I wish", but, is not a sentence
0 = correct response
Total score for part one (0 - 35)
7. Memory: Rates the extent to which the clinician believes that the pt's. difficulties
in completing the exam are a result of memory failures.
4 = pt. completes none
of the tasks due to poor memory. Can not remember any of the instructions.
3 = has difficulty
remembering task instructions over 50% of time, & only completes 1-2
2 = has difficulty
remembering task instructions at least 25% of time, & fails to complete some
1 = has difficulty
remembering task instructions and fails to complete at least one task.
0 = may have some difficulty
in remembering instructions, but completes all tasks.
8. Speech : Rates pt.'s speech during the testing session, both in terms of quantity
and in terms of information conveyed.
4 = does not speak
even when spoken to.
3 = speech is limited to one
or two word utterances.
2 = Over 50% of the
responses are not understandable and vocabulary is significantly
1 = usually has difficulty
responding appropriately and some responses are not
0 = fluent speech but
understandability may sometimes be lost due to memory problems.
9. Comprehension: Rates pt.'s ability to comprehend speech which can be inferred from
either verbal or other responses during testing session.
4 = gives neither verbal nor
nonverbal indications of response.
3 = responds to voices by
orienting, but can follow no commands.
2 = occasionally responds
appropriately, usually to yes or no questions.
1= usually respond
appropriately, but often requires repetition or rephrasing.
0 = normal comprehension, or
only a few instances where repetition or rephrasing are
10. Movement control: Rates the extent to which pt. can perform common movements at
will. Score item based on
4 = has almost no movement
control. (e.g. bedridden due to dementia)
3 = ambulatory, but most
movements appear to be pointless and repetitious (e.g. pacing, rocking,
2 = initiates purposeful
activities, but also spends a significant amount of time in purposeless activity.
1 = has some difficulty
performing common but complex activities such as dressing.
0 = no obvious difficulty in
controlling movements except on specialized tests such as drawing.
11. Affect-Depression: rated on basis of information from caregivers and from direct
examination of the pt. Usual time period for this item is the week prior to the
4 = is continuously
depressed. Expresses depressed feelings (e.g."I wish I were dead.") with
evidence of reduced activity due to depressed mood.
3 = pervasive depressed mood, but
with some evidence of reactivity.
2 = more than one instance of
depressed mood (e.g. crying, depressive thoughts, lack of reactivity not appropriate to
1 = at least one instance of
depressed mood not appropriate to the situation.
0 = normal or appropriate mood.
12. Pathological Thinking/Perceptions: rates evidence of either delusions or
hallucinations based primarily on evidence provided by a caregiver. The time period is one
week prior to the exam.
4 = fixed delusions or frequent
hallucinations. May be paranoid or other delusions, but must not be simply a result
of poor memory or confabulation.
3 = delusions or hallucinations
that are frequent and affect the pt.'s behavior (e.g. wants to run away because he feels
the people around him are possessed.)
2 = any delusions or
hallucinations that occur repeatedly or any single delusion or hallucination that affects
the pt.'s behavior.
1 = any less severe delusion or
0 = no evidence of delusions or
Total score for part two = 0 - 24 _________
13. Memory & learning : Rates the extent to which the pt. shows evidence
of memory impairment outside the testing session.
Examiner asks caregiver about pt.'s usual activities,
and, if possible, determines how pt. responds to changes in surroundings or
4 = profound memory loss with no
evidence of ability to adapt to any change in surroundings;
little or no memory of remote events. (i.e. those prior to disease onset).
3 = severe memory loss; learns
almost no new information, but, may be able to remember people, events, objects from the
2 = serious memory loss with some
learning ability preserved; may be manifested by ability to adapt
rearranged furniture, ability to recognize new pt's., staff etc.
1 = moderate memory impairment,
but, several clear instances where pt. was able to follow and retain verbal instructions.
0 = usually remembers verbal
instructions, but may require reminders.
14. Speech : Rates speech outside the testing situation both in terms of quantity and
4 = never speaks or only
makes sounds that are not words.
3 = speech is limited to a
few words or phrases.
2 = speech is not
understandable at least 50% of the time.
1 = has difficulty
communicating; but, is understandable more than 50% of the time.
0 = fluent speech with
occasional lack of understandability due to memory problems.
15.Spontaneous movement : Rates the extent to which pt's. ability to initiate and
control purposeful movements is impaired.
To assess ask caregiver whether pt.
is able to walk, reach, pick up objects, & use utensils
4 = does not perform any
purposeful movements. (e.g. bedridden, chairbound)
3 = initiates only
occasional purposeful movements. (e.g. while eating & most movements are repetitious
2 = gross movements (e.g.
walking, reaching) performed at will; but, pt. has obvious difficulty with more complex
1 = at least one or more
instances of difficulty in spontaneous movement, even if only trying to dress or use
utensils or appliances.
0 = no difficulty in
16. Social awareness: Rates the extent to which the pt. can recognize and respond
appropriately to people around him.
4 = does not recognize even
3 = usually recognizes
immediate family members, but frequently misidentifies others. Instances of socially
behavior often present. ( Takes off clothes in front of others; does not respond
when spoken to).
2 = more than two
instances where the pt. misidentifies others, or more than two instances of inappropriate
1 = at least one instance
of misidentification or socially inappropriate behavior.
0 = recognizes other
familiar people and is socially appropriate.
Total score for part three: 0 - 16 _________
Items rated on basis of best available information, either from caregiver, pt's. chart,
or direct observation. Time frame of one week.
4 = doubly incontinent
3 = occasionally uses
toilet, but, soils and wets self frequently while awake.
2 = frequent soiling and
wetting while asleep,but no more than one instance per week while
1 = soiling or wetting
while asleep no more than twice per week.
0 = no incontinence or only
a rare accident. (less than 2 per week).
4 = can offer no
assistance in feeding, or actively resists eating.
3 = requires extensive
assistance in feeding; must be attended at every meal.
2 = tries to eat on his own, but,
is untidy, and needs assistance.
1 = often eats without
assistance, but, is messy at least 25% of the time.
0 = eats without assistance.
4 = can offer no assistance
in dressing, or actively resists dressing.
3 = requires extensive
assistance in dressing, but, moves limbs to assist in getting dressed.
2 = attempts to dress on
his own, but, requires assistance each time.
1 = can put clothes on with
few errors when they are selected by someone else.
0 = usually dresses
appropriately unaided, but, may need some assistance in selecting clothes.
20. Physical Ambulation
4 = bedridden, can not sit
3 = sits without support,
but, can not move a wheelchair without assistance.
2 = can move with a walker
or a wheelchair.
1 = can walk with a cane or
0 = walks without aid,
although distance may be reduced.
Total score for part four : 0 - 16 _____________
Total score for entire scale : 0 - 81 ______________