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Glossary of cognitive measures: ADAS-Cog 11/13, MMSE, CDR-SB, mPACC, ADNI-MEM, ADNI-EF and FAQ

These abbreviations name the scales and composite scores that Alzheimer's studies use to report how thinking and daily function change: the ADAS-Cog, MMSE, CDR-SB, PACC, ADNI-MEM and ADNI-EF measure cognition or severity, and the FAQ measures everyday function. Each score comes from a different instrument with its own range, so a number from one scale cannot be read as if it came from another.

What the studies found

ADAS-Cog 11 and ADAS-Cog 13. The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) was developed in the 1980s to assess the level of cognitive dysfunction in Alzheimer's disease. The 11-item version (ADAS-cog11) was the primary outcome in two bapineuzumab trials, with scores ranging from 0 to 70 and higher scores indicating greater impairment. The 13-item version (ADAS-Cog 13) appears as a secondary outcome in a phase 2 donanemab trial.

MMSE. The Mini-Mental State Examination is described in a Cochrane review as the best-known and most often used short screening tool for an overall measure of cognitive impairment in clinical, research and community settings. A second Cochrane review describes it as an 11-item test with a maximum score of 30.

CDR-SB. The Clinical Dementia Rating Sum of Boxes adds up the box scores of the Clinical Dementia Rating. In a study of 1577 participants from the Texas Alzheimer's Research Consortium, the optimal CDR-SB ranges matching the global CDR were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for 1.0, 9.5 to 15.5 for 2.0, and 16.0 to 18.0 for 3.0. A study of 382 ADNI participants with early or mild Alzheimer's found that the CDR-SB assesses both cognitive and functional domains.

PACC and mPACC. The Preclinical Alzheimer Cognitive Composite (PACC) is a cognitive composite designed to be sensitive to cognitive change in preclinical Alzheimer's disease and is used in secondary prevention trials. Studies report several named versions, including the MAPT-PACC in a prevention trial and the PACC5, which a 2017 study of 70 amyloid-positive older adults tested with category fluency added. A 2021 study followed PACC decline in clinically normal participants from three cohorts to locate an amyloid PET threshold.

ADNI-MEM and ADNI-EF. These are composite scores computed from the Alzheimer's Disease Neuroimaging Initiative test battery: ADNI-MEM for memory, ADNI-EF for executive function, and ADNI-LAN for language. The ADNI-EF paper derived the executive score by item response theory from WAIS-R Digit Symbol Substitution, Digit Span Backwards, Trails A and B, Category Fluency and Clock Drawing in 800 ADNI participants. In 390 participants with mild cognitive impairment, ADNI-EF showed the greatest change over time, followed closely by Category Fluency.

FAQ. The Pfeffer Functional Activities Questionnaire (FAQ) is an informant-based measure of everyday function, not a memory test. In a 2002 Neurology study of people with mild cognitive impairment it was given at baseline with the Lawton Instrumental Activities of Daily Living scale, and informant-reported functional deficits, but not self-reported deficits, significantly predicted the development of Alzheimer's disease.

How the scales compare. Using data from 1709 ADNI participants, one study found multiple inflections in CDR-SOB and ADAS-Cog scores within a given MMSE score, suggesting that the CDR-SOB and ADAS-Cog are more precise than the MMSE in measuring the severity of cognitive dysfunction.

What remains uncertain

The abstracts in the library do not spell out every item of the ADAS-Cog 13, and none of the records the library holds states the exact test list of ADNI-MEM or of the modified PACC (mPACC), so this page does not give them. The PACC is also reported in several versions, so a PACC score from one study is not automatically comparable with another.

The 2018 ADAS-Cog review notes that use of the ADAS-Cog has extended into pre-dementia studies despite concerns about its ability to detect important changes at those milder stages. A score on any of these scales is one measurement, and a clinician who knows the person is the one who can say what it means for them.

This page describes what published studies in alzhub's library report. It is not medical advice and does not apply to any one person. Where a decision would follow, a clinician who knows the person is the one who can say what a result or a choice means for them.

Questions

What is the difference between ADAS-Cog 11 and ADAS-Cog 13?
The names refer to the number of items: the 11-item and 13-item versions of the cognitive subscale of the Alzheimer's Disease Assessment Scale. In the bapineuzumab trials the 11-item version scored from 0 to 70, with higher scores indicating greater impairment.
What is the highest MMSE score?
A Cochrane review describes the MMSE as an 11-item test with a maximum score of 30.
Is the FAQ the same as a list of frequently asked questions?
No. In these studies FAQ is the Pfeffer Functional Activities Questionnaire, which assesses everyday function and is typically answered by an informant.

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