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The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment
Fatma Özge Kayhan Koçak, Emre Kumral. PLoS ONE, 2025-05-02
Topic: Risk, prevention and care in population studies
This study analyzed 871 patients with cognitive impairment, 69.8% of whom were having functional impairment. Alzheimer's disease was the most common type of dementia (64.6%), with memory problems as the key symptom (65.6%). Neuropsychiatric symptoms such as hallucinations, delusion, and eating disturbances were significantly associated with disability (p < 0.001), while depression and anxiety were not. CDR scale was the strongest predictor of disability (OR: 4.9, AUC = 0.740), outperforming other dementia staging scales. Cognitive and behavioral scales like MMSE and NPI showed stronger correlations with functional impairment than with the dementia staging scales (-0.132 < rs < 0.472, p < 0.001 and -0.284 < rs < -0.357, p < 0.001, respectively). Our study demonstrated that both cognitive status and behavioral symptoms are critical in determining the level of functional impairment in cognitive impairments, but their contributions differ in magnitude and focus. As well as cognitive decline, neuropsychiatric symptoms may also need targeted management to reduce their impact on functionality. We need a practical tool that can be used in all stages of dementia, that does not overlook the impact of neuropsychological symptoms, and that can assess ADL according to the needs of patients and carers.
Key findings
- This study analyzed 871 patients with cognitive impairment, 69.8% of whom were having functional impairment.
- Alzheimer's disease was the most common type of dementia (64.6%), with memory problems as the key symptom (65.6%).
- Neuropsychiatric symptoms such as hallucinations, delusion, and eating disturbances were significantly associated with disability (p < 0.001), while depression and anxiety were not.
- CDR scale was the strongest predictor of disability (OR: 4.9, AUC = 0.740), outperforming other dementia staging scales.
- Cognitive and behavioral scales like MMSE and NPI showed stronger correlations with functional impairment than with the dementia staging scales (-0.132 < rs < 0.472, p < 0.001 and -0.284 < rs < -0.357, p < 0.001, respectively).
Why it matters
Among 871 patients with cognitive impairment, neuropsychiatric symptoms such as hallucinations, delusion, and eating disturbances were significantly associated with disability, while depression and anxiety were not, and the CDR scale was the strongest predictor of disability. The authors conclude that both cognitive status and behavioral symptoms matter for functional impairment and that neuropsychiatric symptoms may need targeted management, but this is an observational analysis, not a treatment trial.
Study details
- Participants871
- Effect size69.8%; 64.6%; 65.6%
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (PLoS ONE) |
| Journal's citation record | 4 / 4 | PLoS ONE: journal h-index 594 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 871 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Emre Kumral: h-index 31 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Ege University: institution h-index 314 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40315238) |
| Free to read | 2 / 2 | Free to read |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Koçak, F. Ö. K., & Kumral, E. (2025). The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment. PLoS ONE. https://doi.org/10.1371/journal.pone.0322572
Vancouver
Koçak FÖK, Kumral E. The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment. PLoS ONE. 2025. doi:10.1371/journal.pone.0322572. PMID: 40315238.
BibTeX
@article{kocak2025-40315238,
author = {Koçak, Fatma Özge Kayhan and Kumral, Emre},
title = {{The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment}},
journal = {PLoS ONE},
year = {2025},
doi = {10.1371/journal.pone.0322572},
pmid = {40315238},
url = {https://doi.org/10.1371/journal.pone.0322572}
}
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