Reliability of the Clinical Dementia Rating with a Traumatic Brain Injury Population: A Preliminary Study

Abstract

This study examined the inter-rater reliability (IRR) of the Clinical Dementia Rating (CDR) for patients with traumatic brain injury (TBI). The CDR is a commonly used rating of impairment, but there has been no research examining its utility in patients with TBI. It was hypothesized that the CDR would have good IRR when used with patients with TBI. Two hundred and fifty U.S. neuropsychologists were randomly selected from the National Academy of Neuropsychology's membership list and were mailed packets of information (e.g., CDR, patient vignette, mental status, neuropsychological test information, and history). Professionals were asked to complete the CDR for the described patient and return the information. IRR was calculated for the Global CDR score and each of the six CDR domains. Of those packets mailed, 53 were returned and completed as instructed (21.2% response rate). Clinician experience varied from 0 to 31 years. Global CDR score IRR was 73.6%. Domain IRRs were as follows: Orientation, 79.2%; Home and Hobbies, 71.7%; Personal Care, 71.7%; Memory, 56.6%; Judgment and Problem Solving, 49.1%; and Community Affairs, 54.7%. Results suggest the CDR Global score has acceptable IRR (>.70). Overall concordance (W = .527) among raters was significant with moderate-to-strong agreement. Further research to improve the utility of this instrument is discussed.

Key words:

• Clinical Dementia Rating
• disability evaluation
• impairment evaluation
• inter-rater reliability
• traumatic brain injury

Notes

*For mean scores: 0 represents no impairment; 0.5 represents questionable impairment; 1.0 represents mild impairment; 2.0 represents moderate impairment; and 3.0 represents severe impairment.