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BackgroundThe Alzheimer's Disease Assessment Scale Cognitive Behavior Section (ADAS-cog), a measure of cognitive performance, has been used widely in Alzheimer's disease trials. Its key role in clinical trials should be supported by evidence that it is both clinically meaningful and scientifically sound. Its conceptual and neuropsychological underpinnings are well-considered, but its performance as an instrument of measurement has received less attention.ObjectiveTo examine the traditional psychometric properties of the ADAS-cog in a large sample of people with Alzheimer's disease.MethodsData from three clinical trials of donepezil (Aricept) in mild-to-moderate Alzheimer's disease (n=1421; MMSE 10–26) were analysed at both the scale and component level. Five psychometric properties were examined using traditional psychometric methods. These methods of examination underpin upcoming Food and Drug Administration recommendations for patient rating scale evaluation.ResultsAt the scale-level, criteria tested for data completeness, scaling assumptions (eg, component total correlations: 0.39–0.67), targeting (no floor or ceiling effects), reliability (eg, Cronbach's α: = 0.84; test-retest intraclass correlations: 0.93) and validity (correlation with MMSE: −0.63) were satisfied. At the component level, 7 of 11 ADAS-cog components had substantial ceiling effects (range 40–64%).ConclusionsPerformance was satisfactory at the scale level, but most ADAS-cog components were too easy for many patients in this sample and did not reflect the expected depth and range of cognitive performance. The clinical implication of this finding is that the ADAS-cog's estimate of cognitive ability, and its potential ability to detect differences in cognitive performance under treatment, could be improved. However, because of the limitations of traditional psychometric methods, further evaluations would be desirable using additional rating scale analysis techniques to pinpoint specific improvements.

Since the DSM-III-R Axis II borderline personality disorder (BPD) is a polythetic categorization, it is both theoretically and clinically important to examine the covariation of the eight BPD criteria. Seventy-five hospitalized female borderline patients were interviewed with an expanded SCID-II and given dimensional ratings on each of the borderline criteria. These dimensional data were used to factor analyze the criteria, and three factors emerged. The first factor reflected identity problems and interpersonal difficulties. A second factor included affect difficulties and self-harm, and a final factor was composed of only the impulsivity criterion. Results are discussed in terms of implications for treatment planning and future work on construct validity.

Many patients with severe psychiatric disorders have suffered serious abuse and other traumata in their early lives. Documentation of the scope and nature of such associations, however, remains problematic and controversial. Our standardized rating instrument (the RATE) and methodology can serve as an effective and reliable way of assessing the type and degree of traumatic events in the early lives of test subjects; and secondarily, RATE confirms reports of high levels of such events in the histories of borderline patients.

Forty-two women seeking a diagnostic evaluation for premenstrual syndrome provided daily symptom ratings for two or more menstrual cycles. The Personality Diagnostic Questionnaire-Revised (PDQ-R) was completed in the follicular phase; 10 women also completed the PDQ-R in the luteal phase of the same menstrual cycle. The follicular PDQ-Rs indicated a high prevalence of personality dysfunction. Although follicular personality dysfunction was correlated with severity of premenstrual symptoms, personality dysfunction was not significantly associated with the diagnosis of either premenstrual syndrome (PMS) or late luteal phase dysphoric disorder (LLPDD). There was no significant change in the severity of personality dysfunction across the menstrual cycle regardless of the diagnosis of either PMS or LLPDD.

Recent revisions of the psychodiagnostic nomenclature have relied on the specification of explicit criteria and decision rules for psychiatric diagnosis. Although both features have contributed to the increased reliability of psychiatric diagnosis, most empirical attention has been devoted to establishing the reliability of the criteria and the diagnoses, and relatively scant attention has been paid to the development of procedures for the optimization of the decision rules. The present report combines data from four independent studies of borderline personality disorder to illustrate a strategy for the optimization of psychodiagnostic decision rules which rely on polythetic criteria. The strategy considers the relationships among the criteria and the joint conditional probability structure of criteria combinations in optimizing the decision rule for the diagnosis. The advantages to the clinician, researcher, and theoretician of this, or any other, attempt to optimize the decision rules are discussed.