Validation of the Chinese Version of the Relevant Outcome Scale for Alzheimer’s Disease (CROSA)

Abstract

Objectives: To examine the psychometric properties of the Chinese version of the Relevant Outcome Scale for Alzheimer’s disease (CROSA) among persons with AD (PWAD) and their caregivers in China. Design: A single-arm, open-label, multi-center study. Setting: Two tertiary general hospitals in Shanghai. Participants: A total of 336 PWAD and their family caregivers. Intervention: The PWAD completed a 12-week treatment with memantine after a baseline assessment. Measurements: The CROSA and the Chinese versions of the Mini-Mental State Examination, the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, the Disability Activity of Dementia, the Neuropsychiatric Inventory Questionnaire, the Zarit Caregiver Burden Interview and the Self-Efficacy Questionnaire for Chinese Family Caregivers. Results: The Cronbach’s alpha for the total scale was 0.900, and the intraclass correlation coefficient and Pearson’s correlation coefficient were 0.910 (P < 0.001) and 0.836 (P < 0.001), respectively. Confirmatory factor analysis revealed the two-factor model to be consistent with the original version. For the known-group validity, the total score of the CROSA classified the PWAD into three stages and three MMSE score groups. Moderate to large correlations with the validated scales confirmed the criteria validity of the CROSA, and the convergent validity was confirmed via testing a hypothesized caregiving model; however, only minimal responsiveness was found among the deterioration group after 12 weeks of treatment with memantine. Conclusions: The reliability and validity of the CROSA was good or acceptable for use in daily clinical settings. Further studies are needed to examine the psychometric properties of the scale.

Application of the multi-domain relevant outcome measure for Alzheimer’s disease in Chinese population

“…Researchers suggested that an "ideal" instrument for AD should be able to evaluate the relevant areas (such as cognition, activities of daily living, social interaction, behavior, quality of life, and caregiver burden) and all the stages of AD progression (Robert et al, 2010). Consistent with the original version which had been developed by Holthoff V. A. et al (Holthoff et al, 2011), Zhang S. et al reported the psychometric properties of the Chinese version of Relevant Outcome Scale for Alzheimer's disease (CROSA) included items measuring the abovementioned main areas of AD and also caregiver burden (Zhang, et al, 2021). The CROSA was validated through a single-arm, open-label, multicenter pharmacological trial, with a total of 336 AD patients and their family caregivers.…”

“…There are three aspects regarding the value of this study (Zhang et al, 2021). Firstly, it showed that the CROSA could differentiate overall conditions of AD patients among three Mini-Mental State Examination (MMSE) groups or three AD stage groups.…”

“…The main limitations of this study were identified by the authors in the paper (Zhang et al, 2021). Compared to the original version, the responsiveness of CROSA needs further evaluation in future trials.…”

Cognitive impairments and activities of daily living in the Alzheimer’s disease spectrum: the need to consider cognition and functional skills as separate related domains

“…A fairly recent issue of the journal in 2021, International Psychogeriatrics, volume 33, issue 11, targeted international advances in the identification, diagnosis, and assessment in dementia. One of the articles in that special issue, Zhang et al (2021) presented a Chinese language version of the Relevant outcomes scale for Alzheimer's disease (ROSA; Holthoff et al, 2011). The ROSA is an aggregate rating scale, which includes elements of the multiple domains of AD, including cognition, everyday functioning, and behavioral disturbances.…”

“…One of the articles in that special issue, Zhang et al . (2021) presented a Chinese language version of the Relevant outcomes scale for Alzheimer’s disease (ROSA; Holthoff et al ., 2011). The ROSA is an aggregate rating scale, which includes elements of the multiple domains of AD, including cognition, everyday functioning, and behavioral disturbances.…”