Aphasic Depression Rating Scale (ADRS)

Purpose of the measure

The Aphasic Depression Rating Scale (ADRS) was developed to detect and measure depression in patients with aphasia during the subacute stage of stroke.

Available versions

The ADRS was developed by Benaim, Cailly, Perennou, and Pelissier in 2004.

Features of the measure

Items:
The ADRS contains 9 items selected from the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1967), the Montgomery and Asperg Depression Rating Scale (MADRS) (Montgomery & Asberg, 1979), and the Salpetriere Retardation Rating Scale (SRRS) (Dantchev & Widlocher, 1998).

The items measure insomnia, anxiety (both psychic and somatic), somatic symptoms (gastrointestinal), hypochondriasis, loss of weight, apparent sadness, mimic (slowness of facial mobility), and fatigability.

Scoring:
The ADRS is scored by adding the score of each individual item for a total possible score of 32. Each item is scored differently (see detailed scoring table below).

Item Score

1. Insomnia-Middle

0 = No difficulty

1 = Patient indicates being restless and disturbed during night/observed sleep disturbance

2 = waking during the night; any getting out of bed (except to go to bathroom)

2. Anxiety-Psychic

0 = no difficulty

1 = some tension and irritability

2 = worrying about minor matters

3 = apprehensive attitude apparent in patient’s face or speech

4 = fears indicated (verbal/non verbal expression) without questioning

3. Anxiety-Somatic

0 = absent; 1 = mild; 2 = moderate; 3 = severe; 4 = incapacitating

4. Somatic symptoms-Gastrointestinal

0 = none

1 = loss of appetite but continues to eat; heavy feelings in abdomen

2 = difficulty eating (not due to arm paresis); requests/requires laxatives or medication for bowels or for gastrointestinal symptoms

5. Hypochondriasis

0 = not present

1 = self-absorption (bodily)

2 = preoccupation with health

3 = frequent complaints, requests for help, etc

4 = hypochondriacal delusions

6. Loss of weight

0 = <0.5 kg weight loss/week

1 = 0.5 kg to 1 kg weight loss per week

2 = >1 kg weight loss per week

7. Apparent sadness

0 = no sadness

1 = between 0 and 2

2 = looks dispirited but brightens without difficulty

3 = between 2 and 4

4 = appears sad and unhappy most of the time

5 = between 4 and 6

6 = looks miserable all the time; extremely despondent

8. Mimic-Slowness of Facial Mobility

0 = the head moves freely, resting flexibility on the body with the gaze either exploring the room or fixed on the examiner or on other objects of interest in an appropriate manner

1 = there may be some reduction of mobility, not easily confirmed.

2 = reduced mobility is definite but mild; gaze, often fixed, but is still capable of shifting; mimic, although monotonous, is still expressive

3 = does not move head/explore room, usually stares at floor, seldom looking at examiner; patient is slow to smile; expression is unchanging

4 = face is completely immobile and painfully inexpressive

9. Fatigability

0 = fatigability is not indicated spontaneously/after direct questioning

1 = fatigability is not indicated spontaneously, but evidence of it emerges in the course of the interview

2 = patient is distressed by fatigability in his/her everyday life (eating, washing, dressing, climbing stairs, or any physical activity the patient is usually able to do despite motor deficiency).

3 = fatigability is such that the patient must curb some activities

4 = near-total reduction of activities due to overwhelming fatigue

A cutoff score of 9/32 of the ADRS is used to determine the presence of depression in patients with aphasia, with higher scores indicating more depressive symptoms.

Time:
The amount of time it takes to administer the ADRS has not been reported.

Subscales: None.

Equipment:
Only the test copy and a pencil are required to complete the ADRS.

Training:
It is unclear whether training is required to administer the ADRS. However, health professionals working on a neurorehabilitation unit typically administer the ADRS.

Alternative forms of the ADRS

None published.

Client suitability

Can be used with: patients with aphasia due to stroke.

Should not be used with:

  • Individuals who may be depressed but who have not had a stroke, or patients who do not have aphasia. For these patients, other depression measures exist that have more evidence to support their psychometric properties (e.g. Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS), etc.).
In what languages is the measure available?

The ADRS is published in English only.