Alzheimer's Disease Assessment Scale — Cognitive (ADAS-Cog)

The ADAS-Cog 11-item version scores range from 0 to 70. Higher scores indicate greater cognitive impairment. A score of 0–10 is normal, while scores >15 are indicative of cognitive impairment. A change of 3–4 points is considered clinically significant in longitudinal studies (the minimal clinically important difference, MCID).

The ADAS-Cog was developed by Wilma Rosen, Richard Mohs, and Kenneth Davis at the Mount Sinai School of Medicine in New York. It was published in 1984 and rapidly adopted as the primary cognitive endpoint for Alzheimer disease clinical trials. The scale has been used as the primary outcome measure in virtually all pivotal AD treatment trials including donepezil, rivastigmine, galantamine, memantine, and the anti-amyloid monoclonal antibodies (aducanumab, lecanemab, donanemab). Despite criticism regarding its limited executive function assessment and ceiling effects in early disease, it remains the FDA/EMA regulatory standard for AD drug approval.