ADReS Score Sheet

Patient’s Name: ___________________________________________________ Date: _________________________

1. Visual fields: Shade in any areas of deficit. two circle representing the patient's both, right and left eyes

2. Visual acuity: _________________ OU

Was the patient wearing corrective lenses? If yes, please specify: ______________________________________

3. Rapid pace walk: ____________ seconds

Was this performed with a walker or cane? If yes, please specify: ______________________________________

4. Range of motion: Specify ‘Within Normal Limits’ or ‘Not WNL.’ If not WNL, describe.

Neck rotation
Finger curl
Shoulder and elbow flexion
Ankle plantar flexion
Ankle dorsiflexion


5. Motor strength: Provide a score on a scale of 0-5.

Shoulder adduction
Shoulder abduction
Shoulder flexion
Wrist flexion
Wrist extension
Hand grip
Hip flexion
Hip extension
Ankle dorsiflexion
Ankle plantar flexion

6. Trail-Making Test, Part B: ____________ seconds

7. Clock drawing test: Please check ‘yes’ or ‘no’ to the following criteria.

All 12 hours are placed in correct numeric order, starting with 12 at the top
Only the numbers 1-12 are included (no duplicates, omissions, or foreign marks)
The numbers are drawn inside the clock circle
The numbers are spaced equally or nearly equally from each other
The numbers are spaced equally or nearly equally from the edge of the circle
One clock hand correctly points to two o’clock
The other hand correctly points to eleven o’clock
There are only two clock hands

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