For the comprehensive assessment of patients with Alzheimer’s disease (AD) across different stages of disease progression in clinical practice, several multi-domain instruments have been developed to monitor the changes of core symptoms and overall condition of AD patients (Holthoff et al., Reference Holthoff2011; Monahan et al., Reference Monahan2012; Mori et al., Reference Mori2018; Shader, Harmatz and Salzman, Reference Shader, Harmatz and Salzman1974).

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., Reference Robert, Ferris, Gauthier, Ihl, Winblad and Tennigkeit2010). Consistent with the original version which had been developed by Holthoff V. A. et al. (Holthoff et al., Reference Holthoff2011), 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 above-mentioned main areas of AD and also caregiver burden(Zhang, et al., Reference Zhang, Qi, Yang and Guo2021). The CROSA was validated through a single-arm, open-label, multi-center 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., Reference Zhang, Qi, Yang and Guo2021). 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 floor and ceiling effects at scale and item level were acceptable. In China, AD patients’ severity stage and total score of MMSE or MoCA were the two important factors of considered aspects in routine clinical decisions. As an informant scale, the findings implicated that CROSA can be used as a multi-domain assessment without the limitation of MMSE (regarding being affected by patients’ educational level and/or conditions during the measurement) and to comprehensively evaluation overall impairment of AD to both patients and their caregivers. Secondly, since the CROSA contains practical evaluation guidelines, it is applicable for the multidisciplinary team (including specialists, general practitioners, and nurses) in the areas of health management. Considering China’s vast territory and imbalanced service resources, the validated CROSA makes it possible to use even through telemedicine. Thirdly, the CROSA was well consistent with the original and Spanish versions (Carnero Pardo et al., Reference Carnero Pardo, Lopez Alcalde, Espinosa Garcia and Sanchez Magro2017; Holthoff et al., Reference Holthoff2011). Therefore, it is also valuable for the studies conducted in different regions of the world.

The main limitations of this study were identified by the authors in the paper (Zhang et al., Reference Zhang, Qi, Yang and Guo2021). Compared to the original version, the responsiveness of CROSA needs further evaluation in future trials. It is reported the results of convergent validity of CROSA based on their previous caregiver support studies.

The majority of AD patients in China were living in the communities and cared by their family members (Jia et al., Reference Jia2016). The findings implicated that after caregiver training of using the CROSA, there would be possible to improve their ability to provide relatively complete information about their care recipients’ condition, to follow medication regimen of their care recipients, to share decision-making with health professionals and to balance dementia care and self-management of their own condition. In general, the CROSA is a user-friendly, quickly administered, and easily standardized tool and has a broad prospect in the future multidisciplinary management for the dementia patients.