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The Cerebellar Neuropsychiatric Rating Scale Version 2: Development and Validation.

Louisa P Selvadurai^1,2, Anna L Burt¹, Maureen P Daly³

¹Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, MGH Ataxia Center, 101 Merrimac Street, Suite 310, Boston, MA, USA.

Cerebellum (London, England)

|December 5, 2025

Summary

The new Cerebellar Neuropsychiatric Rating Scale Version 2 (CNRS-2) effectively screens for neuropsychiatric symptoms in cerebellar cognitive affective Schmahmann syndrome (CCAS). It shows good reliability and distinguishes patients from healthy individuals.

Keywords:

Ataxia Behavior rating scale Cerebellar cognitive affective syndrome Cerebellar disease Clinical neurology Neuropsychiatry Patient outcome assessment

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Area of Science:

Neuropsychiatry
Cerebellar Disorders
Psychometrics

Background:

The cerebellar cognitive affective Schmahmann syndrome (CCAS) involves neuropsychiatric symptoms across five domains.
The Cerebellar Neuropsychiatric Rating Scale (CNRS) quantifies these CCAS symptoms.
Existing scales may not fully capture the patient perspective or subclinical manifestations.

Purpose of the Study:

To develop and validate the CNRS Version 2 (CNRS-2), a self- and informant-report questionnaire.
To assess the psychometric properties of the CNRS-2 in individuals with cerebellar disorder (CD) and healthy controls (HC).
To evaluate the CNRS-2's utility in identifying neuropsychiatric symptoms associated with CCAS.

Main Methods:

Amended existing CNRS items and incorporated patient feedback to create the 50-item CNRS-2.
Conducted cognitive debriefing for item evaluation.
Performed psychometric evaluation, including internal consistency, test-retest reliability, and group comparisons (CD vs. HC) via online administration.

Main Results:

The CNRS-2 demonstrated adequate internal consistency and moderate-to-good test-retest reliability in the CD cohort.
CNRS-2 scores were not correlated with motor ataxia severity.
Significant differences were found between CD and HC groups, with optimal cut-off scores identified for distinguishing the groups.

Conclusions:

The CNRS-2 is a comprehensive screening instrument for the neuropsychiatric component of CCAS, incorporating patient perspectives.
It shows promise as a transdiagnostic screening tool in neuropsychiatry due to its broad scope and ability to detect subclinical symptoms.