Staging Dementia Using Clinical Dementia Rating Scale Sum of Boxes Scores: A Texas Alzheimer's Research Consortium Study | Dementia and Cognitive Impairment | JAMA Neurology | JAMA Network
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Horowitz  F Developmental theory, prediction, and the developmental equation in follow-up research. Friedman  SHaywood  HC Developmental Follow-up Concepts, Domains, and Methods. San Diego, CA Academic Press1994;27- 44Google Scholar
Perneczky  RWagenpfeil  SKomossa  KGrimmer  TDiehl  JKurz  A Mapping scores onto stages: Mini-Mental State Examination and Clinical Dementia Rating.  Am J Geriatr Psychiatry 2006;14 (2) 139- 144PubMedGoogle ScholarCrossref
Doody  RSStevens  JCBeck  C  et al.  Practice parameter: management of dementia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology 2001;56 (9) 1154- 1166PubMedGoogle ScholarCrossref
Leber  P Guidelines for the Clinical Evaluation of Antidementia Drugs.  Rockville, MD US Food and Drug Administration1990;
Hughes  CPBerg  LDanziger  WLCoben  LAMartin  RL A new clinical scale for the staging of dementia.  Br J Psychiatry 1982;140566- 572PubMedGoogle ScholarCrossref
Berg  LMiller  JPStorandt  M  et al.  Mild senile dementia of the Alzheimer type, 2: longitudinal assessment.  Ann Neurol 1988;23 (5) 477- 484PubMedGoogle ScholarCrossref
Lynch  CAWalsh  CBlanco  A  et al.  The clinical dementia rating sum of box score in mild dementia.  Dement Geriatr Cogn Disord 2006;21 (1) 40- 43PubMedGoogle ScholarCrossref
McKhann  GDrachman  DFolstein  MKatzman  RPrice  DStadlan  EM Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.  Neurology 1984;34 (7) 939- 944PubMedGoogle ScholarCrossref
Petersen  RCed Mild Cognitive Impairment: Aging to Alzheimer's Disease.  New York, NY Oxford University Press2003;
Morris  JC The Clinical Dementia Rating (CDR): current version and scoring rules.  Neurology 1993;43 (11) 2412- 2414PubMedGoogle ScholarCrossref
Morris  JCErnesto  CSchafer  K  et al.  Clinical dementia rating training and reliability in multicenter studies: the Alzheimer's Disease Cooperative Study experience.  Neurology 1997;48 (6) 1508- 1510PubMedGoogle ScholarCrossref
Burke  WJMiller  JPRubin  EH  et al.  Reliability of the Washington University Clinical Dementia Rating.  Arch Neurol 1988;45 (1) 31- 32PubMedGoogle ScholarCrossref
Berg  L McKeel  DW  JrMiller  JPBaty  JMorris  JC Neuropathological indexes of Alzheimer's disease in demented and nondemented persons aged 80 years and older.  Arch Neurol 1993;50 (4) 349- 358PubMedGoogle ScholarCrossref
Morris  JC McKeel  DW  JrStorandt  M  et al.  Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathologic distinction from normal aging.  Neurology 1991;41 (4) 469- 478PubMedGoogle ScholarCrossref
Morris  JCStorandt  M McKeel  DW  Jr  et al.  Cerebral amyloid deposition and diffuse plaques in “normal” aging: evidence for presymptomatic and very mild Alzheimer's disease.  Neurology 1996;46 (3) 707- 719PubMedGoogle ScholarCrossref
Grundman  MPetersen  RCFerris  SH  et al.  Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials.  Arch Neurol 2004;61 (1) 59- 66PubMedGoogle ScholarCrossref
Andersen  KLolk  AKragh-Sorensen  PPetersen  NEGreen  A Depression and the risk of Alzheimer disease.  Epidemiology 2005;16 (2) 233- 238PubMedGoogle ScholarCrossref
Original Contribution
August 2008

Staging Dementia Using Clinical Dementia Rating Scale Sum of Boxes Scores: A Texas Alzheimer's Research Consortium Study

Author Affiliations

Author Affiliations: Department of Neuropsychiatry and Behavioral Science, Texas Tech University Health Sciences Center, Lubbock (Dr O’Bryant); Division of Epidemiology, University of Texas Health Science Center (Dr Waring and Mr Lupo); Departments of Psychiatry (Drs Cullum and Lacritz) and Neurology (Dr Cullum) and Division of Biostatistics, Department of Clinical Sciences (Dr Reisch), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University of North Texas Health Science Center, Fort Worth (Dr Hall); Department of Psychology, University of Houston, Texas (Dr Massman); and Alzheimer's Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine, Houston (Drs Massman and Doody).

Arch Neurol. 2008;65(8):1091-1095. doi:10.1001/archneur.65.8.1091

Background  The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging dementia severity is not well established.

Objective  To investigate the effectiveness of CDR-SOB scores in staging dementia severity compared with the global CDR score.

Design  Retrospective study.

Setting  Texas Alzheimer's Research Consortium minimum data set cohort.

Participants  A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis.

Main Outcome Measures  Receiver operating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample.

Results  Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.0, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, κ scores ranged from 0.86 to 0.94 (P < .001 for all), with 93.0% of the participants falling within the new staging categories.

Conclusions  The CDR-SOB score compares well with the global CDR score for dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of dementia severity. Interpretive guidelines for CDR-SOB scores are provided.