Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study

Abstract

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, kappa 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.

Figures

Figure 1

Receiver operating characteristic curves for Clinical Dementia Rating (CDR) Sum of Boxes scores mapping onto global CDR scores of 0 and 0.5 (area under the receiver operating characteristic curve [AUC]=0.99) (A), 0.5 and 1.0 (AUC=0.97) (B), 1.0 and 2.0 (AUC>0.99) (C), and 2.0 and 3.0 (AUC=0.97) (D).

Figure 2

Receiver operating characteristic curve for Clinical Dementia Rating (CDR) Sum of Boxes scores for identifying patients with Alzheimer disease and mild cognitive impairment and a global CDR score of 0.5 (area under the receiver operating characteristic curve = 0.85).