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A Texas Alzheimer's Research Consortium Study

Sid E. O’Bryant, PhD; Stephen C. Waring, DVM, PhD; C. Munro Cullum, PhD; James Hall, PhD; Laura Lacritz, PhD; Paul J. Massman, PhD; Philip J. Lupo, MPH; Joan S. Reisch, PhD; Rachelle Doody, MD, PhD; for the Texas Alzheimer's Research Consortium

Arch Neurol. 2008;65(8):1091-1095.

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, 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.

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).

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