Staging dementia using clinical dementia rating scale sum of boxes scores: A Texas Alzheimer's research consortium study

Sid E. O'Bryant, Stephen C. Waring, C. Munro Cullum, James Hall, Laura Lacritz, Paul J. Massman, Philip J. Lupo, Joan S. Reisch, Rachelle Doody

Research output: Contribution to journalArticlepeer-review

453 Scopus citations


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.

Original languageEnglish
Pages (from-to)1091-1095
Number of pages5
JournalArchives of Neurology
Issue number8
StatePublished - Aug 2008


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