Validation of the new interpretive guidelines for the clinical dementia rating scale sum of boxes score in the National Alzheimer's Coordinating Center database

Sid E. O'Bryant, Laura H. Lacritz, James Hall, Stephen C. Waring, Wenyaw Chan, Zeina G. Khodr, Paul J. Massman, Valerie Hobson, C. Munro Cullum

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: It was recently demonstrated that the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) score can be used to accurately stage severity of Alzheimer dementia and mild cognitive impairment (MCI). However, to our knowledge, the utility of those interpretive guidelines has not been cross-validated or applied to a heterogeneous sample of dementia cases. Objective: To cross-validate the staging guidelines proposed in a previous study using the National Alzheimer's Coordinating Center (NACC) database. Design: The previously published cut scores were applied to the NACC sample and diagnostic accuracy estimates obtained. Next, analyses were restricted to NACC participants with a CDR global score (CDR-GS) of 0.5 and receiver operating characteristic curves generated to determine optimal CDR-SB cut scores for distinguishing MCI from very early dementia. Setting: The 2008 NACC uniform data set. Participants: There were 12 462 participants (5115 controls; 2551 patients with MCI; 4796 patients with dementia, all etiologies) in the NACC data set used for the current analysis. Main Outcome Measure: Accurate prediction of diagnoses (MCI or dementia) using the CDR-SB score. Results: The previously proposed CDR-SB ranges successfully classified the vast majority of patients across all impairment ranges with a κ of 0.91 and 94% overall correct classification rate. Additionally, the CDR-SB score discriminated between patients diagnosed with MCI and dementia when CDR-GS was restricted to 0.5 (overall area under the curve=0.83). Conclusions: These findings cross-validate the previously published CDR-SB interpretative guidelines for staging dementia severity and extend those findings to a large heterogeneous sample of patients with dementia. Additionally, the CDR-SB scores distinguished MCI from dementia in patients with reasonable accuracy when CDR-GS was restricted to 0.5.

Original languageEnglish (US)
Pages (from-to)746-749
Number of pages4
JournalArchives of Neurology
Volume67
Issue number6
DOIs
StatePublished - Jun 2010

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Dementia
Databases
Guidelines
Data Base
Rating Scales
Alzheimer
ROC Curve
Area Under Curve
Cognitive Dysfunction
Alzheimer Disease
Mild Cognitive Impairment
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Clinical Neurology

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Validation of the new interpretive guidelines for the clinical dementia rating scale sum of boxes score in the National Alzheimer's Coordinating Center database. / O'Bryant, Sid E.; Lacritz, Laura H.; Hall, James; Waring, Stephen C.; Chan, Wenyaw; Khodr, Zeina G.; Massman, Paul J.; Hobson, Valerie; Cullum, C. Munro.

In: Archives of Neurology, Vol. 67, No. 6, 06.2010, p. 746-749.

Research output: Contribution to journalArticle

O'Bryant, Sid E. ; Lacritz, Laura H. ; Hall, James ; Waring, Stephen C. ; Chan, Wenyaw ; Khodr, Zeina G. ; Massman, Paul J. ; Hobson, Valerie ; Cullum, C. Munro. / Validation of the new interpretive guidelines for the clinical dementia rating scale sum of boxes score in the National Alzheimer's Coordinating Center database. In: Archives of Neurology. 2010 ; Vol. 67, No. 6. pp. 746-749.
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abstract = "Background: It was recently demonstrated that the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) score can be used to accurately stage severity of Alzheimer dementia and mild cognitive impairment (MCI). However, to our knowledge, the utility of those interpretive guidelines has not been cross-validated or applied to a heterogeneous sample of dementia cases. Objective: To cross-validate the staging guidelines proposed in a previous study using the National Alzheimer's Coordinating Center (NACC) database. Design: The previously published cut scores were applied to the NACC sample and diagnostic accuracy estimates obtained. Next, analyses were restricted to NACC participants with a CDR global score (CDR-GS) of 0.5 and receiver operating characteristic curves generated to determine optimal CDR-SB cut scores for distinguishing MCI from very early dementia. Setting: The 2008 NACC uniform data set. Participants: There were 12 462 participants (5115 controls; 2551 patients with MCI; 4796 patients with dementia, all etiologies) in the NACC data set used for the current analysis. Main Outcome Measure: Accurate prediction of diagnoses (MCI or dementia) using the CDR-SB score. Results: The previously proposed CDR-SB ranges successfully classified the vast majority of patients across all impairment ranges with a κ of 0.91 and 94{\%} overall correct classification rate. Additionally, the CDR-SB score discriminated between patients diagnosed with MCI and dementia when CDR-GS was restricted to 0.5 (overall area under the curve=0.83). Conclusions: These findings cross-validate the previously published CDR-SB interpretative guidelines for staging dementia severity and extend those findings to a large heterogeneous sample of patients with dementia. Additionally, the CDR-SB scores distinguished MCI from dementia in patients with reasonable accuracy when CDR-GS was restricted to 0.5.",
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AU - Waring, Stephen C.

AU - Chan, Wenyaw

AU - Khodr, Zeina G.

AU - Massman, Paul J.

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AU - Cullum, C. Munro

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