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Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study
O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, Lupo PJ, Reisch JS et al.. Archives of neurology, 2008-08-01
Topic: Risk, prevention and care in population studies
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 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.
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APA 7th
O'Bryant, S. E., Waring, S. C., Cullum, C. M., Hall, J., Lacritz, L., Massman, P. J., et al. (2008). Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study. Archives of neurology. https://doi.org/10.1001/archneur.65.8.1091
Vancouver
O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, et al. Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study. Archives of neurology. 2008. doi:10.1001/archneur.65.8.1091. PMID: 18695059.
BibTeX
@article{obryant2008-18695059,
author = {O'Bryant, S. E. and Waring, S. C. and Cullum, C. M. and Hall, J. and Lacritz, L. and Massman, P. J. and Lupo, P. J. and Reisch, J. S. and others},
title = {{Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study}},
journal = {Archives of neurology},
year = {2008},
doi = {10.1001/archneur.65.8.1091},
pmid = {18695059},
url = {https://doi.org/10.1001/archneur.65.8.1091}
}
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Key findings
- Objective To investigate the effectiveness of CDR-SOB scores in staging dementia severity compared with the global CDR score.
- 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.
Why it matters
In 1,577 people from a Texas research consortium (110 controls, 202 with mild cognitive impairment and 1,265 with probable Alzheimer disease), this retrospective study matched Clinical Dementia Rating "sum of boxes" (CDR-SOB) scores to the overall CDR stage: 0.5–4.0 for stage 0.5, 4.5–9.0 for stage 1, 9.5–15.5 for stage 2 and 16.0–18.0 for stage 3. The ranges were set in one part of the sample and tested in another, where agreement was high (kappa 0.86 to 0.94). The authors say the sum score's wider range makes it more useful for tracking change within and between stages. The study is about reading a rating scale, not about treatment.
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Study details
- Participants1,577
- Evidence strengthModerate
How this study scored 58/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of neurology) |
| Journal's citation record | 3 / 4 | Archives of Neurology: journal h-index 353 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2008 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,577 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 888 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 44.4 citations a year over 20 year(s) since 2008 |
| Impact for its field and year | 3 / 6 | Cited 4.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 56 other studies in this library |
| Still being cited | 4 / 4 | Cited 300 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Sid E. O’Bryant: h-index 63 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Texas Tech University Health Sciences Center: institution h-index 356 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | PubMed indexes it as a multicentre study |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 18695059) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 58 / 100 | — |
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