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
F. Marie Hall Institute for Rural and Community Health, Texas Tech University Health Science Center, 3601 4th St, STOP 6232, Lubbock, TX 79430, USA.
Arch Neurol. 2010 Jun;67(6):746-9. doi: 10.1001/archneurol.2010.115.
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.
To cross-validate the staging guidelines proposed in a previous study using the National Alzheimer's Coordinating Center (NACC) database.
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.
The 2008 NACC uniform data set.
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.
The previously proposed CDR-SB ranges successfully classified the vast majority of patients across all impairment ranges with a kappa 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).
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.
最近有研究表明，临床痴呆评定量表框和得分（CDR-SB）可用于准确划分阿尔茨海默病性痴呆及轻度认知障碍（MCI）的严重程度阶段。然而，据我们所知，这些解释性指南的效用尚未经过交叉验证，也未应用于异质性痴呆病例样本。
使用国家阿尔茨海默病协调中心（NACC）数据库对先前研究中提出的分期指南进行交叉验证。
将先前公布的临界值应用于NACC样本，并获得诊断准确性估计值。接下来，分析仅限于CDR总体得分（CDR-GS）为0.5的NACC参与者，并生成受试者工作特征曲线，以确定区分MCI与极早期痴呆的最佳CDR-SB临界值。
2008年NACC统一数据集。
用于当前分析的NACC数据集中有12462名参与者（5115名对照；2551名MCI患者；4796名痴呆患者，病因不限）。主要结局指标使用CDR-SB得分准确预测诊断（MCI或痴呆）。
先前提出的CDR-SB范围成功地将所有损伤范围内的绝大多数患者进行了分类，kappa值为0.91，总体正确分类率为94%。此外，当CDR-GS限制为0.5时，CDR-SB得分能够区分诊断为MCI和痴呆的患者（曲线下总面积=0.83）。
这些发现对先前公布的用于痴呆严重程度分期的CDR-SB解释性指南进行了交叉验证，并将这些发现扩展到了一大组异质性痴呆患者样本。此外，当CDR-GS限制为0.5时，CDR-SB得分能够以合理的准确性区分MCI和痴呆患者。
