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Tanwani R, Danquah MO, Butris N, Saripella A, Yan E, Kapoor P, Englesakis M, Tang-Wai DF, Tartaglia MC, He D, Chung F. Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant-A systematic review and meta-analysis. PLoS One 2023; 18:e0291291. [PMID: 37699028 PMCID: PMC10497164 DOI: 10.1371/journal.pone.0291291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. OBJECTIVES To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. METHODS/DESIGN We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. RESULTS A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard". CONCLUSIONS The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.
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Affiliation(s)
- Rajiv Tanwani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mercy O. Danquah
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nina Butris
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ellene Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Paras Kapoor
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - David F. Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Frances Chung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Evaluation of Available Cognitive Tools Used to Measure Mild Cognitive Decline: A Scoping Review. Nutrients 2021; 13:nu13113974. [PMID: 34836228 PMCID: PMC8623828 DOI: 10.3390/nu13113974] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Cognitive decline is a broad syndrome ranging from non-pathological/age-associated cognitive decline to pathological dementia. Mild cognitive impairment MCI) is defined as the stage of cognition that falls between normal ageing and dementia. Studies have found that early lifestyle interventions for MCI may delay its pathological progression. Hence, this review aims to determine the most efficient cognitive tools to discriminate mild cognitive decline in its early stages. After a systematic search of five online databases, a total of 52 different cognitive tools were identified. The performance of each tool was assessed by its psychometric properties, administration time and delivery method. The Montreal Cognitive Assessment (MoCA, n = 15), the Mini-Mental State Examination (MMSE, n = 14) and the Clock Drawing Test (CDT, n = 4) were most frequently cited in the literature. The preferable tools with all-round performance are the Six-item Cognitive Impairment Test (6CIT), MoCA (with the cut-offs of ≤24/22/19/15.5), MMSE (with the cut-off of ≤26) and the Hong Kong Brief Cognitive Test (HKBC). In addition, SAGE is recommended for a self-completed survey setting whilst a 4-point CDT is quick and easy to be added into other cognitive assessments. However, most tools were affected by age and education levels. Furthermore, optimal cut-off points need to be cautiously chosen while screening for MCI among different populations.
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Pre-Exposure Prophylaxis (PrEP) Adherence Questionnaire: Psychometric Validation among Sexually Transmitted Infection Patients in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010980. [PMID: 34682730 PMCID: PMC8535751 DOI: 10.3390/ijerph182010980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ensuring adherence guarantees the efficacy of pre-exposure prophylaxis (PrEP). METHODS We conducted a cross-sectional study among 816 sexually transmitted infection (STI) patients in Shanghai. The questionnaire included self-reported demographic characteristics, self-administered items on adherence to free oral PrEP, and PrEP uptake behavior measurement. We conducted item analysis, reliability analysis, validity analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Not all items were considered acceptable in the item analysis. The questionnaire had a McDonald's ω coefficient of 0.847. The scale-level content validity index (CVI) was 0.938 and the item-level CVI of each item ranged from 0.750 to 1. In exploratory factor analysis, we introduced a four-factor model accounting for 79.838% of the aggregate variance, which was validated in confirmatory factor analysis. Adding PrEP adherence questionnaire scores contributed to prediction of PrEP uptake behavior (p < 0.001) in regression analysis. The maximum area under the ROC curve was 0.778 (95% IC: 0.739-0.817). CONCLUSION The PrEP adherence questionnaire presented psychometric validation among STI patients.
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Mansbach WE, Mace RA, Tanner MA, Schindler F. The Columbia Behavior Scale for Dementia (CBS-8): Validity and Reliability of a Rapidly Administered New Instrument for Dementia-Related Behaviors in Long-Term Care Settings. Res Gerontol Nurs 2021; 14:160-168. [PMID: 34039150 DOI: 10.3928/19404921-20210326-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We developed and evaluated the psychometric properties of the Columbia Behavior Scale for Dementia (CBS-8), a rapid instrument that assesses positive symptoms, to enhance behavioral and psychological symptoms of dementia (BPSD) assessment and treatment in long-term care. Psychometric analyses were performed on CBS-8 data from residents (N = 350, age ≥50 years) in 47 Maryland long-term care facilities referred for neurocognitive and mood evaluation. The CBS-8 demonstrated acceptable internal consistency (α = 0.78) and strong interrater reliability (intraclass correlation coefficient = 1.00). CBS-8 scores were correlated with greater cognitive impairment severity (r = -0.34). The diagnosis of dementia with behavioral disturbance had higher CBS-8 scores than other dementia types (e.g., vascular, unspecified) (p < 0.001, η2 = 0.40). Three CBS-8 factors-motor disinhibition, aggression, and psychosis-explained 65% of the variance in overall BPSD. The CBS-8 could enhance BPSD tracking and treatment, strengthen interdisciplinary collaboration, and aid nursing homes in meeting regulations on unnecessary medication use. [Research in Gerontological Nursing, 14(3), 160-168.].
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Chen HH, Sun FJ, Yeh TL, Liu HE, Huang HL, Kuo BIT, Huang HY. The diagnostic accuracy of the Ascertain Dementia 8 questionnaire for detecting cognitive impairment in primary care in the community, clinics and hospitals: a systematic review and meta-analysis. Fam Pract 2018; 35:239-246. [PMID: 29045636 PMCID: PMC5965102 DOI: 10.1093/fampra/cmx098] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score ≧2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.
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Affiliation(s)
- Hsin-Hao Chen
- Family Medicine Department, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Tzu-Lin Yeh
- Family Medicine Department, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Hsueh-Erh Liu
- Degree Program in Healthcare Industry, Chang Gung University, Taoyuan City, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Rheumatology, Chang Gung Memorial Hospital, LinKou, Taiwan
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Benjamin Ing-Tiau Kuo
- Laboratory of Epidemiology and Biostatics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Huang
- Laboratory of Epidemiology and Biostatics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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