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Delgado-Álvarez A, Valles-Salgado M, Delgado-Alonso C, Matias-Guiu J, Matias-Guiu JA. Conversion between the Rowland Universal Dementia Assessment Scale and Mini-Mental State Examination test scores in majority and minority populations. Brain Behav 2024; 14:e3650. [PMID: 39219244 DOI: 10.1002/brb3.3650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Despite the Rowland Universal Dementia Assessment Scale (RUDAS) having significant advantages as a cognitive screening tool, particularly for minority populations, the Mini-Mental State Examination (MMSE) test is the most widely used test for cognitive screening in Alzheimer's disease (AD). This study aimed to develop a conversion table to predict MMSE scores from observed RUDAS scores, allowing an easy-to-use method to compare both screening tests. METHODS The equipercentile equating method was used to develop the conversion table using a training sample consisting of cognitively intact participants and individuals with early-stage AD. The resulting conversion table was validated in two samples, comprising participants from majority and minority populations assessed in Spanish. RESULTS The conversion table demonstrated excellent reliability with intraclass correlation coefficients of.92 in both validation samples. CONCLUSION This study provides a conversion table between RUDAS and MMSE scores, improving the comparability of these cognitive screening tools for use in clinical and research purposes.
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Affiliation(s)
- Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense de Madrid, Madrid, Spain
- Department of Psychobiology & Behavioral Sciences Methods, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Valles-Salgado
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense de Madrid, Madrid, Spain
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Alzola P, Carnero C, Bermejo-Pareja F, Sánchez-Benavides G, Peña-Casanova J, Puertas-Martín V, Fernández-Calvo B, Contador I. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. J Clin Med 2024; 13:3442. [PMID: 38929971 PMCID: PMC11204334 DOI: 10.3390/jcm13123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.
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Affiliation(s)
- Patricia Alzola
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| | - Cristóbal Carnero
- Neurology Department, Granada University Hospital Complex, 18014 Granada, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | | | | | | | | | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
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Russell ML, Justice A. Human Immunodeficiency Virus in Older Adults. Clin Geriatr Med 2024; 40:285-298. [PMID: 38521599 DOI: 10.1016/j.cger.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
As people with HIV live longer, they can experience increased incidence and earlier onset of chronic conditions and geriatric syndromes. Older people are also at substantially increased risk of delayed diagnosis and treatment for HIV. Increasing provider awareness of this is pivotal in ensuring adequate consideration of HIV testing and earlier screening for chronic conditions. In addition, evaluating patients for common geriatric syndromes such as polypharmacy, frailty, falls, and cognitive impairment should be contextualized based on how they present.
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Affiliation(s)
- Matthew L Russell
- Harvard University, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2C, Boston, MA 02114, USA.
| | - Amy Justice
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA
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Delgado-Álvarez A, Díez-Cirarda M, Delgado-Alonso C, Hernández-Lorenzo L, Cuevas C, Valles-Salgado M, Montero-Escribano P, Gil-Moreno MJ, Matías-Guiu J, García-Ramos R, Matias-Guiu JA. Multi-Disease Validation of the RUDAS for Cognitive Screening in Alzheimer's Disease, Parkinson's Disease, and Multiple Sclerosis. J Alzheimers Dis 2023; 91:705-717. [PMID: 36502332 DOI: 10.3233/jad-220907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive test with favorable diagnostic properties for detecting dementia and a low influence of education and cultural biases. OBJECTIVE We aimed to validate the RUDAS in people with Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). METHODS We enrolled one hundred and fifty participants (60 with AD, 30 with PD, 60 with MS, and 120 healthy controls (HC)). All clinical groups completed a comprehensive neuropsychological battery, RUDAS, and standard cognitive tests of each disorder: MMSE, SCOPA-COG, and Symbol Digit Modalities Test. Intergroup comparisons between clinical groups and HC and ROC curves were estimated. Random Forest algorithms were trained and validated to detect cognitive impairment using RUDAS and rank the most relevant scores. RESULTS The RUDAS scores were lower in patients with AD, and patients with PD and MS showed cognitive impairment compared to healthy controls. Effect sizes were generally large. The total score was the most discriminative, followed by the memory score. Correlations with standardized neuropsychological tests were moderate to high. Random Forest algorithms obtained accuracies over 80-90% using the RUDAS for diagnosing AD and cognitive impairment associated with PD and MS. CONCLUSION Our results suggest the RUDAS is a valid test candidate for multi-disease cognitive screening tool in AD, PD, and MS.
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Affiliation(s)
- Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain.,Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Laura Hernández-Lorenzo
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain.,Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Constanza Cuevas
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - María Valles-Salgado
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Paloma Montero-Escribano
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - María José Gil-Moreno
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Rocío García-Ramos
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
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Daniel B, Agenagnew L, Workicho A, Abera M. Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020. PLoS One 2022; 17:e0262483. [PMID: 35051198 PMCID: PMC8775314 DOI: 10.1371/journal.pone.0262483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and validity of Rowland Universal Dementia Assessment Scale to detect major neurocognitive disorder among older people in Ethiopia. METHODS An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of <0.05. Inter-rater, internal consistency reliabilities, content, criterion and construct validities were also determined. RESULTS A total of 116 individuals participated in the study with a 100% response rate. Most (52.7%) of the participants were male and the mean age in years was 69.9± 8. The Cronbach's alpha for RUDAS was 0.7 with an intra-class correlation coefficient value of 0.9. RUDAS has an area under the receivers operating curve of 0.87 with an optimal cutoff value of ≤ 22. At this cutoff point, RUDAS has sensitivity and specificity of 92.3 and 75.3 with positive and negative likelihood ratios as well as positive and negative predictive values of 3.7, 0.1, 65.5%, and 91.5%, respectively. There has also been a significant difference in the mean scores of RUDAS among the two diagnostic groups showing good construct validity. CONCLUSION The Rowland Universal Dementia Assessment Scale has been demonstrated to be a valid and reliable tool to detect major neurocognitive disorder. Policy makers and professionals can incorporate the tool in clinical and research practices in developing countries.
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Affiliation(s)
- Beniam Daniel
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Liyew Agenagnew
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
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Kim LN, Cordato D, McDougall A, Fraser C. Pilot Study: The Queen Square Screening Test for Visual Deficits in Dementia. Neuroophthalmology 2021; 45:380-385. [PMID: 34720268 DOI: 10.1080/01658107.2021.1947324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The Queen Square Screening Test for Visual Deficits (QS test) screens for changes in visual processing. Our pilot study aimed to review the applicability of the QS test in individuals with dementia compared with those with normal cognition. Participants with major and minor neurocognitive disorder scored 50/71 (n=12) and 61/71 (n=10) respectively on the QS test, compared to 65/71 for age-matched healthy controls (n=11). The QS test score correlated with cognitive impairment as measured using the Rowland Universal Dementia Assessment Scale (r = 0.74). The QS test is an affordable and easy bedside screening test for visual processing changes.
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Affiliation(s)
- Leah N Kim
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - Dennis Cordato
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,South Western Sydney Stroke and Neurology Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Alan McDougall
- Department of Neurology, Liverpool Hospital, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.,South Western Sydney Stroke and Neurology Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Clare Fraser
- Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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Forté S, Blais F, Castonguay M, Fadiga N, Fortier-St-Pierre M, Couette M, Ward R, Béland S, Cohn M, Soulières D, Kuo KHM. Screening for Cognitive Dysfunction Using the Rowland Universal Dementia Assessment Scale in Adults With Sickle Cell Disease. JAMA Netw Open 2021; 4:e217039. [PMID: 33983401 PMCID: PMC8120324 DOI: 10.1001/jamanetworkopen.2021.7039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Adults with sickle cell disease (SCD) disproportionally experience early cognitive decline; however, guidance on the optimal screening strategy for cognitive dysfunction is lacking, and several available tools are biased by language, educational level, socioeconomic status, and race/ethnicity. The Rowland Universal Dementia Assessment Scale (RUDAS) was specifically designed for cognitive screening in multicultural populations. OBJECTIVE To ascertain the prevalence of suspected dementia in adults with SCD using the RUDAS, and to identify whether age, sex, educational level, several biological variables, and SCD complications were associated with RUDAS scores. DESIGN, SETTING, AND PARTICIPANTS This multicenter, bilingual, cross-sectional study was conducted in 2 SCD comprehensive care centers in Canada (Centre Hospitalier de l'Université Montréal in Montréal and University Health Network in Toronto). Participants were adults aged 18 years or older and were enrolled in the study between July 1, 2018, and July 30, 2019. All outpatients were eligible and offered study participation, unless they had an acute medical condition that required inpatient care or they were unable to follow study instructions. INTERVENTIONS The RUDAS was administered by trained personnel in either French or English, according to the patient's language preference. A questionnaire on social determinants of health was also administered, and participants underwent screening for anxiety and depression. MAIN OUTCOMES AND MEASURES Proportion of participants with RUDAS scores that were suggestive of dementia and the RUDAS score. Any score lower than 23 points was suggestive of dementia, a score between 23 and 27 points indicated a possible association with mild neurocognitive disorder, and a score higher than 27 points was normal. RESULTS A total of 252 adult patients with SCD were included (136 women [54.0%]; mean [range] age, 34.8 [18-75] years). Overall, 29 patients (11.5%) had RUDAS scores that were suggestive of dementia, and this proportion increased with age (15 [8.7%] in the 18-39 years age group, 10 [14.5%] in the 40-59 years age group, and 4 [36.4%] in the ≥60 years age group). The RUDAS scores were not associated with sex, language, SCD genotype, and SCD complications. The highest level of education was significantly associated with the RUDAS score; however, the association was small (η2 = 0.02; 95% CI, 0.00-0.07; P = .02). In a multivariable analysis, lower glomerular filtration rate (r = 0.40; 95% CI, 0.29-0.50; P < .001) and increasing age (r = -0.37; 95% CI, -0.47 to -0.26; P < .001), but not SCD genotype or disease severity, were associated with lower RUDAS scores. CONCLUSIONS AND RELEVANCE This study found that using the RUDAS revealed a high prevalence of suspected dementia in adult patients with SCD that was associated with worsening kidney function and age. Cognition should be screened in all adult patients with SCD, regardless of age, disease severity, and SCD genotype; further validation of the RUDAS is ongoing.
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Affiliation(s)
- Stéphanie Forté
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network (UHN), Toronto, Ontario, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Florence Blais
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Mathias Castonguay
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Nafanta Fadiga
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network (UHN), Toronto, Ontario, Canada
- Faculty of Arts and Science, Queen’s University, Kingston, Ontario, Canada
| | - Mireille Fortier-St-Pierre
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Maryline Couette
- Neurorehabilitation Department, Albert Chenevier Hospital, Henri Mondor University, Créteil, France
- Sickle Cell Referral Center-Unité des Maladies Génétiques du Globule Rouge, Université Paris-Est Créteil, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France
| | - Richard Ward
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network (UHN), Toronto, Ontario, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sébastien Béland
- Département d'Administration et Fondements de l'Éducation, Faculté des Sciences de l'Éducation, Université de Montréal, Montréal, Québec, Canada
| | - Melanie Cohn
- Krembil Research Institute, UHN, Toronto, Ontario, Canada
| | - Denis Soulières
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network (UHN), Toronto, Ontario, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. Int Psychogeriatr 2020; 32:1031-1044. [PMID: 32146910 DOI: 10.1017/s1041610220000344] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To quantitatively synthesize data on the accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in different sociocultural settings and compare its performance to other brief screening instruments for the detection of dementia. DESIGN Systematic review and meta-analysis. Literature searches were performed in PubMed, EMBASE, and CINAHL from January 1, 2004 until September 1, 2019. SETTING Community, outpatient clinic, and hospital settings in high-, and low- and middle-income countries. PARTICIPANTS Twenty-six studies reporting diagnostic accuracy of the RUDAS were included with almost 4000 participants, including approximately 1700 patients with dementia. MEASUREMENTS Procedures for translation and cultural adaption of the RUDAS, and influence of demographic variables on diagnostic accuracy, were compared across studies. Bivariate random-effects models were used to pool sensitivity and specificity results, and diagnostic odds-ratios and the area under the hierarchical summary receiver operator characteristic curve were used to present the overall performance. RESULTS The pooled sensitivity and specificity for the detection of dementia were .82 (95% CI, .78-.86) and .83 (95% CI, .78-.87), respectively, with an area under the curve of .89. Subgroup analyses revealed that the RUDAS had comparable diagnostic performances across high-, and low- and middle-income settings (z = .63, P = .53) and in samples with a lower and higher proportion of participants with no formal education (z = -.15, P = .88). In 11 studies making direct comparison, the diagnostic performance of the RUDAS was comparable to that of the Mini-Mental State Examination (z = -.82, P = .41), with areas under the curve of .88 and .84, respectively. CONCLUSIONS The RUDAS has good diagnostic performance for detecting dementia in different sociocultural settings. Compared to other brief screening instruments, advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language adaptation.
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Hwang K, De Silva A, Simpson JA, LoGiudice D, Engel L, Gilbert AS, Croy S, Haralambous B. Video-interpreting for cognitive assessments: An intervention study and micro-costing analysis. J Telemed Telecare 2020; 28:58-67. [PMID: 32228142 DOI: 10.1177/1357633x20914445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Evidence in the literature demonstrates the reliability of cognitive screening assessments using video technology in English-speaking older populations. However, this has not been tested in older culturally and linguistically diverse (CALD) populations who require an interpreter, and what the associated costs would be. The aim was to determine if the Rowland Universal Dementia Assessment Scale (RUDAS) and the Geriatric Depression Scale (GDS) could be reliably administered over video-interpreting methods compared with face-to-face interpreting. In addition, the study aims to compare the costs of video-interpreting with the costs of face-to-face interpreting. METHODS We compared similarity of the RUDAS and GDS scores when administered face-to-face and via video-interpreting. The similarity of scores between methods was analysed using paired t-tests and Bland-Altman plots. A costing analysis was done using a micro-costing approach to estimate the costs of video-interpreting compared with face-to-face, extrapolated to a national level. RESULTS Analysis found no significant differences in the mean assessment scores between video-interpreting and face-to-face (RUDAS mean difference: -0.36; 95% confidence interval (CI): -1.09, 0.38, GDS mean difference: 0.22; 95% CI: -0.38, 0.83). Bland-Altman plots demonstrated that 71% of RUDAS scores and 82% of GDS scores were within the maximum allowed difference of ±2 units. Costing analysis showed a A$7 saving per assessment when using video-interpreting compared with face-to-face, with a total national saving of A$247,350. DISCUSSION Video-interpreting was found to be as reliable as face-to-face interpreting for both RUDAS and GDS assessments. Cost analysis indicates that video-interpreting is cheaper than face-to-face interpreting.
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Affiliation(s)
- Kerry Hwang
- National Ageing Research Institute, Parkville, Australia
| | - Anurika De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Dina LoGiudice
- National Ageing Research Institute, Parkville, Australia.,Melbourne Health, Melbourne, Australia
| | - Lidia Engel
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Andrew S Gilbert
- National Ageing Research Institute, Parkville, Australia.,Department of Social Inquiry, La Trobe University, Melbourne, Australia
| | - Samantha Croy
- National Ageing Research Institute, Parkville, Australia
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Hernandez-Córdova G, Cuenca J, Gamboa C, Metcalf T. Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru. Am J Alzheimers Dis Other Demen 2019; 34:513-522. [PMID: 31422688 PMCID: PMC10653366 DOI: 10.1177/1533317519869709] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education. METHODS A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated. RESULTS Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24). CONCLUSIONS The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Dirección de investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Consejo Nacional de Ciencia, Tecnología e Innovación (CONCYTEC), Lima, Peru
| | - Kristy Chavez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Gustavo Hernandez-Córdova
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José Cuenca
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud. Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Validation of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample across five Western European countries: diagnostic accuracy and normative data. Int Psychogeriatr 2019; 31:287-296. [PMID: 30017010 DOI: 10.1017/s1041610218000832] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:With increasing cultural diversity and growing elderly immigrant populations in Western European countries, the availability of brief cognitive screening instruments adequate for assessment of dementia in people from diverse backgrounds becomes increasingly important. The aim of the present study was to investigate diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample and to calculate normative data as a basis for demographic adjustment of RUDAS scores. METHODS The study was a prospective international cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine diagnostic accuracy. Regression analysis was used to assess the impact of demographic variables. RESULTS Data was collected from 341 cognitively intact participants and 80 people with dementia with a wide age- and educational range. Of the 421 included participants, 239 (57%) had immigrant background. The RUDAS had high diagnostic accuracy with an area under the curve (AUC) of 0.93. The optimal cut-off score was <25 (sensitivity 0.80, specificity 0.90). Regression analysis revealed that RUDAS scores were mainly affected by education and were unrelated to data collection site and immigrant status. Education-adjusted normative data was calculated as a basis for education adjustment of RUDAS scores. Applying education-adjusted RUDAS scores slightly but significantly improved diagnostic accuracy with an AUC of 0.95. CONCLUSION We found the RUDAS to have excellent diagnostic properties in our multicultural sample. However, we suggest that RUDAS scores should be adjusted for education to increase diagnostic accuracy and that the choice of cut-off score should be considered based on the clinical context and expected base rate of dementia.
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Ayan G, Afacan C, Poyraz BC, Bilgic O, Avci S, Yavuzer H, Yuruyen M, Erdincler DS, Ayan B, Doventas A. Reliability and Validity of Rowland Universal Dementia Assessment Scale in Turkish Population. Am J Alzheimers Dis Other Demen 2019; 34:34-40. [PMID: 30328357 PMCID: PMC10852419 DOI: 10.1177/1533317518802449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND The aim is to validate Turkish version Rowland Universal Dementia Assessment Scale (RUDAS). METHODS One hundred forty patients (>65 years) were included. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition -V was used in all patients. Rowland Universal Dementia Assessment Scale was applied for 2 days. Results were compared with Mini-Mental State Examination; reliability, validity, and statistical values were determined. RESULTS Time validity was verified. Mini-mental state examination was correlated 45.3% in control and 73% in dementia group. Factor weights varied between 0.44 and 0.81; factor construct was verified as 6-item scoring. When 25 was cutoff point, sensitivity was 92.86% and specificity was 92.86%. Content validity index was found to be 100% by 7 specialists. Cronbach α (0.692) and test-retest reliability (intraclass correlation = 0.987) were determined. CONCLUSION Rowland Universal Dementia Assessment Scale (Turkish) is validated and verified as reliable. Test could be applied for 5 minutes approximately; results are not affected by educational status, immigrant status, and language used; however, age and gender have significant effect on results.
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Affiliation(s)
- Gizem Ayan
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Ceyda Afacan
- Department of Statistics, Institute of Science and Technology, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Burc Cagrı Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Onur Bilgic
- Department of Psychiatry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Suna Avci
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Hakan Yavuzer
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Mehmet Yuruyen
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Burak Ayan
- Istanbul Bilim University, Department of Anestesiology, Istanbul, Turkey
| | - Alper Doventas
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
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Benbow J, Wand AP, Simpson B. A pilot study examining the profile of older people on clozapine. Australas Psychiatry 2018; 26:619-623. [PMID: 30226106 DOI: 10.1177/1039856218797435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. METHOD: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. RESULTS: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate-severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. CONCLUSIONS: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person's Mental Health Services and/or a Geriatric Medicine service.
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Affiliation(s)
- Jen Benbow
- Staff Specialist Geriatrician, Department of Geriatric Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne Pf Wand
- Staff Specialist Psychiatrist, Persons' Mental Health Service, St George Hospital, Eastern Suburbs Mental Health Service, Sydney, NSW, and; Conjoint Senior Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Brett Simpson
- Senior Staff Specialist Psychiatrist, Older Persons' Mental Health Service, St George Hospital, Eastern Suburbs Mental Health Service, Sydney, NSW, and; Conjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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14
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Yokomizo JE, Seeher K, Oliveira GMD, Silva LDSVE, Saran L, Brodaty H, Aprahamian I, Yassuda MS, Bottino CMDC. Cognitive screening test in primary care: cut points for low education. Rev Saude Publica 2018; 52:88. [PMID: 30484482 PMCID: PMC6280619 DOI: 10.11606/s1518-8787.2018052000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.
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Affiliation(s)
- Juliana Emy Yokomizo
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
| | - Katrin Seeher
- University of New South Wales. Dementia Collaborative Research Center. Sydney, New South Wales, Australia
| | | | | | - Laura Saran
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
| | - Henry Brodaty
- University of New South Wales. Dementia Collaborative Research Center. Sydney, New South Wales, Australia
| | - Ivan Aprahamian
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil.,Departmento de Clínica Médica. Faculdade de Medicina de Jundiaí. Jundiaí, SP, Brasil
| | - Monica Sanches Yassuda
- Universidade de São Paulo. Escola de Artes, Ciências e Humanidades. São Paulo, SP, Brasil
| | - Cássio Machado de Campos Bottino
- Universidade de São Paulo. Faculdade de Medicina. Programa Terceira Idade (PROTER), Instituto de Psiquiatria. São Paulo, SP, Brasil
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15
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Goudsmit M, van Campen J, Schilt T, Hinnen C, Franzen S, Schmand B. One Size Does Not Fit All: Comparative Diagnostic Accuracy of the Rowland Universal Dementia Assessment Scale and the Mini Mental State Examination in a Memory Clinic Population with Very Low Education. Dement Geriatr Cogn Dis Extra 2018; 8:290-305. [PMID: 30323830 PMCID: PMC6180264 DOI: 10.1159/000490174] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
Background Diagnosing dementia in elderly immigrants is often difficult due to language and cultural barriers, low education, and illiteracy. We compared the diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) to that of the Mini Mental State Examination (MMSE). Methods A total of 144 patients (42 with intact cognition, 44 with mild cognitive impairment [MCI], and 58 with dementia) were administered both instruments and were diagnosed by specialists blinded for MMSE and RUDAS results. Results Areas under the curve for discriminating intact cognition from MCI and dementia were comparable for RUDAS (0.81; 95% confidence interval 0.74–0.88) and MMSE (0.75; 95% confidence interval 0.69–0.85). Education and literacy were not correlated with the RUDAS but had a medium-large correlation with the MMSE (rho = 0.39). Conclusions The study provides additional evidence for the usefulness of the RUDAS in a highly illiterate, culturally diverse geriatric outpatient population.
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Affiliation(s)
- Miriam Goudsmit
- Department of Medical Psychology/Hospital Psychiatry, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Jos van Campen
- Department of Geriatrics, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Thelma Schilt
- Department of Medical Psychology/Hospital Psychiatry, Medical Centre Slotervaart, Amsterdam, the Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Chris Hinnen
- Department of Medical Psychology/Hospital Psychiatry, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Sanne Franzen
- Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Ben Schmand
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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de Araujo NB, Nielsen TR, Engedal K, Barca ML, Coutinho ES, Laks J. Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). ACTA ACUST UNITED AC 2018; 40:264-269. [PMID: 29451587 PMCID: PMC6899391 DOI: 10.1590/1516-4446-2017-2284] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/16/2017] [Indexed: 11/21/2022]
Abstract
Objective: To validate the Rowland Universal Dementia Assessment Scale for use in Brazil (RUDAS-BR). Methods: We first completed an English-Brazilian Portuguese translation and back-translation of the RUDAS. A total of 135 subjects over 60 years of age were included: 65 cognitively healthy and 70 with Alzheimer’s disease (AD) according to the DSM-IV and Neurological and Communicative Disorders and Stroke/Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria. All participants completed an interview and were screened for depression. The receiver operating characteristic curves of the RUDAS were compared with those of the Mini Mental State Examination (MMSE) regarding the sensitivity and specificity of cutoffs, taking education into consideration. Results: The areas under the curve were similar for the RUDAS-BR (0.87 [95%CI 0.82-0.93]) and the MMSE (0.84 [95%CI 0.7-0.90]). RUDAS-BR scores < 23 indicated dementia, with sensitivity of 81.5% and specificity of 76.1%. MMSE < 24 indicated dementia, with sensitivity of 72.3% and specificity of 78.9%. The cutoff score was influenced by years of education on the MMSE, but not on the RUDAS-BR. Conclusions: The RUDAS-BR is as accurate as the MMSE in screening for dementia. RUDAS-BR scores were not influenced by education. The RUDAS-BR may improve the cognitive assessment of older persons who are illiterate or of lower educational attainment.
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Affiliation(s)
- Narahyana B de Araujo
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thomas R Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Knut Engedal
- Norwegian National Unit for Aging and Health, Vestfold County Hospital, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Maria L Barca
- Norwegian National Unit for Aging and Health, Vestfold County Hospital, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Evandro S Coutinho
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Biomedicina Translacional (Biotrans), Universidade do Grande Rio (Unigranrio), Duque de Caxias, RJ, Brazil
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Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis. Int Psychogeriatr 2017; 29:897-929. [PMID: 28274299 DOI: 10.1017/s1041610216001976] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use. METHOD A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed. RESULTS Forty-five eligible studies were quality assessed. A significant proportion utilized a case-control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853. CONCLUSION Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.
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18
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Nielsen TR, Phung TKT, Chaaya M, Mackinnon A, Waldemar G. Combining the Rowland Universal Dementia Assessment Scale and the Informant Questionnaire on Cognitive Decline in the Elderly to Improve Detection of Dementia in an Arabic-Speaking Population. Dement Geriatr Cogn Disord 2016; 41:46-54. [PMID: 26613533 DOI: 10.1159/000441649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to assess whether combining the Rowland Universal Dementia Assessment Scale (RUDAS) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) could improve diagnostic accuracy when screening for dementia in an Arabic-speaking population with low levels of literacy. METHODS Based on data from 225 elderly participant and informant dyads, the screening performances of the two instruments were compared and three methods for combining them--'or', 'and' and 'weighted sum' rules--were assessed. RESULTS The 'weighted sum' method had a significantly better area under the curve value compared to the RUDAS used alone. The 'weighted sum' method and the 'and' rule had the highest specificity, while the 'or' rule had the best sensitivity. CONCLUSION Harnessing the RUDAS and IQCODE increased diagnostic accuracy when screening for dementia in this study population.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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19
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Chaaya M, Phung TKT, El Asmar K, Atweh S, Ghusn H, Khoury RM, Prince M, Nielsen TR, Waldemar G. Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging Ment Health 2016; 20:880-7. [PMID: 25984584 DOI: 10.1080/13607863.2015.1043620] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.
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Affiliation(s)
- M Chaaya
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - T K T Phung
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - K El Asmar
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - S Atweh
- c Department of Neurology , American University of Beirut Medical Center , Beirut , Lebanon
| | - H Ghusn
- d Department of Geriatrics , American University of Beirut Medical Center , Beirut , Lebanon
| | - R M Khoury
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - M Prince
- e Department of Health Service and Population Research , Institute of Psychiatry , King's College London , London , UK
| | - T R Nielsen
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - G Waldemar
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
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Radford K, Mack HA, Draper B, Chalkley S, Delbaere K, Daylight G, Cumming RG, Bennett H, Broe GA. Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians. Dement Geriatr Cogn Disord 2016; 40:22-32. [PMID: 25896073 DOI: 10.1159/000377673] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Validated cognitive screening tools for use in urban and regional Aboriginal populations in Australia are lacking. METHODS In a cross-sectional community-based study, 235 participants were assessed on the Mini-Mental State Examination (MMSE), the Rowland Universal Dementia Assessment Scale (RUDAS) and an urban modification of the Kimberley Indigenous Cognitive Assessment (mKICA). Performance on these cognitive screening tools was compared to dementia diagnosis by clinical consensus. RESULTS All tests were culturally acceptable with good psychometric properties. Receiver operating characteristic curve analyses revealed that the MMSE and mKICA were the most accurate. CONCLUSION The MMSE is an effective cognitive screening tool in urban Aboriginal populations. The mKICA is a good alternative when illiteracy, language or cultural considerations deem it appropriate. The RUDAS also has adequate validity in this population.
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Affiliation(s)
- Kylie Radford
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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21
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Abstract
BACKGROUND With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrooke's Cognitive Assessment Version III (ACE-III). METHODS The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed. RESULTS All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80-0.95) for the ACE-III, 0.84 (0.75-0.91) for the MoCA, and 0.86 (0.77-0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78-0.90) between the ACE-III and MoCA, 0.70 (0.57-0.80) between the ACE-III and RUDAS; and 0.65 (0.50-0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%). CONCLUSIONS All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.
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Thunborg C, von Heideken Wågert P, Götell E, Ivarsson AB, Söderlund A. Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units. BMC Geriatr 2015; 15:6. [PMID: 25884797 PMCID: PMC4333260 DOI: 10.1186/s12877-015-0003-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/20/2015] [Indexed: 11/20/2022] Open
Abstract
Background Mobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents’ maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads. Methods This study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations. Results The development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers’ facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale. Conclusions To enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0003-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotta Thunborg
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden. .,School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | | | - Eva Götell
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden.
| | - Ann-Britt Ivarsson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anne Söderlund
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden.
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Joliffe L, Brown T, Fielding L. Are clients' performances on the Rowland Universal Dementia Assessment Scale associated with their functional performance? A preliminary investigation. Br J Occup Ther 2015. [DOI: 10.1177/0308022614561236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The process of selecting the most appropriate cognitive assessments to use with clients presenting with symptoms of dementia is an important consideration. Are cognitive assessment results associated with the functional performance of clients presenting suspected cognitive decline? The purpose of this study was to investigate whether the Rowland Universal Dementia Assessment Scale was associated with the functional performance of clients with suspected dementia. Method A within-subjects quantitative research design was employed whereby a sample of 30 participants suspected of having dementia were recruited from three acute care hospital sites in the Melbourne metropolitan region. The Rowland Universal Dementia Assessment Scale was used to assess participants' cognitive abilities, while the Functional Independence Measure was the functional scale used. Linear regression analyses were completed. Results The six Rowland Universal Dementia Assessment Scale items were found to be significantly linked with the Functional Independence Measure total score (adjusted R2 = 0.298, p < 0.05), the Functional Independence Measure ‘cognition’ subscale score (adjusted R2 = 0.349, p < 0.05) and the Functional Independence Measure ‘physical’ subscale score (adjusted R2 = 0.244; p < 0.05). Conclusion The Rowland Universal Dementia Assessment Scale appears to be associated with the functional performance of clients with suspected dementia. The findings provide an insight into the link between cognition and everyday functional performance.
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Affiliation(s)
- Laura Joliffe
- Occupational Therapist, Alfred Health, Victoria, Australia
| | - Ted Brown
- Associate Professor, Monash University, Australia
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Abstract
BACKGROUND As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests. METHODS Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data. RESULTS 22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings. CONCLUSIONS Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.
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Prevalence of dementia in urban and regional Aboriginal Australians. Alzheimers Dement 2014; 11:271-9. [PMID: 24985534 DOI: 10.1016/j.jalz.2014.03.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/20/2014] [Accepted: 03/23/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of dementia in collaboration with urban/regional Aboriginal communities. METHODS A census of Aboriginal and Torres Strait Islander men and women aged 60 years and above in the target communities identified 546 potential participants, with 336 (61.5%) participating in this cross-sectional study. Participants completed a structured interview and cognitive screening tests. One hundred fifty-three participants also completed a detailed medical assessment. Assessment data were reviewed by a panel of clinicians who determined a diagnosis of dementia or mild cognitive impairment (MCI) according to standard criteria. RESULTS Crude prevalence of dementia was 13.4%, and age-standardized prevalence was 21.0%. The most common types of dementia were Alzheimer's dementia (44%) and mixed dementia diagnoses (29%). Estimated prevalence of MCI was 17.7%. CONCLUSION Consistent with previous findings in a remote population, urban and regional Aboriginal Australians face high rates of dementia at younger ages, most commonly Alzheimer's dementia.
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Nielsen TR, Andersen BB, Gottrup H, Lützhøft JH, Høgh P, Waldemar G. Validation of the Rowland Universal Dementia Assessment Scale for multicultural screening in Danish memory clinics. Dement Geriatr Cogn Disord 2014; 36:354-62. [PMID: 24022429 DOI: 10.1159/000354375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. METHODS Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to the standard diagnostic workup. RESULTS Diagnostic accuracy for the RUDAS [area under the curve (AUC) = 0.838] was similar to that of the Mini-Mental State Examination (MMSE; AUC = 0.840). The cutoff score with the best balance of sensitivity, specificity and accuracy was <24/30 for the RUDAS (sensitivity 0.69, specificity 0.80) and <25/30 for the MMSE (sensitivity 0.76, specificity 0.83). In contrast to the MMSE, regression analyses revealed that the RUDAS was unaffected by factors related to the patients' immigrant backgrounds. CONCLUSION The RUDAS showed high specificity and proved to be less affected by cultural and linguistic factors than the MMSE, making it a particularly valuable tool when screening for cognitive impairment in elderly multicultural patient populations.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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NIELSEN TR, VOGEL A, GADE A, WALDEMAR G. Cognitive testing in non-demented Turkish immigrants - comparison of the RUDAS and the MMSE. Scand J Psychol 2012; 53:455-60. [DOI: 10.1111/sjop.12018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The Mini-Mental State Examination (MMSE) is arguably the best-known cognitive screen in the world. Originally designed to assess cognitive impairment in elderly populations, it has become one of the first steps toward a dementia diagnosis. Routinely used in the clinic and in research internationally, the MMSE, despite its flaws, has managed to retain its popularity for more than 30 years. This review explores when and how the test is used, lists its advantages and disadvantages, and ultimately questions its value. The specific issue that is addressed here is whether the test has outlived its original purpose. The conclusion is that although the MMSE may be a useful tool in many circumstances where a cognitive screen is required, practitioners should be wary of using MMSE total scores as a shortcut toward a dementia diagnosis.
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