The reliability, validity, sensitivity, specificity and predictive values of the Chinese version of the Rowland Universal Dementia Assessment Scale

Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people

Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population.

Objective

To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it.

Methods

A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items.

Results

Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147).

Conclusion

This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.

Systematic Review and Meta-Analysis of Brief Cognitive Instruments to Evaluate Suspected Dementia in Chinese-Speaking Populations

Background

Chinese is the most commonly spoken world language; however, most cognitive tests were developed and validated in the West. It is essential to find out which tests are valid and practical in Chinese speaking people with suspected dementia.

Objective

We therefore conducted a systematic review and meta-analysis of brief cognitive tests adapted for Chinese-speaking populations in people presenting for assessment of suspected dementia.

Methods

We searched electronic databases for studies reporting brief (≤20 minutes) cognitive test's sensitivity and specificity as part of dementia diagnosis for Chinese-speaking populations in clinical settings. We assessed quality using Centre for Evidence Based Medicine (CEBM) criteria and translation and cultural adaptation using the Manchester Translation Reporting Questionnaire (MTRQ), and Manchester Cultural Adaptation Reporting Questionnaire (MCAR). We assessed heterogeneity and combined sensitivity in meta-analyses.

Results

38 studies met inclusion criteria and 22 were included in meta-analyses. None met the highest CEBM criteria. Five studies met the highest criteria of MTRQ and MCAR. In meta-analyses of studies with acceptable heterogeneity (I2 <  75%), Addenbrooke's Cognitive Examination Revised &III (ACE-R & ACE-III) had the best sensitivity and specificity; specifically, for dementia (93.5% & 85.6%) and mild cognitive impairment (81.4% & 76.7%).

Conclusions

Current evidence is that the ACE-R and ACE-III are the best brief cognitive assessments for dementia and mild cognitive impairment in Chinese-speaking populations. They may improve time taken to diagnosis, allowing people to access interventions and future planning.

Validation of the Rowland Universal Dementia Assessment Scale in Indonesia: Preliminary Evidence

The South-East Asia region has one of the fastest-growing aging populations, for which standardized dementia screening measures will be essential for geriatric care. The Rowland Universal Dementia Assessment Scale (RUDAS) is adopted for use in the Indonesian setting but lacks evidence of its cross-cultural transportability. This study aimed to examine the reliability and validity of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) in the Indonesian setting. Indonesian older adults from a geriatric nursing center (N = 135; 52 males, 83 females; age range 60-82) completed the Indonesian translation of the RUDAS (RUDAS-Ina), following content adaptation study with community living older adults (N = 35), nine neurologists and two geriatric nurses. For face and content validity, we utilized a consensus-building procedure. Results following confirmatory factor analysis yielded a single-factor model. The reliability of scores from the RUDAS-Ina was marginally satisfactory for research purposes (Cronbach α = 0.61). Multi-level linear regression for examining the association of the RUDAS-Ina scores with gender and age indicated older age to be associated with lower RUDAS-Ina scores. In contrast, the association with gender was not significant. Findings suggest a need to develop and validate locally generated items with cultural sensitivity to the Indonesian setting, which may also be studied in other Southeast Asian countries.

Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury

Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.

Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020

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.

Performance of the Rowland Universal Dementia Assessment Scale in Screening Mild Cognitive Impairment at an Outpatient Setting

Introduction

Mild cognitive impairment (MCI) is defined as the symptomatic pre-dementia phase on the continuum of cognitive decline. Early recognition and application of potential interventions could prevent or delay the progression to dementia. The Rowland Universal Dementia Assessment Scale (RUDAS) shows good performance in the screening of dementia but has limited data regarding its diagnostic properties in the screening of MCI. The objectives of this study were to assess the psychometric properties of the Thai version of the RUDAS (RUDAS-Thai) in the screening of MCI, identify associated factors for the RUDAS performance, and determine the optimal cutoff point in detecting MCI.

Methods

This was a cross-sectional study conducted from January 2020 to March 2021. Older patients at the outpatient clinic of an internal medicine department at a tertiary care hospital in Thailand were examined. Baseline data were collected, and the RUDAS-Thai was administered to each patient. Afterward, a geriatrician assessed each patient for MCI.

Results

A total of 150 patients were included, of whom 42 cases (28%) had MCI. The overall performance of the test using an area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval 0.75–0.89). At the optimal cutoff point of 25/30, the AUC was 0.76 with sensitivity and specificity of 76.2 and 75%, respectively. The educational level affected the test performance according to regression analysis. For patients with years of education ≤6 and >6, the optimal cutoff points were 25/30 and 26/30, respectively.

Conclusion

The RUDAS-Thai performed well in differentiating patients with MCI from normal cognition; however, it was affected by educational level. A score of 25/30 or lower for persons with ≤6 years of education or 26/30 or lower for persons with higher than 6 years of education is the optimal cutoff point for indication of developing MCI.

Comparative analysis of rowland universal dementia assessment scale and mini-mental state examination in cognitive assessment of traumatic brain injury patients

BACKGROUND

Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China.

OBJECTIVE

To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use.

METHODS

86 inpatients with TBI in a hospital were selected from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS.

RESULTS

(1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r = 0.611, P < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r = -0.344, P = 0.001) and RUDAS (r = -0.407, P < 0.001), while education years were positively correlated with MMSE (r = 0.367, P = 0.001) and RUDAS (r = 0.375, P < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively.

CONCLUSIONS

MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China.

Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

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.

Translation and cross-cultural adaptation of the Nepali version of the Rowland universal dementia assessment scale (RUDAS)

Background

Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia during ageing process. Early screening of elderly for MCI can help for early prevention and treatment of dementia. Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive assessment tool with excellent psychometric properties and is particularly useful in culturally and linguistically diverse (CALD) populations. The purpose of this study was to translate RUDAS into Nepali and to evaluate internal consistency of Nepali version of RUDAS.

Methods

RUDAS was translated to Nepali following recommended guidelines for translation and cross-cultural adaptation of patient reported measures. The pre-final Nepali version of RUDAS was tested on 30 elderly and appropriate changes were made by expert committee. The final Nepali version of RUDAS was developed and was administered on 100 elderly populations (mean age 67.70) to assess internal consistency.

Results

The rating of the participants upon their understanding of each 6 items of Nepali version of RUDAS on a 10-point Likert scale received a good score of more than 8 except ‘cube drawing’ which only received a mean score of 5.5. Additionally, only 8(27%) elderly have responded to the item ‘cube drawing’. The preference test was done and cube drawing was replaced by stick design test. Nepali version of RUDAS showed acceptable internal consistency with Cronbach’s alpha 0.7.

Conclusion

The results of our study presents translated and cross-culturally adapted Nepali version of RUDAS that has been proved to be an appropriate assessment tool for screening cognitive impairment among elderly.

Electronic supplementary material

The online version of this article (10.1186/s41687-019-0132-3) contains supplementary material, which is available to authorized users.

Reliability and Validity of Rowland Universal Dementia Assessment Scale in Turkish Population

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.

Cross-cultural adaptation methods of instruments in the nursing area

OBJECTIVE

To analyze scientific publications in order to identify the cross-cultural adaptation methods of instruments that are mainly applied in nursing.

METHOD

Integrative review, in the electronic sources Medline - Pubmed, Cinahl, Lilacs, Scopus and Web of Science. 96 peer-reviewed papers, published between 2010 and 2015 were selected.

RESULTS

The articles that composed the sample were published in 59 different journals, 15.2% were Brazilian. The largest number of publications was concentrated in 2015 (31.2%), 28 countries appeared on the list which is led by Brazil (33.3%), followed by China (10.4%). It was used 26 different guidelines, however the one proposed by Beaton and their collaborators was mentioned in 47 (49.0%) articles and the Brislin's in 12 (12.5%).

CONCLUSION

This review does not allow us to define the most appropriate method, however all methods applied agreed on the use of back translation. In addition, many studies in different languages and countries showed the international acceptability of the method developed by Beaton et al.