Performance of the Rowland Universal Dementia Assessment Scale for the Detection of Mild Cognitive Impairment and Dementia in a Diverse Cohort of Illiterate Persons From Rural Communities in Peru

Abstract

Background: The accurate diagnosis of neurocognitive disorders in illiterate Peruvian populations is challenging, largely owing to scarcity of brief cognitive screening tools (BCST) validated in these diverse populations. The Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) is a BCST that relies minimally on educational attainment and has shown good diagnostic accuracy in an urban illiterate population in Peru, yet its psychometric properties in illiterate populations in rural settings of the country have not been previously investigated.Objectives: To establish the diagnostic accuracy of the RUDAS-PE compared to expert clinical diagnosis using the Clinical Dementia Rating (CDR) Scale in healthy and cognitively impaired illiterate persons living in two culturally and geographically distinct rural communities of Peru.Methods: A cross-sectional, population-based study of residents ≥ 50 years of age living in the Peruvian rural communities of Santa Clotilde and Chuquibambilla. A total of 129 subjects (76 from Santa Clotilde and 53 from Chuquibambilla) were included in this study. Gold standard diagnostic neurocognitive evaluation was based on expert neurological history and examination and administration of the CDR. Receiver operating characteristics, areas under the curve (AUC), and logistic regression analyses were conducted to determine the performance of RUDAS-PE compared to expert gold standard diagnosis.Results: Compared to gold standard diagnosis, the RUDAS-PE was better at correctly discriminating between MCI and dementia than discriminating between MCI and controls in both sites (97.0% vs. 76.2% correct classification in Chuquibambilla; 90.0% vs. 64.7% in Santa Clotilde). In Chuquibambilla, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.4% (optimal cutoff at <18), whereas between MCI and controls it was 82.8% (optimal cutoff at <22). In Santa Clotilde, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.1% (optimal cutoff at <17), whereas between MCI and controls it was 75.5% (optimal cutoff at <21).Conclusions: The RUDAS-PE has acceptable psychometric properties and performed well in its ability to discriminate MCI and dementia in two cohorts of illiterate older adults from two distinct rural Peruvian communities.

A first approach to MCI and Dementia prevalence through Q-RUDAS in the elderly Quechua population

“…Similar results we found in our previous study (9) in two culturally distinct cohorts of illiterate subjects from two rural communities in the jungle of Peru (Santa Clotilde y Chuquibambilla), who compared to illiterate persons from de city of Lima, they performed signi cantly worse on the same both cognitive domains of the Q-RUDAS, suggesting that educational level, unspeci ed sociocultural or linguistic factors present in rural environments may in uence performance on the Q-RUDAS in illiterate persons.…”

“…Although several studies reported an effect of limited (< 7 years) or no formal education on RUDAS scores, which some studies suggest to be speci c to the visuo-spatial construction and Praxis items (7)(8)(9), this generally did not affect diagnostic performance when the cutoff value was lowered by one or two points in these participants. An advantage of the RUDAS across LMIC and HIC settings appear to be its suitability for dementia screening in populations with limited or no formal education.…”

“…An advantage of the RUDAS across LMIC and HIC settings appear to be its suitability for dementia screening in populations with limited or no formal education. In Peru, RUDAS compared to expert clinical diagnosis, was superior at discriminating between persons with MCI and persons with dementia than discriminating between persons with normal cognition and persons with MCI in illiterate and low-education level from urban (10) and rural communities (9). Using instruments that have not been validated for use in the populations in which they were applied (e.g., the Mini Mental State Examination is not valid for populations with low educational level), a community dementia prevalence dementia of 6.7% (11) and 6.85% (12), while mild cognitive impairment was reported among 37.3% on 60 years and older Peruvian population (Herrera-Perez, et al, Submitted) Moreover, these studies are outdated and given an increase in the elderly population worldwide, the prevalence of dementia may have increased in Peru.…”

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults

“…In this order of ideas, the PT would meet the conditions to be administered to detect CD and dementia in elderly people with a low educational level or illiterate through TNP. This would be the first study that supports the use of PT through the TNP in LA, although the computerized version of the RUDAS 65 was recently analyzed in Peru and reported adequate psychometric indicators to discriminate CD and dementia in populations with heterogeneous educational levels, illiterate, and rural 19,62,63 . This is pioneering research in LA, although it has some limitations.…”

Propiedades psicométricas de la escala de evaluación sobre los conocimientos de la demencia: revisión sistemática

“…Por otro lado, Custodio et al (12) señalan que la versión peruana de la Escala Universal de Evaluación de Demencia de Rowland (RUDAS-PE) es una BCST que se basa mínimamente en el nivel educativo y ha demostrado una buena precisión diagnóstica en una población analfabeta urbana en Perú, sin embargo, sus propiedades psicométricas en poblaciones analfabetas en entornos rurales del Perú país no han sido investigados previamente, llegando a la conclusión que el RUDAS-PE tiene propiedades psicométricas aceptables y se desempeñó bien en su capacidad para discriminar DCL y demencia en dos cohortes de adultos mayores analfabetos de dos comunidades rurales peruanas distintas.…”