Rowland Universal Dementia Assessment Scale, Mini-Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community-dwelling older persons with early dementia

Abstract

Early dementia can be difficult to diagnose in older persons from culturally and linguistically diverse (CALD) backgrounds. The Folstein Mini‐Mental State Examination (MMSE), the General Practitioner Assessment of Cognition (GPCOG) and the Rowland Universal Dementia Assessment Scale (RUDAS) were compared in 151 older, community‐dwelling persons. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy, while logistic regression was used to evaluate the influence of age, gender, CALD status and years of education. All three instruments were equally accurate in predicting dementia (ROC area under curve 0.92–0.97, p > 0.05 for all comparisons). At the recommended cut‐offs, the RUDAS was best for ruling in dementia (positive LR = 8.77), while the GPCOG was best for ruling out dementia (negative LR = 0.03). All three instruments were influenced by concomitant depression. Whereas the MMSE was influenced by CALD status, the RUDAS and GPCOG were not. While the GPCOG combines participant and informant data, the RUDAS is a stand‐alone measure specifically designed for, and validated in, multicultural populations.

Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

“…Nine studies compared the RUDAS to another cognitive assessment tool, which was the MMSE in all studies. One study 23 also assessed the General Practitioner Assessment of Cognition (GPCOG) in addition to the MMSE and RUDAS. Because the GPCOG is a participant-and informant-based questionnaire and only assessed in this single study, no further comparison has been made in this review.…”

“…Four studies did not report clearly on the method of participant selection. 20,21,23,25 Of the 8 studies that were used to assess the psychometric properties of the RUDAS, one was a casecontrol study 21 and one did not prespecify the cut-off point to determine a positive test on the RUDAS. 24 Two studies also excluded participants with mild cognitive impairment in their analyses.…”

The KICA Screen: The psychometric properties of a shortened version of the KICA (Kimberley Indigenous Cognitive Assessment)

“…This pattern is seen with other cognitive screening tools [17], possibly because of the uncertain clinical significance of CIND.…”

“…The predictive value of a screening tool will vary with the prevalence rate of a condition, such as dementia in the population tested [16]. Despite these limitations, the validity of the KICA Screen was comparable with the MMSE in a sample of Australian Aged Care Assessment Team clients (sensitivity 87.5% and specificity 85.3%) [16], and with the RUDAS in a multicultural cohort of community dwelling older people (sensitivity 84.3% and specificity 87.9%) [17]. The original KICA-Cog had a sensitivity of 90.6% and of 92.6% in the Kimberley [9], which may indicate that the KICA Screen is a slightly less sensitive tool.…”

“…In both populations studied the sensitivity of the KICA screen decreased when CIND was combined with those with dementia, whereas when CIND was combined with the normal groups specificity decreased. This pattern is seen with other cognitive screening tools [17], possibly because of the uncertain clinical significance of CIND. …”