Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru

Custodio, Nilton; Montesinos, Rosa; Lira, David; Herrera-Pérez, Eder; Chavez, Kristhy; Reynoso-Guzman, Willyams; Pintado-Caipa, Maritza; Cuenca-Alfaro, José; Gamboa, Carlos Andrés Cano; Metcalf, Tatiana

doi:10.3389/fneur.2020.00374

Cited by 23 publications

(31 citation statements)

References 32 publications

(46 reference statements)

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“…In this regard, in our study, the RUDAS-PE showed promise in discriminating between controls and MCI, with the cut-off score in Santa Clotilde being one point lower than in Chuquibambilla (21 and 22, respectively). Of note, both cut-off scores were lower than the RUDAS-PE cut-off score obtained in our previously reported findings in an urban illiterate population in Lima, Peru (23) ( 21 ). Similarly, the specificity, percentage of correctly classified groups and the AUC for the RUDAS-PE was lower in the Santa Clotilde cohort (S = 50.0%; CC = 64.7%; AUC = 0.75) compared to Chuquibambilla (sensitivity [S] = 68.2%: correctly classified [CC] = 76.2% AUC = 0.8284).…”

Section: Discussioncontrasting

confidence: 70%

“…Similarly, the specificity, percentage of correctly classified groups and the AUC for the RUDAS-PE was lower in the Santa Clotilde cohort (S = 50.0%; CC = 64.7%; AUC = 0.75) compared to Chuquibambilla (sensitivity [S] = 68.2%: correctly classified [CC] = 76.2% AUC = 0.8284). In turn, these were lower compared to those obtained among urban illiterate persons of Lima (S = 93.3%: CC = 91.1%; AUC = 0.98) ( 21 ). These results are difficult to compare with previously published studies, since most of them compare controls with persons with dementia, not MCI, and have been conducted in urban, higher-income populations; but again, these findings suggest that there are important cultural and environment factors to consider when assessing illiterate populations with mild cognitive changes in rural communities of Peru.…”

Section: Discussionmentioning

confidence: 77%

“…Our study results suggest that a cut-off point of 21/22 is optimal for MCI screening and a cut-off point of 17/18 is optimal for dementia screening when the RUDAS-PE is used in illiterate persons form rural communities where the expected baseline rates of MCI and dementia are 17.7% and 32.3%, respectively (28). Whereas cut-off points of 23 and 19 may be optimal for predicting the presence or absence of MCI and dementia, respectively, in illiterate persons living in the city of Lima, where expected baseline rates of cognitive impairment differ (21,29). We found that compared to illiterate persons from the city of Lima our study subjects performed significantly worse on the domains of motor praxis and visuospatial construction on the RUDAS-PE.…”

Section: Discussionmentioning

confidence: 99%

“…The study personnel who administered the RUDAS-PE were a resident physician in geriatrics from Universidad Peruana Cayetano Heredia (UPCH) Medical School [KC] and a certified practicing neurologist [WR], both of whom who had been previously trained in administering the RUDAS-PE and other BCSTs following previously reported procedures ( 21 ) as part of their training experience at the IPN. These evaluators (KC and WR) were blinded to the results of the gold standard clinical diagnostic evaluation.…”

Section: Methodsmentioning

confidence: 99%

“…It is minimally influenced by educational attainment and measures a wide range of cognitive domains, hence it is promising for the detection of different types of dementia in sociodemographically diverse populations (17). Our group has validated the Peruvian version of the RUDAS (RUDAS-PE) in low literacy and illiterate populations in the capital city of Lima, Peru (18)(19)(20), where RUDAS-PE was useful in differentiating MCI from dementia with high sensitivity (89.0%) and specificity (93.0%) (21). In the present study we expand on this body of knowledge by testing the performance of the RUDAS-PE in two culturally distinct cohorts of illiterate subjects from two rural communities in Peru.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2021

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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.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 77%