Comparative analysis between the MMSE and the RUDAS for dementia screening in low educated people in a Spanish psychogeriatric clinic

Abstract

Background and objectivesThe Mini-Mental State Examination (MMSE) remains the most widely used test for the screening of dementia, but its limitations in low educated people are well known. This justified the development of new scales aimed at rooting out any socio-cultural bias, such as the Rowland Universal Dementia Assessment Scale (RUDAS). The aim of this paper is to compare the accuracy of the Spanish RUDAS and the MMSE for the diagnosis of dementia in a population with low level of education. MethodsIn a Psychogeriatric Unit a total of 97 outpatients were administered the RUDAS (by blinded examiners) and the MMSE (by an expert clinician, blind to the RUDAS results). Results35 of the 97 subjects received the diagnosis of dementia. The area under the ROC curve (AUC) for the RUDAS, 0.901 (IC 95% 0.84–0.96) was similar to MMSE AUC 0.889 (IC 95% 0.82–0.95). The ideal cut-off point for the RUDAS was 21/22 with 94.3% sensitivity and 72.6% specificity. The “best” cut point for the MMSE was 16/17, lower than the standard 23/24, with 85.7% sensitivity and 77.4% specificity.The MMSE correlated with educational level (r=0.432, p<0.01), but the RUDAS did not (r=0.087; n.s.). ConclusionsThe RUDAS was not only as accurate as the MMSE for the screening of dementia, but also, it was found to be free of biases associated withed the education level. Hence, the RUDAS seems to be a more adequate test for dementia screening in our cultural context than the MMSE. These results should be replicated in a primary care setting.