Abstract
Background:The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire).Methods:This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania.In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history.Results:3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment.Conclusions:The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.
Highlights
Dementia disproportionately affects low and middle income countries (LMICs)[1] and demographic transition and population ageing are predicted to result in a rapid and ongoing increase in those affected
1,337 (44.4%) had an informant able to complete the Interventions for Elderly Africans (IDEA)-IADL questionnaire at initial screening
This study indicates that if this strategy is to be used with lay health workers a focus on case-finding in those more likely to have dementia may be more useful
Summary
Dementia disproportionately affects low and middle income countries (LMICs)[1] and demographic transition and population ageing are predicted to result in a rapid and ongoing increase in those affected. In sub-Saharan Africa (SSA), as in many other LMIC settings, human-resource shortages in mental health and geriatric medicine are well recognized, in rural areas.[2,3,4,5] This can present challenges in access to healthcare leading to a substantial diagnostic and treatment gap for people with dementia and other non-communicable diseases (NCDs), as previously demonstrated by our team in Tanzania.[6,7,8] Identification of dementia and receiving a diagnosis is felt to be Journal of Geriatric Psychiatry and Neurology XX(X). Conclusions: The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized
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