Abstract
BackgroundCognitive tests have been used in population surveys as first stage screens for dementia but are biased by education. However functional ability scales are less biased by education than the cognitive scale and thus can be used in screening for dementia.ObjectiveTo validate Activities of Daily Living (ADL) scale appropriate for use in assessing the presence of dementia in an elderly population living in care homes in Sri Lanka.MethodSinhalese version of the modified Bristol and Blessed scale was administered to subjects aged 55 years and above residing in 14 randomly selected elders' homes. Receiver Operating Characteristic (ROC) was used to determine the cut-off scores of both the scales.ResultsBased on the ROC analysis, optimal cut off score of the modified Bristol scale was 20 with a sensitivity of 100%, specificity of 74.2% and the area under the curve 0.933(95% CI: 0.871-0.995) while the optimal cut off score of the modified Blessed scale was 10.5 with a sensitivity of 100%, specificity of 71% and the area under the curve 0.892 (95% CI: 0.816-0.967).ConclusionThe findings confirm that both the scales can be used in screening for dementia in the elderly living in care homes in Sri Lanka.
Highlights
Cognitive tests have been used in population surveys as first stage screens for dementia but are biased by education
Based on the Receiver Operating Characteristic (ROC) analysis, optimal cut off score of the modified Bristol scale was 20 with a sensitivity of 100%, specificity of 74.2% and the area under the curve 0.933(95% CI: 0.871-0.995) while the optimal cut off score of the modified Blessed scale was 10.5 with a sensitivity of 100%, specificity of 71% and the area under the curve 0.892
The findings confirm that both the scales can be used in screening for dementia in the elderly living in care homes in Sri Lanka
Summary
Cognitive tests have been used in population surveys as first stage screens for dementia but are biased by education. Functional ability scales are less biased by education than the cognitive scale and can be used in screening for dementia. Cognitive tests (e.g. Mini Mental State Examination -MMSE) [1] have been used in population surveys as first stage screens for dementia [2,3,4] but are biased by education [5,6] and it is more difficult to use them as case finding tools in primary care especially in low literacy settings [7]. Administration of cognitive tests to above setting may be demeaning to a patient and requires a tool that would adequately detect dementia in early stage
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