Abstract
Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education.Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores.Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cut-off <23 (sensitivity 89%, specificity 93%).Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.
Highlights
Illiteracy rates among youth and adults are decreasing worldwide
The study began with 344 participants; 79 of whom were lost to follow-up: BCTs identified participants with severe stages of dementia (n = 25), difficulty attending scheduled visits (n = 22), hearing problems (n = 12), withdrew informed consent (n = 11), and visual problems (n = 9)
An additional 35 participants were excluded in the current analysis for the following reasons: incomplete Clinical Dementia Rating (CDR) interview due to absent caregiver (n = 15), incomplete CDR interview due to poor collaboration among study participants (n = 12), incomplete DSM-5 diagnostic criteria questionnaires (n = 2), severe stage dementia (n = 3), and moderate traumatic brain injury (n = 3) (Figure 1)
Summary
Illiteracy rates among youth (age 15 to 24 years) and adults are decreasing worldwide. It is common to find large portions of the older population experience limited access to health care systems, whether as a result of age discrimination or other barriers such as cost. This raises a high concern as the health and medical needs for this age group, in the ability to detect cognitive deterioration and dementia [3, 4], are largely unmet [5]. In Peru, this is primarily due to a lack of validated and standardized instruments to evaluate cognition and functionality in marginalized populations, i.e., low-levels of education and literacy rates, rural communities, indigenous groups or populations where multiple languages exist in addition to Spanish [6, 7]
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