Community Screening Instrument For Dementia Research Articles

A Comparative Study of Three Dementia Screening Instruments (CSI-D, CMMSE, and ECAQ) in a Multi-Ethnic Asian Population

Background—There is no validated dementia screening tool for multi-ethnic Asian populations comprising Chinese, Malays, and Indians. This study aimed to establish the psychometric properties of the Community Screening Instrument for Dementia (CSI-D), Chinese Mini Mental State Examination (CMMSE), and Elderly Cognitive Assessment Questionnaire (ECAQ) in multi-ethnic Singapore. Methods—Participants were randomly drawn from a community-based neurological diseases study of older adults conducted in Singapore, with oversampling to allow similar subject numbers from the three major ethnicities: Chinese, Malay, and Indian. The CSI-D, CMMSE, and ECAQ were administered by trained research nurses using a standardised translated questionnaire in a language the participant was most conversant in. Participants were independently diagnosed as a case/non-case of dementia using the DSM-IV. Results—There were 259 participants (85 Chinese, 85 Malays, and 89 Indians, mean age 70.15 years, 65.4% female, 58.8% had no/minimal formal education); 22.8% (n = 59) had dementia. Correlations between the measures were substantial. All the measures had acceptable overall discriminative abilities. Diagnostic accuracies of the instruments did not differ across the ethnic groups. Effects of education were present in the cognitive screening measures. Conclusions—The CSI-D, CMMSE, and ECAQ are valid dementia instruments in this multi-ethnic Asian setting.

GENDER DIFFERENCES IN INFORMANT REPORTS OF COGNITIVE FUNCTIONING IN MEXICO AND THE US

Abstract Background Increasingly, researchers are attempting to measure cognitive functioning in large population-based surveys using both direct measurement and informant reports, but little work examines how gender affects measurements. For example, the role of gender in the division of labor is different in the U.S. and Mexico so questions relating to household chores will overestimate functional impairment in Mexico relative to the U.S. Method: Data from the U.S. Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) will be used to examine disparities in how informants report cognitive change, measured by the total Community Screening Instrument for Dementia (CSI′D’) score, are related to gender of participants and informants. Result: Female participants in Mexico have higher CSID scores than men but not in the U.S. Conversely, female informants report higher CSID scores than male informants in the U.S. but not in Mexico. Conclusion Further analysis is needed to determine if national differences in the association of gender and reports of cognitive impairment are due to differences in how informants report impairment.

Joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old: a cross-sectional study.

During the long preclinical phase of dementia, accelerated cognitive impairment is regarded as a cardinal marker. Thus, the identification of risk factors for cognitive impairment is of great significance for dementia prevention. This study aims to examine the joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old, and provide suggestions for improving the cognitive function in rural elderly over 65 years old. A cross-sectional study was conducted in rural Nanjing by recruiting 1147 individuals aged above 65 years. Cognitive function was assessed using the brief community screening instrument for dementia. Physical activity was assessed using the Global Physical Activity Questionnaire. Data were analyzed by multivariate logistic regression models, and a significant difference was set at P < 0.05. Compared with participants with proper sleep duration and sufficient physical activity, participants with short sleep duration and insufficient physical activity (odds ratio (OR): 1.820; 95% CI: 1.265 ~ 2.618), long sleep duration and sufficient physical activity (OR: 2.428; 95% CI: 1.137 ~ 5.183) showed an increased likelihood of cognitive impairment. Inappropriate sleep duration combined with insufficient physical activity was associated with a significantly higher likelihood of cognitive impairment in rural elderly over 65 years old.

Comparing informant‐based measures of cognitive functioning between the US and Mexico

AbstractBackgroundInformant reports are important for understanding cognitive impairment and dementia in older populations. Recently, several population‐based aging studies have included harmonized direct and informant assessments to assess the prevalence of dementia globally as part of the international Harmonized Cognitive Assessment Protocol (HCAP). However, the social and cultural contexts of nations, sociodemographic characteristics of informants, and the participant‐informant relationship may affect the accuracy of informant ratings of cognitive decline and functioning. This study examines the extent to which informant characteristics and the participant‐informant relationships are associated with informant‐reported cognitive function in the United States and Mexico.MethodsData are from the 2016 US Health and Retirement Study (HRS) HCAP (N = 2,918) and the Ancillary Study of Cognitive Aging in Mexico (Mex‐Cog) (N = 1,750). Informant‐reported cognitive function was measured by the informant Community Screening Instrument for Dementia (CSI‐D). Participants’ cognitive function was measured using the HCAP. We compared the characteristics of informants, informant ratings, and directly‐assessed cognitive functioning in both nations, and used regression to assess the association of informant characteristics and the participant‐informant relationship with the informant CSI‐D score.ResultsWe find older Americans have worse informant‐reported cognitive functioning but higher directly‐assessed cognitive functioning than Mexicans. Nearly 80% of informants lived with the subject in Mexico, compared to less than half in the US. In both countries, older informants, children and other family members (compared to spouse) report less cognitive impairment. In Mexico, female informants reported more impairment. In the US, coresident informants reported more impairment.ConclusionThis research shows how social environments influence informant reporting. Understanding heterogeneity in informants is vital when examining informant measures of cognitive function in cross‐countries studies.

Prevalence of dementia screen positive among older adults in rural Kenya: results from a dementia screening program

AbstractBackgroundSub‐Saharan African countries have the fastest growing rates of older people, yet little is known about the number of cases of dementia. In Kenya, the little we know about dementia is derived from studies involving the few individuals who receive a diagnosis, but typically in the more advanced stages of the condition when carers have reached a crisis point. Effective and routine data screening is important for the early detection of dementia, but also provides insights into the number of people living with cognitive and functional impairment associated with dementia. We aimed to describe the number of people screening positive for dementia within rural Kenya, and identify factors associated with screening positive.MethodCommunity Health Workers conducted an opportunistic household survey among community‐dwelling residents aged 60 and above in rural Kenya. The brief Community Screening Instrument for Dementia (CSID), which allows for potential cases of dementia to be identified without the need for specialist tools or intensive training was used to identify number of people living with dementia and socio‐demographic information collected. This is an interim analysis of the data.Result672 older adults (M = 71.0 years old; SD = 8.96) were screened for dementia. Participants were predominantly Kamba (n = 664, 98.8%) and from Makueni county (n = 617, 91.8%). 209 people screened positive for dementia (31.1% (95%CIs 27.6 to 34.8). Males (OR = 0.67, 95%CIs 0.52 to 0.87) and people who were literate (OR = 0.51, 95%CIs 0.41 to 0.64) were less likely to screen positive for dementia. Screening positive for dementia was also associated with old age, with the oldest age group (90 years+) being 3.7 times more likely to screen positive for dementia than the youngest group (60‐64 years) (OR = 3.67, 95%CIs 2.54 to 5.37).ConclusionThese findings form the first‐ever dementia screening programme in rural Kenya and highlight the numbers of people living with cognitive and functional impairment, potentially indicating dementia. Although such cases need to be clinically confirmed, these data can support the planning, policy development and inclusion of dementia care within policy discussions.

Living without a diagnosis: Quality of life differences between those who screen positive and negative for dementia in rural Kenya

AbstractBackgroundWithin Kenya, dementia is commonly under‐recognised and under‐diagnosed. As a result, many people living with dementia do so without any formal support. The DEM‐SKY project seeks to address this gap by implementing a dementia screening program in Kenya using Community Health Volunteers. The aim of this study is to understand some of the consequences of living with cognitive and functional impairment.MethodsOlder adults (aged 60 years and older) were opportunistically screened for dementia using the Brief Community Screening Instrument for Dementia (CSID) within Makueni County, Kenya. Secondary outcomes included Quality of life (EUROHIS‐8) and loneliness (UCLA). Regression models were created to understand how quality of life and loneliness outcomes differ between those who screen positive and negative for dementia.ResultsOf the 672 older adults screened, 31.1% (n = 209) screened positive for dementia. People who screen positive for dementia reported to have poorer quality of life (p = 0.01) and were also lonelier (p = 0.03) than those who screened negative. Quality of life (b = ‐0.93, 95%CIs = ‐1.83 to ‐0.02; p = 0.04) and loneliness (b = 0.34, 95%CIs = 0.03 to 0.65; p = 0.03) outcomes remained statistically significant after controlling for age, sex, ethnicity, geographic location, and social status.ConclusionThe findings indicate that people who experience cognitive and functional impairment (indicative of dementia) in Kenya are more likely to be lonely and have poorer quality of life. Further research is needed to understand the underlying mechanisms within a Kenyan context, but our findings are indicative that even without a diagnosis the impact of dementia can be felt by people living with it.

Dementia prevalence in Southern Switzerland across community‐dwelling and institutionalised older adults – the SwissDEM study

AbstractBackgroundEpidemiological evidence on dementia prevalence is outdated and still limited, and recent estimates (including those from the Institute for Health Metrics and Evaluation, IHME) may be an underestimation. Moreover, the recent WHO blueprint exercise confirmed that the quality of data we have is poor and based on weak and non‐standardized or even flawed methods. Dementia prevalence in nursing homes (NH) is likely high but evidence is scarce. We aimed to explore dementia and compare dementia prevalence in Southern Switzerland in community and in NH settings, using standardized and previously validated procedures and assessments.MethodWe conducted a cross‐sectional study among a random sample of community dweller older adults and a convenience sample of NH residents in the Canton of Ticino. Participants were dyads formed by an older adult (≥65 years old) and an informant. We collected socio‐demographic data and assessed cognitive function using the electronic version of the 10/66 short Dementia Diagnostic Schedule, which comprises the Community Screening Instrument for Dementia (CSI‐D), the CERAD animal verbal fluency and ten‐word list learning tasks, and the EURO‐Depression scale (EURO‐D). We performed descriptives, t‐tests, and chi‐square tests.ResultWe recruited 462 participants between June 2021 and August 2022. Participants living in the community (N = 300) had a mean age of 76.11 (SD = 6.46), and those living in NH (N = 162) of 87.62 (SD = 6.44). The prevalence of dementia was 6.3% (CI: 3.56‐9.11) in the community, and 75% (CI: 68.6‐82.02) in NH. Overall, dementia caseness was positively associated with age (p‐value &lt;0.001), being a woman (p‐value &lt; 0.001), and lower educational level (p‐value &lt;0.001). However, these associations were not significant in the NH subsample (all p‐values &gt;0.05). Among community‐dwelling older adults, dementia caseness was associated with age (p‐value &lt;0.001), but not with gender, and education (all p‐values &gt;0.05).ConclusionOur study shows the marked differences in dementia prevalence between community and NH settings, expanding recent models from the IHME. It is crucial to include institutionalised older adults when measuring dementia prevalence in populations, particularly in high‐income countries, and where people with dementia are more likely to and can live in NH.

95 Examining the Utility of Demographically Adjusted Scores on the Community Screening Instrument for Dementia in Congolese Older Adults

Objective:Given the lack of comprehensive neuropsychological tools and neuropsychological services in Sub-Saharan Africa (SSA), cognitive screeners for dementia can be useful tools to screen for suspected dementia at the population level. However, most available screeners have not been developed or validated in SSA populations. The Community Screening Instrument for Dementia (CSID) was developed for cross-cultural use, and it has a cognitive testing component and informant interview. We have previously demonstrated that lower years of education and female sex are associated with lower scores on the CSID. Here, we examine the utility of demographically adjusted CSID scores in a community sample of Congolese older adults.Participants and Methods:354 participants (mean age=73.6±6.7, mean education (years) =7.3±4.7; 50% female) were randomly recruited in Kinshasa, Democratic Republic of the Congo, and completed the CSID and the Alzheimer's Questionnaire (AQ) to examine functional abilities. Raw scores were demographically adjusted for education and sex by adding 1 point for &lt;12 years of education and 1 point for female. Cognitive impairment was classified as a total score below 25.5. Rates of impairment were compared between raw scores and demographically-adjusted scores. Demographic profiles were examined between both classificationsResults:Average raw CSID scores were 25.23 (SD=4.19) and average demographically-adjusted scores were 26.59 (SD= 4.09). Approximately 43.1% of the sample was impaired based on the raw CSID scores compared to 30.4% with the demographically-adjusted scores (x2= 12.334, p&lt;.001). There was a higher proportion of females (n=95; 26.8%) classified as impaired with the raw SCID scores compared to the demographically-adjusted scores (n=62; 17.5%; x2= 8.87, p=0.003). Approximately 27.4% (n=97) of the participants classified as impaired with the raw SCID scores had primary education or less (i.e., 1-6 years) compared to 18.9% with the demographically-adjusted scores (n=67; (x2= 107.77, p&lt;.001). Forty-five participants were re-classified as not impaired with the demographically-adjusted scores with the majority of these participants being female (73.3%), having primary education (66.7%), and being functionally unimpaired on the AQ (91.1% unimpaired).Conclusions:We demonstrate that raw scores on the CSID can lead to misclassification of impairment in females and in individuals with lower years of education. Demographically-adjusted scores on the CSID can help properly capture those with suspected dementia while reducing false positives. Given the effects of education and sex on performance, future studies should examine if demographically adjusted scores improve the sensitivity and specificity of the CSID in Congolese populations and compare its performance to other screening tools to determine the most appropriate screener for this population.

96 Health Factors and Psychosocial Factors as Predictors of Depressive Symptoms and the Association of Depressive Symptoms and Cognitive Functioning in Congolese Older Adults

Objective:Late-life depression is a complex condition impacted by both mental and physical health outcomes and psychosocial factors. Psychosocial predictors of depression are reliant on cultural factors including socioeconomic variables, stigmas, and cultural values. Most research on late-life depression and its effect on cognitive functioning has been completed in so-called Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations and findings may not generalize to older adults living in other areas of the world. The current study explored predictors of depressive symptoms as well as the association between depressive symptoms and neuropsychological functioning in Congolese older adults.Participants and Methods:A total of 319 participants (mean age=72.7±6.15, mean education in years=7.6±4.56; 47% female) were randomly recruited. Depressive symptoms were assessed with the Geriatric Depression Scale. Given the exploratory nature of the current study, forward stepwise linear regression models were run to assess predictors of depressive symptoms. The independent variables assessed as potential predictors included age, years of education, gender, participant income, parental income, living arrangement (i.e., alone or with others), functional abilities (FAQ), fragility, and self-rated overall health. Analyses were run in the overall sample as well as stratified by gender. The association between depressive symptoms and performance on the Community Screening Instrument for Dementia (SCID) was also explored.Results:Higher depressive symptoms were found in women (ß=.228, p=0.036), those with lower parental income (ß=-.156, p=.005), higher fragility (ß=-.237, p&lt;.001), and worse overall health (ß=-.311, p=.020). Among women, lower parental income, (ß=-.230, p=.002), higher fragility (ß=-.312, p&lt;.001), and lower overall health (ß=-.235, p=.004) predicted higher depressive symptoms, while in men only higher fragility (ß=-.164, p=.041) and living alone (ß=-.184, p=.022) predicted higher depressive symptoms. There was also a significant association between depressive symptoms and lower scores on the CSID (ß=-.189, p=.001)Conclusions:Similar to results in WEIRD populations, general health and fragility predicted depressive symptoms in Congolese older adults. However, parental income (more so than participant income) also predicted depressive symptoms in Congolese older adults, particularly in women, while living alone was a predictor in Congolese older men. It is possible that the difference in depressive symptoms between men and women is driven by underreporting of depressive symptoms among men. Our results also showed that there was an association between depressive symptoms and global cognitive functioning similar to prior findings in WEIRD populations. Our results are important for clinicians assessing depressive symptoms in patients in or from Congo or sub-Saharan Africa.

Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China.

The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing "internet use×urban-rural status" interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=-.027, 95% CI -.043 to -.009). The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.

Prevalence of dementia and its association with central nervous system infections among older persons in northern Uganda: cross-sectional community-based study

BackgroundDementia is a condition in which there is deterioration in cognitive function beyond what might be expected from the usual consequence of biological aging. Few studies have been conducted on the prevalence of dementia and its association with central nervous system (CNS) infections among older persons in African settings, particularly in Uganda. Therefore, this study assessed the prevalence of dementia and its association with CNS infections among older persons in Lira District, northern Uganda.MethodsThis was a cross-sectional community-based study in Lira district northern Uganda. The study was conducted in March 2022 among 434 older persons aged 50 and above years who were selected by multistage sampling. Data were collected using an interviewer-administered questionnaire supplemented with information from participant’s medical records and a brief community screening instrument for dementia. The instrument classifies dementia into unlikely, probable or possible dementia. Data were entered in duplicate into EpiData version 3.0, then transferred to Statistical Package for Social Sciences (SPSS) version 23 for statistical analysis.ResultsOur study found almost one in four (23%) of the older persons in Lira district northern Uganda were suffering from probable or possible dementia. Our study further found that older persons in Lira district northern Uganda with a positive history of central nervous system infections (CNS) had nearly five times higher odds of having probable or possible dementia compared to their counterparts (cOR: 4.5; 2.76–7.23; p ≤ 0.001). Being in advanced age of 70 + years (aOR: 2.6; 1.6–4.3; p ≤ 0.001), positive history of CNS infection particularly Herpes simplex virus-1 (aOR: 5.4; 1.4–20.5; p = 0.013), and chronic headache (aOR: 1.9; 1.1–3.1; p = 0.019) were independent predictors of probable or possible dementia among participants in this study.Conclusion and recommendationsDementia is a common condition among older persons in Lira district northern Uganda with a prevalence of 23% in our study. Older persons with a positive history of CNS infection had higher odd of developing dementia compared to their counterparts. Having advanced age, cerebral malaria, Herpes simplex virus − 1 (HSV-1) infections, and chronic headache were independent predictors for dementia. These results imply that health assessment for the risk of dementia should include screening for history of CNS conditions particularly cerebral malaria, HSV-1 and chronic headache.

Exploring factors contributing to caregiver burden in family caregivers of congolese adults with suspected dementia.

Predicting caregiver burden in individuals with suspected dementia - is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub-Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC). Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient-caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI). Average caregiver burden on the ZBI was 36.1 (SD=14.6; range=12-58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden. Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden.

Frequency, pattern and predictors of cognitive impairments in patients with Parkinson's disease using the Community Screening Instrument for Dementia.

Parkinson's disease (PD) is a chronic neurodegenerative disorder complicated by cognitive dysfunctions which are associated with increased caregiver burden, pressure on community health facilities, and mortality in affected patients. Most of the data concerning cognitive dysfunctions in PD are from studies conducted in Europe and North America, but there is paucity of data from Sub-Saharan Africa. The objective of this study is to determine the frequency, pattern and predictors of cognitive impairments amongst patients with Parkinson's disease. This was a cross sectional case control study carried out at a tertiary health facility in South-south Nigeria. Participants with PD were consecutively recruited from the neurology outpatient clinics. Demographic and disease-specific data were obtained with the use of a pre-tested questionnaire. Cognitive performance of thirty patients with PD were compared with thirty demographically matched controls using the Community Screening Instrument for Dementia (CSID). CSID was already validated among Nigerians. The frequency of cognitive impairment using the CSID was 50% for PD patients (3.3% for controls). Poor cognitive performance was observed across several cognitive domains including language, executive dysfunction, psychomotor speed, and constructional apraxia among PD patients. The independent predictors of the overall cognitive impairment in patients with PD determined by logistic regression analysis include recall deficiency (p = 0.007), impairment with naming (p = 0.044), apraxia (p = 0.003), Hoen&Yahr staging (p = 0.046), UPDRS score (p = 0.015) and age at presentation (p = 0.014). Cognitive impairments occur more frequently in patients with PD compared to controls. This study also demonstrated the predictive role of severity of disease based on Hoehn &Yahr staging and UPDRS score, and presence of recall deficiency, poor naming ability and apraxia.

Prevalence of suspected dementia in a sample of adults living in Kinshasa-Democratic Republic of the Congo.

The prevalence of dementia in Sub-Saharan Africa, particularly in French-speaking countries, has received limited attention. This study investigates the prevalence and risk factors of suspected dementia in elderly adults in Kinshasa, Democratic Republic of the Congo (DRC). A community-based sample of 355 individuals over 65 years old was selected using multistage probability sampling in Kinshasa. Participants were screened using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire, Geriatric Depression Scale, Beck Anxiety Inventory, and Individual Fragility Questionnaire, followed by clinical interview and neurological examination. Suspected dementia diagnoses were made based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria including significant cognitive and functional impairments. Prevalence and odds ratios (ORs) with 95% confidence interval (CI) were calculated using, respectively, regression and logistic regression. Among 355 participants (mean age 74, SD=7; 51% male), the crude prevalence of suspected dementia was 6.2% (9.0% in women and 3.8% in men). Female sex was a significant factor associated with suspected dementia [OR=2.81, 95% CI (1.08-7.41)]. The prevalence of dementia increased with age (14.0% after 75 years and 23.1% after 85 years), with age being significantly associated with suspected dementia [OR=5.42, 95% CI (2.86-10.28)]. Greater education was associated with a lower prevalence of suspected dementia [OR=2.36, 95% CI (2.14-2.94), comparing those with ≥7.3 years of education tothose with <7.3 years of education]. Other factors associated with the prevalence of suspected dementia included being widowed (OR=1.66, 95% CI (1.05-2.61), being retired or semi-retired (OR=3.25, 95% CI (1.50-7.03)], a diagnosis of anxiety [OR=2.56, 95% CI (1.05-6.13)], and death of a spouse or a relative after age 65 [OR=1.73, 95% CI (1.58-1.92)]. In contrast, depression [OR=1.92, 95% CI (0.81-4.57)], hypertension [OR=1.16, 95% CI (0.79-1.71)], body mass index (BMI) [OR=1.06, 95% CI (0.40-2.79)], and alcohol consumption [OR=0.83, 95% CI (0.19-3.58)] were not significantly associated with suspected dementia. This study found a prevalence of suspected dementia in Kinshasa/DRC similar to other developing countries and Central African countries. Reported risk factors provide information to identify high-risk individuals and develop preventive strategies in this setting.

Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations.

The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings. We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N=11,250) to quantify associations between items on functional limitations and cognitive impairment. Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD=0.73vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR]=2.23vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]). Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies. There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.

COMPARING INFORMANT BASED MEASURES OF COGNITIVE FUNCTIONING BETWEEN THE US AND MEXICO

Abstract Informant reports are important for understanding cognitive impairment and dementia in older populations. Recently, several population-based aging studies have included harmonized direct and informant assessments to assess the prevalence of dementia globally as part of the international Harmonized Cognitive Assessment Protocol (HCAP). However, the social and cultural contexts of nations, sociodemographic characteristics of informants, and the subject-informant relationship may affect the meaning and accuracy of informant reports of cognitive decline and functioning. This study examines the extent to which informant characteristics and the informant-respondent relationships are associated with informant-reported cognitive function in the United States and Mexico. Data are from the 2016 US Health and Retirement Study (HRS) HCAP (Nf 2,918) and the Ancillary Study of Cognitive Aging in Mexico (Mex-Cog) (Nf 1,750). Informant-reported cognitive function was measured by the informant Community Screening Instrument for Dementia (CSI-D). Linear regression is used to assess the association of informant characteristics and the information-participant relationship with the total CSI-D score. We find older Americans have worse informant-reported cognitive functioning but higher directly-assessed cognitive functioning than Mexicans. Nearly 80% of informants lived with the subject in Mexico, compared to less than half in the US. In both countries, older informants, children and other family members (compared to spouse) report less cognitive impairment. In Mexico, female informants reported more impairment. In the US, coresident informants reported more impairment. This research shows how social environments influence informant reporting. Understanding heterogeneity in informants is vital when examining informant measures of cognitive function in cross-countries studies.

Prevalence of Suspected Dementia in a Sample of Adults Living in Kinshasa‐Democratic Republic of the Congo

AbstractBackgroundThe improved life expectancy in Sub‐Saharan Africa are leading to increased burden of dementia. This study investigates the prevalence and risk factors for suspected dementia in elderly adults in Kinshasa, Democratic Republic of the Congo (DRC).MethodParticipants included 356 individuals over 65 years old (mean = 73.6 years; SD = 6.7 years; range = 65‐98 years) recruited in Kinshasa. The sample was 51% male with an average 7.3 (SD = 4.7 years; range 0‐20 years) years of education. Participants were screened using Community Screening Instrument for Dementia, Alzheimer’s Questionnaire, Geriatric Depression Scale, Beck Anxiety Inventory and Individual Fragility Questionnaire followed by clinical interview and neurological screening. Suspected dementia diagnoses were made based on DSM‐5 criteria including significant cognitive and functional impairments. Prevalence and odd ratios with 95% confidence interval were calculated using logistic regression.ResultThe crude prevalence was 6.2% in Kinshasa. The prevalence of suspected dementia was 9.0% in women and 3.8% in men. Female sex was a significant predictor of suspected dementia [OR = 2.81, 95% CI (1.08‐7.41), p = 0.03]. The prevalence of dementia increased with age (14.0% after 75 years and 23.1% after 85 years), with age being a significant risk factor [OR = 5.42, 95% CI (2.86‐10.28), p &lt;.0001. Greater education was associated with lower prevalence of suspected dementia [OR = 0.36, 95% CI (0.14‐0.94), p = 0.04, comparing those with ≥7.3 to &lt;7.3 years of education]. Widow and being semi‐retired or retired were significant risk factors. Anxiety [OR = 2.56, 95% CI (1.05‐6.13), p = 0.04] and death of a spouse or a relative after age 65 [OR = 0.73, 95% CI (0.58‐0.92), p = 0.01] were significant risk factors for suspected dementia while depression [OR = 1.92, 95% CI (0.81‐4.57)], hypertension [OR = 1.16, 95% CI (0.79‐1.71)], BMI [OR = 1.06, 95% CI (0.40‐2.79)], and alcohol consumption [OR = 0.83, 95% CI (0.19‐3.58)] were not significant predictors of suspected dementia.ConclusionThis study found a prevalence of suspected dementia in Kinshasa/DRC similar to other developing countries and Central African countries. Being elderly, female, less educated, widow, retired, having anxiety and experiencing death after age 65 were significant risk factors for suspected dementia.

The role of disability and depressive symptoms in the relation between objective cognitive performance and subjective cognitive decline.

Subjective cognitive decline (SCD) and subjective memory decline (SMD) are common among older people. Evidence linking SCD and SMD with cognitive and memory impairment is inconsistent. Moreover, little is known about the associations of SCD and SMD with disability. We aimed to explore the associations of SCD and SMD with objective cognitive and memory performance, disability, and depressive symptoms. In a cross-sectional study we conducted face to face interviews in a randomized sample of people aged ≥65 years living in the Canton of Ticino, southern Switzerland, between May 2021 and April 2022. We measured subjective cognitive decline with the MyCog, a subsection of the Subjective Cognitive Decline Questionnaire (SCD-Q); cognitive functioning with the Community Screening Instrument for Dementia; memory with the consortium to establish a registry for alzheimer's disease (CERAD) 10-word list learning task; and disability and depressive symptoms with the world health organization disability assessment schedule 2.0 (WHO-DAS 2.0) and the Euro-Depression (EURO-D) scales, respectively. Of the 250 participants 93.6% reported at least one cognitive difficulty, and 40.0% SMD. Both SCD and SMD were associated with poorer objective cognitive/memory performance, and independently with greater disability, and more depressive symptoms. But in participants with high disability and depressive symptoms subjective and objective cognition were no longer associated. Disability fully mediated the associations of poorer objective cognitive and memory performance with subjective cognitive and memory decline. Routine clinical assessments of cognitive function should include formal enquires about SCD and SMD, and also account for disability and depressive symptoms.

A-3 Examining The Sociodemographic Factors Associated with Performance on The Community Screening Instrument for Dementia in Congolese Older Adults

Abstract Objective: Given the lack of comprehensive neuropsychological tools in Sub-Saharan Africa, there is a need to examine the clinical utility of dementia cognitive screeners in this setting. We examined the contribution of sociodemographic factors to performance on the Community Screening Instrument for Dementia (CSID) in Congolese older adults. Methods: 354 participants (mean age = 73.6 ± 6.7, mean education (years) =7.3 ± 4.7; 50% female) were randomly recruited. All participants completed the CSID (mean = 25.23 ± 4.19). Multiple linear regressions were conducted to examine the contribution of age, education, sex, and the interactions between education, school type, and participant income to CSID raw scores. Raw scores were demographically adjusted for education and sex by adding 1 point for ≤12 years of education and 1 point for female. Results: Older age (β = −0.362, p &amp;lt; 0.001), fewer years of education (β = −0.335, p = 0.022), female sex (β = −0.223, p = 0.035), and public schools (β = −0.185, p = 0.008) were associated with lower CSID scores. There was a trend for lower-income associated with lower CSID scores (β = −0.185, p = 0.062). The interaction between education and school was significant (p = 0.007), with education having a stronger effect on CSID scores for private (β = 0.25) relative to public schools (β = 0.16). The effect of education and sex decreased in the education- and sex-adjusted CSID scores (education β = 0.121; sex β = −0.0.056). Conclusion: We demonstrate that the effects of education on CSID varied based on sociodemographic characteristics in Congolese older adults, with private school associated with better performance. Given the effects of education and sex on performance, future studies should examine if demographically adjusted scores improve the sensitivity and specificity of the CSID in Congolese populations.

Informant measures of cognition in the Mexican Health and Aging Cognition Study

AbstractBackgroundTo describe the correlates of informant assessed cognitive functioning among older Mexican adults.MethodWe include participants in the 2016 Mexican Health and Aging Study Cognition Study Informant Questionnaire (MexCog). Cognitive functioning, measured by total Community Screening Instrument for Dementia (CSID), and CSID split into a cognition and functioning component are regressed as a function of participant characteristics, informant characteristics, and relationship characteristics.ResultsInformant measurements of cognition have distinct correlates from direct measurements. Participant education is significantly associated the total CSID and the cognition component but not the functioning component. Community size is not significantly associated with informant measures of cognition. Spousal informants reported higher total CSID scores and cognitive component but were not significantly associated with the functioning component. Other family members and other non‐family members reported fewer CSID cognition items than spouses.ConclusionSpousal informants may be more attuned to their partners cognitive functioning than other informants. Functional components and cognitive components of the CSID measure distinct domains and have different correlates.