Rowland Universal Dementia Assessment Scale Research Articles

Test-Re-Test Reliability and Internal Consistency of Rowland Universal Dementia Assessment Scale (RUDAS) among Palestinian Older Adults

The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive assessment suitable for diverse populations. However, the test-retest reliability and internal consistency of the Arabic version of RUDAS were not examined. This study aimed to examine these aspects. The Arabic RUDAS was administered twice to a sample of 37 older adults. The intraclass correlation coefficients and the Kappa coefficient examined the test-retest reliability. The internal consistency of the Arabic RUDAS was assessed using Cronbach’s alpha. The RUDAS showed high internal consistency (α = 0.866) and test-retest reliability (ICC = 0.971), with substantial agreement between tests (Kappa = 0.78). The Arabic RUDAS is highly reliable with Palestinian older adults.

Is Multidimensional Poverty Associated to Dementia Risk? The Case of Older Adults in Pakistan.

Multidimensional poverty is associated with dementia. We aimed at establishing this association in Pakistan. A cross-sectional study was conducted in Punjab and Sindh, Pakistan, between March 30, 2002, and August 22, 2022, among adults aged 50 and older. Multidimensional poverty measures were composed of 6 dimensions and 15 indicators. Poverty was compared between adults with and without dementia using the Rowland Universal Dementia Assessment Scale, adjusting for sex, age, marital status, and household size. Associations between dementia and poverty were investigated using a multivariate logistic regression model. We found that 594 (72.7%), 171 (20.9%), and 52 (6.4%) had no, mild, and moderate-to-severe dementia, respectively. More women than men had dementia (11.4% vs 2.9%). Approximately 40.4% of adults with dementia were found to be deprived in 4 or more dimensions compared to 8.9% without dementia, and the difference in multidimensional poverty between them was 348.6%. Education, health, living conditions, and psychological well-being were the main contributors to poverty. Poverty in 4 or more dimensions was strongly associated with dementia (odds ratio [OR], 5.02; 95% confidence interval [CI], 2.07-12.16) after adjusting for sex, marital status, age, and household size, with greater odds for older women (OR, 2.02; 95% CI, 1.41-2.90). Our findings suggest that early improvement in social determinants of health through targeted structural policies may prevent dementia later in life. Improving access to free, quality education, health care including mental health care and basic living standards, and employment should reduce the collective risk of dementia.

Cross-Cultural Adaptation of Gujarati Version of Rowland Universal Dementia Assessment Scale for Assessing Cognition in Elderly Population

Background: The Rowland Universal Dementia Assessment Scale (RUDAS) has less educational bias when compared to other cognitive assessment scales like MMSE and MoCA. But its performance has not been adequately addressed in Indian population. Moreover, there are very less scales for cognition which are available in Guajarati language which can be taken in elderly population. Therefore, the reliability and validity of Gujarati-RUDAS in elderly population needs to be tested. Purpose: To determine the reliability and validity of the translated Gujarati version of Rowland Universal Dementia Assessment Scale (RUDAS) for assessing cognition in elderly population. Methodology: A total of 60 subjects were included in this study according to the inclusion criteria. After gaining cross-cultural adaptations, reliability was assessed with intra-rater and inter-rater reliability, analyzed by intraclass correlation coefficient (ICC). Validity was assessed with content validity, analyzed by content validity index (CVI), Result: Intra-rater reliability was having good reliability with ICC value of 0.757 and inter-rater reliability was found to be moderately reliable with ICC value of 0.700. Content validity was found to be good with CVI of 1. Conclusion: The Gujarati version of RUDAS (G-RUDAS) is a reliable and valid tool for the screening of cognitive impairment among elderly population. Keywords: Cognition, Validation, Rowland Universal Dementia Assessment Scale (RUDAS), Gujarati version, Geriatrics, Psychometric properties, cross-cultural adaptation.

Diagnostic Accuracy of the Swedish Version of the Multicultural Cognitive Examination for Cognitive Assessment in Swedish Memory Clinics.

Cognitive assessment for foreign-born individuals is suboptimal. The Multicultural Cognitive Examination (MCE) was developed for use in culturally, linguistically and educationally diverse populations. The MCE includes the Rowland Universal Dementia Assessment Scale (RUDAS) and performs assessment of memory, verbal fluency, and visuospatial function. To compare the psychometric properties of the Swedish version of the Multicultural Cognitive Examination (MCE-S) with the Swedish versions of the RUDAS (RUDAS-S), the Mini-Mental State Examination (MMSE-SR), and the Clock Drawing Test (CDT), and to explore the ability of the MCE-S test to differentiate patients with and without dementia in a multicultural population. 117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment. Significant differences between patients with and without dementia were observed for all MCE-S components. There were significant differences between foreign-born and Swedish-born patients in the MMSE-SR, but not in the MCE-S or the RUDAS-S. The MCE-S, had good diagnostic performance for detecting dementia (AUC, 0.82), and was at least as good as the RUDAS-S alone (AUC, 0.79). The MCE-S also distinguished Alzheimer's disease (AD) from non-AD dementia. Contrary to expectations, the MCE-S was also at least as good as the MMSE-SR among the Swedish-born patients. The MCE-S is adequate for detecting dementia in both foreign-born and Swedish-born populations. Based on the cultural diversity of general society, adapted cognitive tests that can be used for everyone are practical and beneficial for both patients and health-care professionals. Further studies are needed within primary care.

Developing an automated Cognitive assessment based on language; CognoSpeak‐ working with an ethnic minority group

AbstractBackgroundThis study aimed to explore the issues around developing a new automated cognitive assessment. Current cognitive screening or stratification tools were typically developed only using white people so having a normative data set from almost exclusively white populations. In this part of the project we are co‐developing an automated cognitive assessment tool; CognoSpeak (https://cognospeak.github.io/website/) with a Somali ethnic minority group.CognoSpeak is a fully automated cognitive assessment tool based in language an interaction. A virtual clinician asking questions and listening to responses using automatic speech recognition and Machine Learning algorithmsMethodsWe recruited 2 members of the Somali community team (Israac) and undertook workshops to explore the themes of dementia and cognitive impairment. We trained the Research champions to use cognitive assessment tools and have piloted these on 20 healthy controls from the Somali community. Participants were assessed using the Montreal Cognitive Assessment (MoCA), Rowland Universal Dementia Assessment Scale (RUDAS) and the Multicultural Cognitive Examination (MCE).ResultsWe have undertaken a pilot study, recruiting 14 females, and 7 males ranging from 34 years to 80 years old (with mean age of 48.8). Participants were all from a non‐English background and spoke English and identified as either Somalian or British Somalian. 76.19%(16/21 scored below MoCA = 26; MoCA. Zero scored below cut off on RUDAS (RUDAS = 22; RUDAS: all the patients scored more than 22 and zero scored below cut off of 70 on MCE and 14.29% (3/21)We will aim to recruit 50 participants to interact with CognoSpeak and have results from the three cognitive screens described above.ConclusionWe have trained two research champions with no prior research experience to help recruit Healthy controls to start testing CognoSpeak. Validation of novel cognitive tools needs co‐developed methodologies and culturally appropriate cognitive assessment tools. We will have further data on a larger data set, comparing different cognitive screening tools and our automated tool.

Evaluation of cognitive profile through Q‐RUDAS: first approach in Quechua Participants

AbstractBackgroundThe Rowland Universal Dementia Assessment Scale (RUDAS) has proven to be one ofthe best instruments of cognitive function evaluation in illiterate and low‐educated participants; it is easyto adapt in different countries, languages, and cultures, showing good validation properties. In Peru, weare working to bring this instrument to Quechua speakers. The present study aimed to obtain the firstapproach to cognitive prevalence in elderly individuals in their native language.MethodsAfter an initial pilot study (Malaga in preparation), we use the culturally and language‐adapted Q‐RUDAS in the Peruvian Quechua population of the Puno region (n = 511), with a mean age of65.04 ± 6.73 means (ranging from 59 to 92 years), 80.4% of the sample were females. We obtain socio‐demographic data (educational level, occupation, and precedence residence area) and the Q‐RUDASscores. Additionally, we asked the patients open‐ended questions about the test adaptation. Weexcluded patients with antecedents of pathologies that may interfere with the performance of the test. Verbal and signed consent were obtained. We use the previous RUDAS cut‐off from Peruvian validationstudies to have an initial approach to cognitive prevalence.ResultsWe include 502 participants without relevant medical history. Participants understood all Q‐RUDAS items but reported difficulties with visuospatial construction (more than 50% could not draw thecube, more than 25% failed to draw some parts, and around 20% drew it accordingly). The mean scoreof Q‐RUDAS was 26.01 ± 2.71. We found that 448 participants have standard scores (26.67 ± 1.92), 46MCI (21.49 ± 1.92), and 11 participants that meet scores of dementia (17.00 ± 2.71). Besides, differences were found in the total score regarding the precedence area of participants, with Urban´shaving an increased score.ConclusionThe previously adapted RUDAS test to Quechua (Q‐RUDAS) in Peru was well understoodamong native patients. This culturally sensitive tool is essential for diagnosing dementia in indigenouspopulations, but more studies are needed, such as cross‐validation studies. An initial approach of theprevalence of MCI and dementia is around 10.8% in the native population.

Using real‐world general practitioner data to study the diagnosis and management of dementia: rationale and design

AbstractBackgroundGeneral practitioners (GPs) play a critical role in the early recognition of cognitive deficits and management of dementia. Timely diagnosis is important in light of potential disease‐modifying therapies and the potential to improve patient outcomes. We aimed to establish a real‐world data cohort utilizing data from GPs on individuals with dementia as a starting point, with the goal of gaining valuable insights into trajectories and management of dementia and patient outcomes. Here we describe the rationale and design.MethodWe selected individuals with dementia using Dutch GP data from the PHARMO Data Network, which includes diagnoses, symptoms, examinations, prescriptions, and communication between GPs and specialists. Diagnosis of dementia was defined as a diagnosis code or prescription of anti‐dementia drugs between January 1, 2011 and December 31, 2020. Persons were included if they had one year of history prior to dementia diagnosis. We described the cohort in terms of demographics and screening tests for cognitive impairment.ResultA total of 52,911 individuals with dementia were selected from a source population of 4.7 million persons. The mean age was 81 years (standard deviation [SD] = 8.65) and 31,343 (59%) were female (Table 1). On average, patients have 8.6 years (SD = 4.09) of data available prior to dementia diagnosis and can be followed‐up for 2.8 years (SD = 2.19) after diagnosis. The reason for end of follow‐up was death for 16,978 persons (32%), end of data availability for 21,314 persons (40%), and 14,699 (28%) reached December 31, 2020 and are still registered (i.e., active). We found the Mini‐Mental State Examination (MMSE) in GP records of 31,759 persons (60%), and the Montreal Cognitive Assessment (MoCA) and Rowland Universal Dementia Assessment Scale (RUDAS) for only 1,777 (3%), and 29 persons (<0.5%), respectively.ConclusionWe created a cohort of 52,991 individuals with dementia, providing a starting point for further research on trajectories and management of AD in primary care and patient outcomes. Next steps include matching the cohort with dementia‐free controls, enriching the cohort by established linkages to other data sources (e.g. hospital data), and examining healthcare resource utilization, indicators of cognitive decline, treatment, and young‐onset dementia.

Normative Data in Cross-Cultural Neuropsychological Instruments in Spaniards and Colombians Living in Spain.

Cross-Cultural Dementia Screening (CCD), Rowland Universal Dementia Assessment Scale (RUDAS), and European Cross-cultural Neuropsychological Test Battery (CNTB) are three novel neuropsychological instruments developed from a cross-cultural perspective to reduce the impact of culture in cognitive assessment and improve the assessment in diverse populations. We aimed to collect and present normative data on these tests in a majority population sample (Spaniards living in Spain) and in a minority population sample (Colombians living in Spain). CCD, RUDAS, and CNTB were administered to a group of 300 cognitively healthy participants (150 Spaniards and 150 Colombians). Linear regression modeling strategy was used to provide adjusted norms for demographic factors and to explore the influence of these factors on test performance. Most of the CCD and CNTB scores were predicted by age and years of education, with some tests only predicted by age or showing a ceiling effect. The comparison of normative data between the two samples confirmed the favorable cross-cultural properties of these instruments, with only some differences in processing speed and executive functioning scores. Our study finds a comparable influence of demographic factors in both populations on the performance of CCD, RUDAS, and CNTB, confirming their adequate cross-cultural properties. We provide normative data for these tests in Spaniards and Colombians living in Spain.

P.009 Comparison of Montreal Cognitive Assessment (MoCA) and Rowland Universal Dementia Assessment Scale (RUDAS) scores in diverse populations

Background: The Montreal Cognitive Assessment (MoCA) and Rowland Universal Dementia Assessment Scale (RUDAS) are tests used to detect mild cognitive impairment (MCI) and dementia. However, it has been suggested that the MoCA may not be appropriate for diverse populations, and that the relatively newer RUDAS may be better suited as a universal cognitive test. Methods: The MoCA and RUDAS were administered at baseline visits for participants enrolled in the Prospective Registry of Persons with Memory Symptoms (PROMPT). Test scores were compared for patients with different levels of educational attainment, first language, and race using the Kruskal-Wallis test. Results: The difference in MoCA (0.029) and RUDAS (0.0041) scores between patients with different levels of educational attainment (n = 141) was significant. The difference in MoCA (0.62) and RUDAS (0.78) scores between patients with a different first language (n = 141) was not significant. The difference in MoCA (0.64) and RUDAS (0.96) scores between patients of different race (n = 141) was not significant. Conclusions: The difference between MoCA and RUDAS scores remained consistent regardless of level of educational attainment, first language and race. The results suggest that the RUDAS may not be more appropriate than the MoCA in detecting MCI and dementia across diverse populations.

P.004 Comparison of the Montreal Cognitive Assessment (MoCA) and Rowland Universal Dementia Assessment Scale (RUDAS) for identification of mild cognitive impairment and dementia

Background: There are many cognitive tests that detect mild cognitive impairment (MCI) and dementia such as the Montreal Cognitive Assessment (MoCA) and Rowland Universal Dementia Assessment Scale (RUDAS). The comparative performance of these screening tests for identifying MCI and dementia is unknown. Methods: The MoCA and RUDAS were administered during baseline visits for patients in the Calgary Neurosciences Program. Those that enrolled in the Prospective Registry of Persons with Memory Symptoms (PROMPT) had their scores related to their final clinical diagnosis. Cut-off scores of 26 for the MoCA and 22 for the RUDAS were used to indicate a positive result. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of both cognitive scores were compared. Results: The sensitivity, specificity, PPV, NPV, and accuracy of the MoCA (n = 125) was 89.3%, 72.7%, 93.9%, 59.3%, and 86.4%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the RUDAS (n = 125) was 47.6%, 100%, 100%, 29.0%, 56.8%, respectively. Conclusions: In patients with cognitive complaints presenting to a specialist clinic, the MoCA was more sensitive and accurate than the RUDAS for a final clinician diagnosis of mild cognitive impairment or dementia when using the standard cut-offs.

Multidimensional poverty is associated with dementia among adults in Afghanistan

Multidimensional poverty is associated with dementia, but no evidence is available for countries in conflict. A cross-sectional study was conducted in two provinces of Afghanistan between February 15th 2022 and April 20th 2022 among adults age 50 and older. Multidimensional poverty included six dimensions of well-being and 16 indicators of deprivation. The Rowland Universal Dementia Assessment Scale measured dementia. Poverty between adults with and without dementia was examined, adjusting for sex. Associations between dementia and poverty were investigated using multivariate regression model. Of the 478 adults included, 89 (52.7%) had mild, and 25 (14.8%) had moderate to severe dementia. More women than men had mild (52.7% vs 33.3%) and moderate-to-severe dementia (14.8% vs 5.8%). Approximately 33.9% adults with mild and 51.2% adults with moderate-to-severe dementia were found to be deprived in four or more dimensions compared to 21.8% without dementia. The difference in four dimensions of multidimensional poverty between adults with mild and moderate-to-severe dementia and adults without dementia was respectively 59.5% and 152.88%. Education, employment, health, and living conditions were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty in four or five dimensions was strongly associated with dementia among older adults particularly over 70 years old (odds ratio [OR], 17.38; 95% CI, 2.22-135.63), with greater odds for older women overall (OR, 2.69; 95% CI, 1.76-4.11). Our findings suggest that early improvement in social determinants of health through targeted structural policies may lower dementia risk later in life. Specifically, better access to free, quality education, healthcare, and basic living standard together with employment opportunities could reduce risk of dementia. The present study was funded by a grant from the Alzheimer Association (AARG-NTF-21-851241).

Validation of the Rowland Universal Dementia Assessment Scale in Indonesia: Preliminary Evidence

The South-East Asia region has one of the fastest-growing aging populations, for which standardized dementia screening measures will be essential for geriatric care. The Rowland Universal Dementia Assessment Scale (RUDAS) is adopted for use in the Indonesian setting but lacks evidence of its cross-cultural transportability. This study aimed to examine the reliability and validity of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) in the Indonesian setting. Indonesian older adults from a geriatric nursing center (N = 135; 52 males, 83 females; age range 60-82) completed the Indonesian translation of the RUDAS (RUDAS-Ina), following content adaptation study with community living older adults (N = 35), nine neurologists and two geriatric nurses. For face and content validity, we utilized a consensus-building procedure. Results following confirmatory factor analysis yielded a single-factor model. The reliability of scores from the RUDAS-Ina was marginally satisfactory for research purposes (Cronbach α = 0.61). Multi-level linear regression for examining the association of the RUDAS-Ina scores with gender and age indicated older age to be associated with lower RUDAS-Ina scores. In contrast, the association with gender was not significant. Findings suggest a need to develop and validate locally generated items with cultural sensitivity to the Indonesian setting, which may also be studied in other Southeast Asian countries.

Multi-Disease Validation of the RUDAS for Cognitive Screening in Alzheimer's Disease, Parkinson's Disease, and Multiple Sclerosis.

The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive test with favorable diagnostic properties for detecting dementia and a low influence of education and cultural biases. We aimed to validate the RUDAS in people with Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). We enrolled one hundred and fifty participants (60 with AD, 30 with PD, 60 with MS, and 120 healthy controls (HC)). All clinical groups completed a comprehensive neuropsychological battery, RUDAS, and standard cognitive tests of each disorder: MMSE, SCOPA-COG, and Symbol Digit Modalities Test. Intergroup comparisons between clinical groups and HC and ROC curves were estimated. Random Forest algorithms were trained and validated to detect cognitive impairment using RUDAS and rank the most relevant scores. The RUDAS scores were lower in patients with AD, and patients with PD and MS showed cognitive impairment compared to healthy controls. Effect sizes were generally large. The total score was the most discriminative, followed by the memory score. Correlations with standardized neuropsychological tests were moderate to high. Random Forest algorithms obtained accuracies over 80-90% using the RUDAS for diagnosing AD and cognitive impairment associated with PD and MS. Our results suggest the RUDAS is a valid test candidate for multi-disease cognitive screening tool in AD, PD, and MS.

Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people.

To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it. A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items. Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147). This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.

Exploration of Multidimensional Poverty and Dementia in Adults older than 50 years old in South Africa

AbstractBackgroundMultidimensional poverty is associated with chronic health conditions. However, limited research exists investigating the association between multidimensional poverty and dementia on a population level in low‐and middle‐income countries (LMICs).MethodThis study was conducted in Soweto between 11 November 2019 and 28 February 2020. Participants included older adults above 50 years old. Data analysis was concluded in August 2021. We calculated a measure of multidimensional poverty that includes seven dimensions and eleven indicators. Assessing Dementia 8 (AD8) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to measure dementia. Differences in level and depth of poverty between adults with no dementia and those with a score above the threshold for either AD8 or RUDAS, or for both AD8/RUDAS, and for comparing gender, age group and marital status were examined. Correlation analyses to assess overlap of dimensions of deprivation were carried out. Association between dementia and multidimensional poverty were investigated using multivariate regression model.ResultAmong 227 participants living in Soweto, South Africa, 151 adults were identified with dementia by the AD8 (66.5%), 64 by the RUDAS (28.2%) and 50 by both AD8 and RUDAS (22.0%). More men (32.1%) had no dementia compared to women (24.7%); and 20% of adults with dementia compared to 9.7% of those without dementia were found to be poor on four dimensions or more. The difference in multidimensional poverty index for k = 3 was 77.1% and 67.3% between adults with and without dementia. Education, health and employment were the main contributors of poverty. Multidimensional poverty was strongly associated with dementia as measured by AD8/RUDAS (adjusted OR 2.31, 95% CI 1.08‐4.95), with higher odds for older female (OR 2.03, 95% CI 1.00‐4.12) or those living in large households (OR 1.27, 95% CI 1.05‐1.53).ConclusionThis study found that the prevalence and depth of poverty is higher among older adults with dementia. A lack of education, poor health and unemployment are major dimensions of poverty which was associated with higher risk of dementia. These findings suggest that early improvement in social determinants of health through targeted structural policies may prevent dementia later in life.

Neuropsychological assessment in the multicultural memory clinic: development and feasibility of the TULIPA battery

AbstractBackgroundNeuropsychological assessment of culturally diverse populations is hindered by barriers in language, culture, education, and a lack of suitable tests. Furthermore, individuals from diverse backgrounds are often unfamiliar with being cognitively tested. The aim of this study was to develop a new neuropsychological test battery and study its feasibility in multicultural memory clinics.MethodComposition of the TULIPA battery (Towards a Universal Language: Intervention and Psychodiagnostic Assessment) entailed a literature review and consultation with experts and individuals from diverse backgrounds. Feasibility was investigated by examining administration and completion rates and the frequency of factors complicating neuropsychological assessment in 345 patients from 37 countries visiting four multicultural memory clinics in the Netherlands.ResultThe test battery included existing tests such as the Cross‐Cultural Dementia screening (CCD), Rowland Universal Dementia Assessment Scale (RUDAS), and tests from the European Cross‐Cultural Neuropsychological Test Battery, and newly developed tests. Completion rates for the test battery were generally high (82%‐100%), except for CCD Dots subtest B (58%). Although tests of the ‘core’ TULIPA battery were administered often (median: 6 of 7, IQR: 5–7), supplementary tests were administered less frequently (median: 1 of 9; IQR: 0–3). The number of administered tests correlated with disease severity (RUDAS, ρ = .33, adjusted p<.001), but not with other patient characteristics. Complicating factors were observed frequently, e.g., suboptimal effort (29%‐50%), fatigue (29%), depression (37%‐57%).ConclusionThe TULIPA test battery is a promising new battery to assess culturally diverse populations in a feasible way, provided that complicating factors are taken into account.

Cognitive Screening in Adults with Sickle Cell Disease: Prospective Validation of the Rowland Universal Dementia Assessment Scale

Background: Adults with sickle cell disease (SCD) are at increased risk of early cognitive decline. The American Society of Hematology recommends surveillance for cognitive impairment. However, optimal screening strategies in this population have not been established. The RUDAS (Rowland Universal Dementia Assessment Scale) is a short screening questionnaire developed for use in culturally diverse patient populations. In adults with SCD, it is less biased by educational attainment than the Montreal Cognitive Assessment (MoCA). Hypothesis: We hypothesized that the RUDAS is a valid tool to predict neurocognitive disorder (NCD) in adults with SCD. Aims: 1. Describe trends in RUDAS scores during long-term cognitive surveillance; 2. Evaluate the ability of RUDAS scores to predict the diagnosis of NCD. Method: A retrospective study was conducted. All patients who had undergone cognitive screening with RUDAS in 2018 and repeat testing as part of routine surveillance in 2021-2022 were identified. Starting in 2021, all adults with SCD are assessed by a multidisciplinary team (neurologist, hematologist, neuropsychologist) for neurocognitive screening and assessment. RUDAS was administered and scored as previously described (Forté et al, JAMA Net Open 2021). A clinical diagnosis of NCD was established by a neurologist and/or neuropsychologist. Repeated measure t-test was performed to compare RUDAS trends over time. Standard t-test was used to compare RUDAS between a priori defined subgroups (with and without NCD). Positive predictive values (PPV) were calculated. Results: From an initial assessment of 92 patients, 28 adult SCD patients met the inclusion criteria. The median age was 39 years [range: 24-65], 16 (57%) were female and the median educational level was 14 years [range: 10-18]. Genotype distribution was 18 (64%) with the SS or Sβ0-thalassemia genotype and 10 (36%) with the SC or Sβ+-thalassemia genotype. None of the patients had an established diagnosis of NCD, and 5 (18%) had a prior history of stroke. The mean (±standard deviation (SD)) RUDAS scores were 26.7±2.0 in 2018 and 27.3±2.7 in 2021-2022. Overall, the scores did not significantly change over time (+0.6±2.8, paired t-test P=0.3). In table 1, we present the results of the subgroup analysis according to NCD diagnosis. In those in whom a diagnosis of NCD was established in 2021-2022, RUDAS score declined by -0.9±2.8 points (P=0.3). In those not meeting the criteria for NCD, the mean change was +1.7±2.4 (P=0.01). RUDAS scores differed significantly in those with and without NCD (25.5±2.8 and 28.6±1.5, P<0.001). RUDAS scores <28 and even more significantly those <23 were highly predictive of a diagnosis of NCD (PPV=86% and 100%, respectively, P<0.001, table 2). Conclusion: The results of our study suggest that lower RUDAS scores are associated with the diagnosis of neurocognitive disorder in adults with SCD. Prospective validation is ongoing with a larger sample size. In addition, patient characteristics will be explored as potential predictors of NCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

VALIDITY AND RELIABILITY OF THE ROWLAND UNIVERSAL DEMENTIA ASSESSMENT SCALE: IMPLICATIONS OF AN INDONESIAN STUDY

Abstract Standardized dementia screening self-report assessments from developing countries are increasingly adopted in developing countries. Yet the cross-cultural transportability of dementia screening tools cannot be assumed. The Southeast Asia region has one of the fast-growing geriatric populations but no locally developed or validated measures of cognitive decline among older adults. This study aimed to determine the validity and reliability of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) for use in the multiethnic older adult population in Indonesia. Participants were 135 Indonesian older adults (females = 61.5%, males = 38.5%; age range = 60-82) who were patients of a geriatric nursing centre. They completed the Indonesian translation of the Rowland Universal Dementia Assessment Scale (RUDAS-Ina). Exploratory factor analysis and confirmatory factor analysis of the scores yielded two factors explaining a total of 55.13% (the first factor explained 38.18%; the second factor explained 16.96%) of the variance for the entire set of variables. The reliability of scores from the RUDAS-Ina was marginally satisfactory (Cronbach α = .61), suggesting a need for locally developed measures for use with the Indonesian geriatric population. Future studies should consider the feasibility of developing and calibrating an adapted RUDAS to the Indonesian setting, which also may be studied in other Southeast Asian countries.

Diagnostic Accuracy of the Swedish Version of the Rowland Universal Dementia Assessment Scale (RUDAS-S) for Multicultural Cognitive Screening in Swedish Memory Clinics.

Background:The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations.Objective:To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics.Methods:We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment.Results:RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score <25 its sensitivity was 0.92, specificity 0.60, and accuracy 76%. The AUC for the MMSE-SR was 0.79. At a cutoff score <23 its sensitivity was 0.65, specificity 0.81, and accuracy 73%.Conclusion:RUDAS-S is at least as accurate as MMSE-SR for detecting dementia in memory clinics in Sweden and can be used for all patients undergoing a cognitive assessment, irrespective of their cultural, language, and educational background. However, there is a need for other cross-cultural cognitive tests to complement RUDAS-S to extend cognitive examination.

The need for an institution-specific normal pressure hydrocephalus management protocol.

Background: Despite the publication of international guidelines, the management of normal pressure hydrocephalus (NPH) varies due to clinician preference and varying clinical evidence. An audit was performed to review the current pathways used in clinical practice with the aim of formulating an institution-specific protocol to optimize and standardize care.Methods: An internal audit was performed on the management of patients with NPH who presented to the Princess Alexandra Hospital, Brisbane between January 2016 and February 2019.Results: Forty-one patients were included in the study. Lumbar puncture (LP) was the main diagnostic test used (63.4%). About 14.6% underwent lumbar drain (LD) insertion instead. About 12.2% did not undergo either LP or LD before definitive treatment. Only 60% of all patients underwent ventriculoperitoneal shunt insertion. Overall, five treatment pathways were noted. LP + VP shunt showed the greatest average improvement in Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) (+3.8 ± 3.18), followed by LD + VP shunt (+3.25 ± 3.52) and sole treatment with LP (+1.83 ± 1.18). Both pre and post intervention assessment of gait and cognition were only performed in 31% and 48.8% of patients, respectively. Four types of cognitive assessment were used (MOCA 46.4%, MMSE 46.4%, Rowland Universal Dementia Assessment Scale 3.6%, and Addenbrooke’s Cognitive Examination-III 3.6%). MoCA showed greater cognition improvement (2.07) compared to MMSE (1.3) post intervention. There was no consistent objective gait assessment test used.Conclusion: The multiple NPH treatment pathways, low rate of pre and post objective symptom assessment, and lack of standardized gait and cognitive assessment tests demonstrate a clear need for an institution-specific NPH management protocol to standardize diagnostic workup, definitive management, and allied health assessment.