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Validation of the Rowland Universal Dementia Assessment Scale in Indonesia: Preliminary Evidence. J Cross Cult Gerontol 2023; 38:83-95. [PMID: 36795256 DOI: 10.1007/s10823-023-09472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
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.
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Cheng Y, Zhang Y, Zhang Y, Wu YH, Zhang S. Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1160-1166. [PMID: 33321049 DOI: 10.1080/23279095.2020.1856850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
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Daniel B, Agenagnew L, Workicho A, Abera M. Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020. PLoS One 2022; 17:e0262483. [PMID: 35051198 PMCID: PMC8775314 DOI: 10.1371/journal.pone.0262483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Rowland Universal Dementia Assessment Scale (RUDAS) is currently widely used for research and clinical purposes in many countries. However, its applicability and validity have not been evaluated in the Ethiopian context so far. Therefore, we designed this study to assess the reliability and validity of Rowland Universal Dementia Assessment Scale to detect major neurocognitive disorder among older people in Ethiopia. METHODS An institution-based cross-sectional study was conducted among selected older people residing in Macedonia institutional care center, Addis Ababa, Ethiopia. The gold standard diagnosis was determined using the Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders. Stata v16 statistical software was used for data analysis. Receivers operating curve analysis, correlations, linear regression, and independent t-test were performed with statistically significant associations declared at a p-value of <0.05. Inter-rater, internal consistency reliabilities, content, criterion and construct validities were also determined. RESULTS A total of 116 individuals participated in the study with a 100% response rate. Most (52.7%) of the participants were male and the mean age in years was 69.9± 8. The Cronbach's alpha for RUDAS was 0.7 with an intra-class correlation coefficient value of 0.9. RUDAS has an area under the receivers operating curve of 0.87 with an optimal cutoff value of ≤ 22. At this cutoff point, RUDAS has sensitivity and specificity of 92.3 and 75.3 with positive and negative likelihood ratios as well as positive and negative predictive values of 3.7, 0.1, 65.5%, and 91.5%, respectively. There has also been a significant difference in the mean scores of RUDAS among the two diagnostic groups showing good construct validity. CONCLUSION The Rowland Universal Dementia Assessment Scale has been demonstrated to be a valid and reliable tool to detect major neurocognitive disorder. Policy makers and professionals can incorporate the tool in clinical and research practices in developing countries.
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Affiliation(s)
- Beniam Daniel
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Liyew Agenagnew
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
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Can RUDAS Be an Alternate Test for Detecting Mild Cognitive Impairment in Older Adults, Thailand? Geriatrics (Basel) 2021; 6:geriatrics6040117. [PMID: 34940342 PMCID: PMC8701789 DOI: 10.3390/geriatrics6040117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
The Montreal Cognitive Assessment (MoCA) is the commonly used cognitive test for detecting mild cognitive impairment (MCI) in Thailand. Nevertheless, cultural biases and educational levels influence its performance. The Rowland Universal Dementia Assessment Scale (RUDAS) seems to lower the limitation of the MoCA. This study aimed to compare the performance of the RUDAS and the MoCA for the diagnosis of MCI and demonstrate the correlation between them. A cross-sectional study of 150 older participants from the outpatient setting of the Internal Medicine Department, Srinagarind Hospital, Thailand was recruited during January 2020 and March 2021. The diagnostic properties in detecting MCI of the RUDAS and the MoCA were compared. MCI was diagnosed in 42 cases (28%). The AUC for both RUDAS (0.82, 95% CI 0.75-0.89) and MoCA (0.80, 95% CI 0.72-0.88) were similar. A score of 25/30 provided the best cut-off point for the RUDAS (sensitivity 76.2%, specificity 75%) and a score of 19/30 for the MoCA had sensitivity and specificity of 76.2% and 71.3%. The Spearman's correlation coefficient between both tests was 0.6. In conclusion, the RUDAS-Thai could be an option for MCI screening. It was correlated moderately to the MoCA.
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Manjavong M, Limpawattana P, Sawanyawisuth K. Performance of the Rowland Universal Dementia Assessment Scale in Screening Mild Cognitive Impairment at an Outpatient Setting. Dement Geriatr Cogn Dis Extra 2021; 11:181-188. [PMID: 34721496 PMCID: PMC8460978 DOI: 10.1159/000517821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Mild cognitive impairment (MCI) is defined as the symptomatic pre-dementia phase on the continuum of cognitive decline. Early recognition and application of potential interventions could prevent or delay the progression to dementia. The Rowland Universal Dementia Assessment Scale (RUDAS) shows good performance in the screening of dementia but has limited data regarding its diagnostic properties in the screening of MCI. The objectives of this study were to assess the psychometric properties of the Thai version of the RUDAS (RUDAS-Thai) in the screening of MCI, identify associated factors for the RUDAS performance, and determine the optimal cutoff point in detecting MCI. Methods This was a cross-sectional study conducted from January 2020 to March 2021. Older patients at the outpatient clinic of an internal medicine department at a tertiary care hospital in Thailand were examined. Baseline data were collected, and the RUDAS-Thai was administered to each patient. Afterward, a geriatrician assessed each patient for MCI. Results A total of 150 patients were included, of whom 42 cases (28%) had MCI. The overall performance of the test using an area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval 0.75–0.89). At the optimal cutoff point of 25/30, the AUC was 0.76 with sensitivity and specificity of 76.2 and 75%, respectively. The educational level affected the test performance according to regression analysis. For patients with years of education ≤6 and >6, the optimal cutoff points were 25/30 and 26/30, respectively. Conclusion The RUDAS-Thai performed well in differentiating patients with MCI from normal cognition; however, it was affected by educational level. A score of 25/30 or lower for persons with ≤6 years of education or 26/30 or lower for persons with higher than 6 years of education is the optimal cutoff point for indication of developing MCI.
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Affiliation(s)
- Manchumad Manjavong
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Fox ST, Thompson LE, Rowland JTJ. The relationship between common cognitive screening tests (Standardised Mini-Mental State Examination and Rowland Universal Dementia Assessment Scale) and the Cognitive Functional Independence Measure. Australas J Ageing 2021; 41:106-115. [PMID: 34585484 DOI: 10.1111/ajag.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess whether the Cognitive Functional Independence Measure (Cog-FIM) is correlated with the Standardised Mini-Mental State Examination (SMMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) and whether there is agreement between the Cog-FIM and these two tests. METHODS Functional Independence Measure assessments were undertaken on 98 subacute patients. Forty-eight (48) patients were administered the SMMSE, and 50 were administered the RUDAS. Agreement was examined using the Bland-Altman plot. RESULTS Correlation was observed between the Cog-FIM and both the SMMSE and the RUDAS. The Bland-Altman analysis demonstrated agreement between the Cog-FIM and RUDAS, but not the Cog-FIM and SMMSE. The limits of agreement between the Cog-FIM and RUDAS were -13 to 13. CONCLUSION The Cog-FIM is correlated with the RUDAS, but the agreement is unclear. Despite agreement of the means, the limits of agreement are large, which may suggest a clinically meaningful difference. The study should be repeated with a larger sample size.
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Affiliation(s)
- Sarah Therese Fox
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Qld, Australia
| | | | - Jeffrey T J Rowland
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Qld, Australia
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Cheng Y, Wang YZ, Zhang Y, Wang Y, Xie F, Zhang Y, Wu YH, Guo J, Fei X. Comparative analysis of rowland universal dementia assessment scale and mini-mental state examination in cognitive assessment of traumatic brain injury patients. NeuroRehabilitation 2021; 49:39-46. [PMID: 34057101 DOI: 10.3233/nre-210044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China. OBJECTIVE To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use. METHODS 86 inpatients with TBI in a hospital were selected from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS. RESULTS (1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r = 0.611, P < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r = -0.344, P = 0.001) and RUDAS (r = -0.407, P < 0.001), while education years were positively correlated with MMSE (r = 0.367, P = 0.001) and RUDAS (r = 0.375, P < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively. CONCLUSIONS MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yong-Zheng Wang
- Department of Rehabilitation Medicine, People's Hospital of Deyang City, Sichuan, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Wang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fan Xie
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jing Guo
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao Fei
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
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D'Souza AN, Granger CL, Patrick CJ, Kay JE, Said CM. Factors Associated With Discharge Destination in Community-Dwelling Adults Admitted to Acute General Medical Units. J Geriatr Phys Ther 2021; 44:94-100. [PMID: 32366793 DOI: 10.1519/jpt.0000000000000272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND AND PURPOSE General medical patients often present to the hospital with medical, social, cognitive, and functional issues that may impact discharge destination. The aim of this study was to investigate the association between patient factors at hospital admission and discharge destination in general medical patients. METHODS This was a prospective, single-site observational study conducted on the general medical wards at a tertiary hospital. Inpatients admitted to the general medical unit and referred to physical therapy were included. Patients admitted from residential care were excluded. MAIN OUTCOME MEASURES Data were collected a median of 2 days (interquartile range: 1-3) from hospital admission and included demographics, comorbidities (Charlson Comorbidity Index), premorbid physical function (Blaylock Risk Assessment Screening Score, BRASS), current function (de Morton Mobility Index, DEMMI and Alpha Functional Independence Measure, AlphaFIM), and cognition (Rowland Universal Dementia Assessment Scale, RUDAS). RESULTS Between July 2016 and August 2017, 417 patients were recruited (53% female, median age: 81 years (interquartile range: 76-86). Of these, 245 patients were discharged directly home; 172 were not discharged home of whom 140 were discharged to a subacute temporary facility providing further opportunity for therapy and discharge planning. Patients discharged directly home had higher functional, mobility, and cognitive scores. Data were partitioned into training, validation, and test sets to provide unbiased estimates of sensitivity, specificity, receiver operating characteristic curve, and area under the curve. Models best associated with discharge were "DEMMI and toilet transfers" (sensitivity 82.1%, specificity 66.2%, area under the curve 83.8%, 95% confidence interval: 76.4-91.2) and "AlphaFIM and walking independence" (sensitivity: 66.7%, specificity: 83.1%, area under the curve: 81.5, 95% confidence interval: 73.2-89.7). CONCLUSION Two models were created that differentiated between discharge home and not home and had similar statistical measures of validity. Although the models require further validation, clinicians should consider whether identification of patients likely to be discharged home or not home is of greater relevance for their clinical setting.
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Affiliation(s)
- Aruska N D'Souza
- The University of Melbourne, Department of Physiotherapy, School of Health Science, Carlton, Victoria, Australia
- Melbourne Health, Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine L Granger
- The University of Melbourne, Department of Physiotherapy, School of Health Science, Carlton, Victoria, Australia
- Melbourne Health, Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cameron J Patrick
- The University of Melbourne, School of Mathematics and Statistics, Carlton, Victoria, Australia
| | - Jacqueline E Kay
- Melbourne Health, Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Catherine M Said
- The University of Melbourne, Department of Physiotherapy, School of Health Science, Carlton, Victoria, Australia
- Western Health, Department of Physiotherapy, Sunshine Hospital, St Albans, Victoria, Australia
- Australian Institute for Musculoskeletal Science, Western Centre for Health, Research and Education, St Albans, Victoria, Australia
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Nepal GM, Shrestha A, Acharya R. Translation and cross-cultural adaptation of the Nepali version of the Rowland universal dementia assessment scale (RUDAS). J Patient Rep Outcomes 2019; 3:38. [PMID: 31321572 PMCID: PMC6639471 DOI: 10.1186/s41687-019-0132-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022] Open
Abstract
Background Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia during ageing process. Early screening of elderly for MCI can help for early prevention and treatment of dementia. Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive assessment tool with excellent psychometric properties and is particularly useful in culturally and linguistically diverse (CALD) populations. The purpose of this study was to translate RUDAS into Nepali and to evaluate internal consistency of Nepali version of RUDAS. Methods RUDAS was translated to Nepali following recommended guidelines for translation and cross-cultural adaptation of patient reported measures. The pre-final Nepali version of RUDAS was tested on 30 elderly and appropriate changes were made by expert committee. The final Nepali version of RUDAS was developed and was administered on 100 elderly populations (mean age 67.70) to assess internal consistency. Results The rating of the participants upon their understanding of each 6 items of Nepali version of RUDAS on a 10-point Likert scale received a good score of more than 8 except ‘cube drawing’ which only received a mean score of 5.5. Additionally, only 8(27%) elderly have responded to the item ‘cube drawing’. The preference test was done and cube drawing was replaced by stick design test. Nepali version of RUDAS showed acceptable internal consistency with Cronbach’s alpha 0.7. Conclusion The results of our study presents translated and cross-culturally adapted Nepali version of RUDAS that has been proved to be an appropriate assessment tool for screening cognitive impairment among elderly. Electronic supplementary material The online version of this article (10.1186/s41687-019-0132-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Govinda Mani Nepal
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | | | - Ranjeeta Acharya
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Ayan G, Afacan C, Poyraz BC, Bilgic O, Avci S, Yavuzer H, Yuruyen M, Erdincler DS, Ayan B, Doventas A. Reliability and Validity of Rowland Universal Dementia Assessment Scale in Turkish Population. Am J Alzheimers Dis Other Demen 2019; 34:34-40. [PMID: 30328357 PMCID: PMC10852419 DOI: 10.1177/1533317518802449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND The aim is to validate Turkish version Rowland Universal Dementia Assessment Scale (RUDAS). METHODS One hundred forty patients (>65 years) were included. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition -V was used in all patients. Rowland Universal Dementia Assessment Scale was applied for 2 days. Results were compared with Mini-Mental State Examination; reliability, validity, and statistical values were determined. RESULTS Time validity was verified. Mini-mental state examination was correlated 45.3% in control and 73% in dementia group. Factor weights varied between 0.44 and 0.81; factor construct was verified as 6-item scoring. When 25 was cutoff point, sensitivity was 92.86% and specificity was 92.86%. Content validity index was found to be 100% by 7 specialists. Cronbach α (0.692) and test-retest reliability (intraclass correlation = 0.987) were determined. CONCLUSION Rowland Universal Dementia Assessment Scale (Turkish) is validated and verified as reliable. Test could be applied for 5 minutes approximately; results are not affected by educational status, immigrant status, and language used; however, age and gender have significant effect on results.
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Affiliation(s)
- Gizem Ayan
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Ceyda Afacan
- Department of Statistics, Institute of Science and Technology, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Burc Cagrı Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Onur Bilgic
- Department of Psychiatry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Suna Avci
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Hakan Yavuzer
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Mehmet Yuruyen
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
| | - Burak Ayan
- Istanbul Bilim University, Department of Anestesiology, Istanbul, Turkey
| | - Alper Doventas
- Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Geriatric Medicine, Istanbul, Turkey
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Komalasari R, Chang HCR, Traynor V. A review of the Rowland Universal Dementia Assessment Scale. DEMENTIA 2019; 18:3143-3158. [PMID: 30606042 DOI: 10.1177/1471301218820228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Hui Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia
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Reeve E, Anthony AC, Kouladjian O'Donnell L, Low LF, Ogle SJ, Glendenning JE, Lorang CEB, Hilmer SN. Development and pilot testing of the revised Patients’ Attitudes Towards Deprescribing questionnaire for people with cognitive impairment. Australas J Ageing 2018; 37:E150-E154. [DOI: 10.1111/ajag.12576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Emily Reeve
- NHMRC Cognitive Decline Partnership Centre; Faculty of Medicine and Health; Kolling Institute of Medical Research; Northern Clinical School; University of Sydney; Sydney New South Wales Australia
- Geriatric Medicine Research; Faculty of Medicine; Dalhousie University and Nova Scotia Health Authority; Halifax Nova Scotia Canada
- College of Pharmacy; Dalhousie University; Halifax Nova Scotia Canada
| | - Allicia C Anthony
- Departments of Aged Care and Clinical Pharmacology; Royal North Shore Hospital; Sydney New South Wales Australia
- Department of Aged Care; Liverpool Hospital; Sydney New South Wales Australia
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre; Faculty of Medicine and Health; Kolling Institute of Medical Research; Northern Clinical School; University of Sydney; Sydney New South Wales Australia
- Departments of Aged Care and Clinical Pharmacology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Lee-Fay Low
- University of Sydney; Sydney New South Wales Australia
| | - Susan J Ogle
- Departments of Aged Care and Clinical Pharmacology; Royal North Shore Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - James E Glendenning
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | | | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre; Faculty of Medicine and Health; Kolling Institute of Medical Research; Northern Clinical School; University of Sydney; Sydney New South Wales Australia
- Departments of Aged Care and Clinical Pharmacology; Royal North Shore Hospital; Sydney New South Wales Australia
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McGrath M, Botti M, Redley B. Clinicians' perceptions and recognition of practice improvement strategies to prevent harms to older people in acute care hospitals. J Clin Nurs 2017; 26:4936-4944. [PMID: 28771874 DOI: 10.1111/jocn.13978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Explore clinicians' perceptions of practice improvement strategies used to prevent harms to older people during acute hospitalisation. BACKGROUND Older people are vulnerable to many interrelated preventable harms during acute care hospitalisation. Improvement strategies recommend standardisation of practices to assist healthcare staff to mitigate risk; however, older people continue to suffer preventable harms in acute hospitals. METHODS A qualitative exploratory descriptive design was used to collect data using focus groups and individual interviews from a purposive sample of 33 participants. Participants represented a wide range of clinicians from four diverse healthcare organisations. Qualitative content analysis used a framework informed by common preventable harms derived from key literature and policy documents. RESULTS Participants' perceptions of practice improvement strategies varied depending on their role within their organisational hierarchy. Recognition of preventable harms was guided by standard risk assessment and management tools used in their organisations. Preventable harms relating to skin integrity and falls were universally recognised across all sites and roles. Alternatively, there was variability in participant recognition of preventable harms related to nutrition, continence, medications and cognition; pain was consistently overlooked as a contributor to preventable harms. CONCLUSIONS Hospital staff perceived standard clinical risk assessment and management tools as the main practice improvement strategy to prevent harms. These tools prompted staff recognition of preventable harms to older people during acute hospitalisation. Variability in the recognition of some preventable harms was attributed to variable use of standard assessment tools. Pain was unlikely to be recognised as contributing to preventable harms. RELEVANCE TO CLINICAL PRACTICE Clinical Risk Management tools may assist clinicians in recognising and responding to preventable harms to older people during hospitalisation. These tools provide critical resources for consistent and timely assessment and evaluation of risk for preventable harms.
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Affiliation(s)
- Michele McGrath
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
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Nielsen TR, Phung TKT, Chaaya M, Mackinnon A, Waldemar G. Combining the Rowland Universal Dementia Assessment Scale and the Informant Questionnaire on Cognitive Decline in the Elderly to Improve Detection of Dementia in an Arabic-Speaking Population. Dement Geriatr Cogn Disord 2016; 41:46-54. [PMID: 26613533 DOI: 10.1159/000441649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to assess whether combining the Rowland Universal Dementia Assessment Scale (RUDAS) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) could improve diagnostic accuracy when screening for dementia in an Arabic-speaking population with low levels of literacy. METHODS Based on data from 225 elderly participant and informant dyads, the screening performances of the two instruments were compared and three methods for combining them--'or', 'and' and 'weighted sum' rules--were assessed. RESULTS The 'weighted sum' method had a significantly better area under the curve value compared to the RUDAS used alone. The 'weighted sum' method and the 'and' rule had the highest specificity, while the 'or' rule had the best sensitivity. CONCLUSION Harnessing the RUDAS and IQCODE increased diagnostic accuracy when screening for dementia in this study population.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chaaya M, Phung TKT, El Asmar K, Atweh S, Ghusn H, Khoury RM, Prince M, Nielsen TR, Waldemar G. Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging Ment Health 2016; 20:880-7. [PMID: 25984584 DOI: 10.1080/13607863.2015.1043620] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.
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Affiliation(s)
- M Chaaya
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - T K T Phung
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - K El Asmar
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - S Atweh
- c Department of Neurology , American University of Beirut Medical Center , Beirut , Lebanon
| | - H Ghusn
- d Department of Geriatrics , American University of Beirut Medical Center , Beirut , Lebanon
| | - R M Khoury
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - M Prince
- e Department of Health Service and Population Research , Institute of Psychiatry , King's College London , London , UK
| | - T R Nielsen
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - G Waldemar
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
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Aitken SJ, Naganathan V, Blyth FM. Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter? Vascular 2016. [DOI: 10.1177/1708538115597079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This study is a systematic review to determine the types of outcomes reported in abdominal aortic aneurysm (AAA) studies of patients aged 80 and over. Specifically, it determines the types of patient-centered outcomes reported. Method MEDLINE and EMBASE were searched from 2000 to 2014 for studies on AAA surgery with outcome data on patients aged 80 and over. Outcomes were categorized according to Donabedian’s framework for health quality indicators, with further classification as procedural, complication, resource or patient-centered outcome indicators. Findings Forty studies were reviewed. Patient-centered outcomes were infrequently reported (13%, n=5), with limited outcomes specifically relevant to older patients. No studies reported physical function, activities of daily living or cognition using validated assessment methods. Short-term mortality (95%, n=38) and complications (85%, n=34) were reported most frequently. Conclusion Reporting of aortic surgery outcomes in patients aged 80 and over requires a focus upon outcomes of primary importance to people of this age.
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Affiliation(s)
- SJ Aitken
- Concord Clinical School, Professorial Surgery Unit, Department of Vascular Surgery, New South Wales, Australia
| | - V Naganathan
- Concord Clinical School, Centre for Education and Research on Ageing, Concord, Sydney, New South Wales, Australia
| | - FM Blyth
- Concord Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Abstract
BACKGROUND With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrooke's Cognitive Assessment Version III (ACE-III). METHODS The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed. RESULTS All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80-0.95) for the ACE-III, 0.84 (0.75-0.91) for the MoCA, and 0.86 (0.77-0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78-0.90) between the ACE-III and MoCA, 0.70 (0.57-0.80) between the ACE-III and RUDAS; and 0.65 (0.50-0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%). CONCLUSIONS All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.
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Naqvi RM, Haider S, Tomlinson G, Alibhai S. Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. CMAJ 2015; 187:E169-75. [PMID: 25691786 PMCID: PMC4361127 DOI: 10.1503/cmaj.140802] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Canada has a growing multinational immigrant population. Many commonly used cognitive assessment tools have known cultural biases and are difficult to use in ethnically diverse patient populations. The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive assessment tool that was created for culturally and linguistically diverse populations. We performed a systematic review and meta-analysis to assess the psychometric characteristics of the RUDAS and to compare it with other available tools. METHODS We identified studies that assessed the psychometric properties of the RUDAS compared with a reference standard for diagnosing dementia or compared the RUDAS to other cognitive assessment tools. Two independent reviewers screened the abstracts and full-text articles and reviewed bibliographies for further references. We extracted data using standardized forms and assessed studies for risk of bias. RESULTS Our search resulted in 148 articles, from which 11 were included. The RUDAS was assessed in 1236 participants and was found to have a pooled sensitivity of 77.2% (95% confidence interval [CI] 67.4-84.5) and a pooled specificity of 85.9% (95% CI 74.8-92.6) yielding a positive likelihood ratio of 5.5 (95% CI 2.9-10.7) and a negative likelihood ratio of 0.27 (95% CI 0.17-0.40). A pooled estimate of the correlation between the RUDAS and the Mini-Mental State Examination (MMSE) was 0.77 (95% CI 0.72-0.81). Results of the RUDAS were less affected by language and education level than the MMSE. INTERPRETATION The RUDAS is a brief and freely available cognitive assessment tool with reasonable psychometric characteristics that may be particularly useful in patients with diverse backgrounds.
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Affiliation(s)
- Raza M Naqvi
- Department of Medicine (Naqvi), and Health and Rehabilitation Sciences (Haider), Western University, London, Ont.; Department of Medicine, and Institute of Health Policy, Management and Evaluation (Tomlinson, Alibhai), University of Toronto, Toronto, Ont.
| | - Sehrish Haider
- Department of Medicine (Naqvi), and Health and Rehabilitation Sciences (Haider), Western University, London, Ont.; Department of Medicine, and Institute of Health Policy, Management and Evaluation (Tomlinson, Alibhai), University of Toronto, Toronto, Ont
| | - George Tomlinson
- Department of Medicine (Naqvi), and Health and Rehabilitation Sciences (Haider), Western University, London, Ont.; Department of Medicine, and Institute of Health Policy, Management and Evaluation (Tomlinson, Alibhai), University of Toronto, Toronto, Ont
| | - Shabbir Alibhai
- Department of Medicine (Naqvi), and Health and Rehabilitation Sciences (Haider), Western University, London, Ont.; Department of Medicine, and Institute of Health Policy, Management and Evaluation (Tomlinson, Alibhai), University of Toronto, Toronto, Ont
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Nielsen TR, Andersen BB, Gottrup H, Lützhøft JH, Høgh P, Waldemar G. Validation of the Rowland Universal Dementia Assessment Scale for multicultural screening in Danish memory clinics. Dement Geriatr Cogn Disord 2014; 36:354-62. [PMID: 24022429 DOI: 10.1159/000354375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. METHODS Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to the standard diagnostic workup. RESULTS Diagnostic accuracy for the RUDAS [area under the curve (AUC) = 0.838] was similar to that of the Mini-Mental State Examination (MMSE; AUC = 0.840). The cutoff score with the best balance of sensitivity, specificity and accuracy was <24/30 for the RUDAS (sensitivity 0.69, specificity 0.80) and <25/30 for the MMSE (sensitivity 0.76, specificity 0.83). In contrast to the MMSE, regression analyses revealed that the RUDAS was unaffected by factors related to the patients' immigrant backgrounds. CONCLUSION The RUDAS showed high specificity and proved to be less affected by cultural and linguistic factors than the MMSE, making it a particularly valuable tool when screening for cognitive impairment in elderly multicultural patient populations.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Yennurajalingam S, Kang JH, Cheng HY, Chisholm GB, Kwon JH, Palla SL, Bruera E. Characteristics of advanced cancer patients with cancer-related fatigue enrolled in clinical trials and patients referred to outpatient palliative care clinics. J Pain Symptom Manage 2013; 45:534-41. [PMID: 22917716 PMCID: PMC3855412 DOI: 10.1016/j.jpainsymman.2012.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 01/12/2023]
Abstract
CONTEXT Limited published data exist on whether characteristics of patients with advanced cancer enrolled in cancer-related fatigue clinical trials (CCTs) differ from patients in outpatient palliative care clinics (OPCs). OBJECTIVES The primary aim of this study was to compare the characteristics of two groups of patients with advanced cancer and moderate-to-severe fatigue: patients in CCTs and patients at an OPC. METHODS We retrospectively reviewed the records of 337 patients who were enrolled in one of five CCTs for advanced cancer patients at The University of Texas M. D. Anderson Cancer Center as well as the records of 1896 consecutive patients who were referred to our OPC from January 2003 through December 2010. Patients with fatigue scores of ≥4/10 (measured by the Edmonton Symptom Assessment System [ESAS]) were eligible (1252 OPC patients and 337 CCT patients). Patient characteristics, ESAS scores, and survival times were compared using Chi-square tests, Wilcoxon rank sum tests, and the Kaplan-Meier method. RESULTS Compared with the CCT patients, OPC patients were more likely to be older (58 vs. 59 years; P=0.009) and male (38% vs. 52%; P<0.001). The most common primary cancer type was breast cancer (22%) in the CCT patients and lung cancer (23%) in the OPC patients (P<0.001). The median ESAS scores in the OPC and CCT groups, respectively, were 6 and 4 for pain (P<0.001), 7 and 7 for fatigue (P=0.525), 3 and 2 for depression (P=0.004), 3 and 2 for anxiety (P<0.001), 3 and 2 for dyspnea (P<0.001), and 43 and 32 for the symptom distress score (P<0.001). The median overall survival times were 17.9 months (95% CI 13.5-22.3 months) in the CCT group and 3.8 months (95% CI 3.5-4.1 months) in the OPC group (P<0.001). CONCLUSION Baseline characteristics and overall survival times significantly differed between patients enrolled in the CCT and OPC groups. Therefore, we conclude that the results of CCTs cannot be generalized to patients being treated in OPCs.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Monroe T, Carter M. Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. Eur J Ageing 2012; 9:265-274. [PMID: 28804426 PMCID: PMC5547414 DOI: 10.1007/s10433-012-0234-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.
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Affiliation(s)
- Todd Monroe
- John A. Hartford Foundation & Atlantic Philanthropies Claire M. Fagin Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 USA
| | - Michael Carter
- The University of Tennessee Health Science Center, Memphis, TN USA
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Monroe T, Carter M. Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. Eur J Ageing 2012. [PMID: 28804426 DOI: 10.1007/s10433‐012‐0234‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.
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Affiliation(s)
- Todd Monroe
- John A. Hartford Foundation & Atlantic Philanthropies Claire M. Fagin Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 USA
| | - Michael Carter
- The University of Tennessee Health Science Center, Memphis, TN USA
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Limpawattana P, Tiamkao S, Sawanyawisuth K, Thinkhamrop B. Can Rowland Universal Dementia Assessment Scale (RUDAS) replace Mini-mental State Examination (MMSE) for dementia screening in a Thai geriatric outpatient setting? Am J Alzheimers Dis Other Demen 2012; 27:254-9. [PMID: 22615482 PMCID: PMC10697337 DOI: 10.1177/1533317512447886] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Mini-mental-State Examination (MMSE) is a widely used tool for dementia screening. However, several limitations are found and the Rowland Universal Dementia Assessment Scale (RUDAS) appears to be an alternative test. The objective in this study was to compare the performance of MMSE-Thai 2002 and RUDAS-Thai for dementia screening, and to determine their performances and identify their optimal cut-off points. The participants were older patients from a Geriatric and Neurology Outpatient Clinic, Srinagarind Hospital, Khon Kaen University. The RUDAS-Thai and the MMSE-Thai 2002 were administered to each participant. Subsequently, a specialist physician assessed each participant for dementia. Results showed the area under receiver operating characteristic curve for both RUDAS-Thai (81.0%; 95%CI, 74.8-87.2) and MMSE-Thai 2002 (81.2%; 95%CI, 74.9-87.4) were equal. A score of 24 or lower provided an optimal cut-off point. Our finding supports that the RUDAS-Thai can be an effective alternative test for dementia screening. For both test scores, a score of 24 or lower is an optimal cut-off point to provide an indication of developing dementia.
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