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

Utility of the Rowland Universal Dementia Assessment Scale and INECO Frontal Screening for differentiating dementia subtypes between Alzheimer's disease and Parkinson's disease dementia

Background

Time to dementia diagnosis is a major barrier to effective care, particularly in resource-limited settings such as Latin America. Barriers to timely dementia diagnosis include the lack of access to comprehensive neuropsychological testing, cognitive specialists, and advanced diagnostic tools. Brief cognitive assessments, such as the Rowland Universal Dementia Assessment Scale (RUDAS) and INECO Frontal Screening (IFS) offer promise for diverse populations, and may help in specific dementia subtypes, including Alzheimer's disease (AD) and Parkinson's disease dementia (PDD).

Objective

This study evaluates the efficacy of RUDAS and IFS in comparison to the Mini-Mental Status Exam (MMSE).

Methods

A total of 243 participants (70 normal cognition Controls, 62 PD with normal cognition, 46 PDD, and 75 AD) were recruited as part of an observational cross-sectional study at a cognitive clinic in Peru. Diagnosis was based on clinical criteria and confirmed with a comprehensive neuropsychological battery. Participants underwent cognitive assessment using RUDAS, IFS, and MMSE.

Results

Both RUDAS and IFS differentiated dementia from normal cognition groups with 100% specificity, compared to 53% for MMSE. The IFS identified early cognitive changes in PD (median score: PD = 24; Controls = 27, p < 0.001). RUDAS was particularly effective in distinguishing AD and PDD using the memory and visuospatial tasks.

Conclusions

These results suggest that RUDAS and IFS can enable faster and clearer diagnoses for dementia subtypes, offering clinicians and community health workers practical tools to improve care in resource-limited settings where comprehensive evaluations are not always feasible.

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

BACKGROUND

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.

OBJECTIVE

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.

METHODS

117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment.

RESULTS

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.

CONCLUSIONS

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.

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.