RESUMO
OBJECTIVE: Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity. METHODS: We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D. RESULTS: Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region. CONCLUSION: A brief version of the full CSI-D appears to share the favourable culture- and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care.
Assuntos
Escalas de Graduação Psiquiátrica Breve/normas , Características Culturais , Demência/diagnóstico , China , Cuba , Demência/psicologia , Humanos , Índia , América Latina , Nigéria , Projetos Piloto , Reprodutibilidade dos Testes , População Rural , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
The Community Screening Interview for Dementia (CSI 'D') was developed as a screening instrument for dementia for use in cross-cultural studies. It consists of two components, a cognitive test for non-literate and literate populations and an informant interview regarding performance in everyday living. The development of the CSI 'D', involving harmonization, translation, back translation and pilot testing, for use in five sites is described. The results demonstrate the adaptability and utility of the CSI 'D' in populations from very different socioeconomic backgrounds. The inclusion of informant data adds significantly to the performance of the CSI 'D' as a dementia screen. The combination of informant and cognitive scores in a discriminant score produces better sensitivity and specificity for dementia than cognitive scores alone. The informant score has a significant independent effect in predicting dementia.
Assuntos
Doença de Alzheimer/diagnóstico , Comparação Transcultural , Demência/diagnóstico , Avaliação Geriátrica/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Testes Neuropsicológicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Canadá , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Jamaica , Masculino , Nigéria , Psicometria , Reprodutibilidade dos Testes , Estados UnidosRESUMO
Information on the clinical utility of neuropsychological tests in non-North-American samples is limited. We examined the diagnostic efficacy of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery in Jamaican men and women age 65 and older. A total of 72 elders were diagnosed as normal and 12 were demented based on history, physical, and neurological examination. Independent of this medical examination, participants were tested with the CERAD battery. Normal controls scored significantly better than dementia patients on all tests in the CERAD battery. A discriminant function found that a combination of Word List Learning Sum Recall and Boston Naming Test correctly classified a total of 81% of the cases (83% of the dements and 81% of the normal controls). This study is the first to demonstrate the clinical utility of the CERAD neuropsychological battery in the differential diagnosis of memory disorders of the aged in a non-North-American sample.
Assuntos
Transtornos Cognitivos/diagnóstico , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Information on the clinical utility of neuropsychological tests in non-North-American samples is limited. We examined the diagnostic efficacy of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery in Jamaican men and women age 65 and older. A total of 72 elders were diagnosed as normal and 12 were demented based on history, physical, and neurological examination, participants were tested with the CERAD battery. Normal controls scored significantly better than dementia patients on all tests in the CERAD battery. A discriminant function found that a combination of Word List Learning Sum Recall and Boston Naming Test correctly classified a total of 81 percent of the cases (83 percent of the dements and 81 percent of the normal controls). This study is the first to demonstrate thr clinical utility of the CERAD neuropsychological battery in the differential diagnosis of memory disorders of the aged in a non-North-American sample.(Au)