Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

Abstract

Objectives: To quantitatively synthesize data on the accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in different sociocultural settings and compare its performance to other brief screening instruments for the detection of dementia. Design: Systematic review and meta-analysis. Literature searches were performed in PubMed, EMBASE, and CINAHL from January 1, 2004 until September 1, 2019. Setting: Community, outpatient clinic, and hospital settings in high-, and low- and middle-income countries. Participants: Twenty-six studies reporting diagnostic accuracy of the RUDAS were included with almost 4000 participants, including approximately 1700 patients with dementia. Measurements: Procedures for translation and cultural adaption of the RUDAS, and influence of demographic variables on diagnostic accuracy, were compared across studies. Bivariate random-effects models were used to pool sensitivity and specificity results, and diagnostic odds-ratios and the area under the hierarchical summary receiver operator characteristic curve were used to present the overall performance. Results: The pooled sensitivity and specificity for the detection of dementia were .82 (95% CI, .78–.86) and .83 (95% CI, .78–.87), respectively, with an area under the curve of .89. Subgroup analyses revealed that the RUDAS had comparable diagnostic performances across high-, and low- and middle-income settings (z = .63, P = .53) and in samples with a lower and higher proportion of participants with no formal education (z = −.15, P = .88). In 11 studies making direct comparison, the diagnostic performance of the RUDAS was comparable to that of the Mini-Mental State Examination (z = −.82, P = .41), with areas under the curve of .88 and .84, respectively. Conclusions: The RUDAS has good diagnostic performance for detecting dementia in different sociocultural settings. Compared to other brief screening instruments, advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language adaptation.

Diagnosing dementia in the Arctic: translating tools and developing and validating an algorithm for assessment of impaired cognitive function in Greenland Inuit

“…The original RUDAS study with a cut-off of 23 had sensitivity and specificity of 89% and 98% [11,12]. A systematic review and meta-analysis [20] showed that the performance of RUDAS varied with cut-off values and between studies. As evaluated from the Youden index, our data suggest a cut-off at ≤23 for detecting cognitive impairment, supported by best-combined sensitivity and specificity at 100% and 75.7%, respectively.…”

“I Know Hyena. Do you Know Hyena?” Challenges in Interpreter-Mediated Dementia Assessment, Focusing on the Role of the Interpreter

“…The commonly used screening instrument is not always adjusted for use when assessing patients born in other countries (Ardila, 2005;Daker-White et al, 2002;Naqvi et al, 2015;Nielsen et al, 2015;Nielsen, Vogel, Phung, et al, 2011a;Plejert et al, 2015;Sagbakken et al, 2018). RUDAS, The Rowland Universal Dementia Assessment Scale, is a cognitive screening instrument that is less affected by the patient's linguistic, cultural and educational background (Nielsen & Jorgensen, 2020;Nielsen et al 2017). This test is currently used in several countries including Sweden.…”

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

“…RUDAS [21], developed in Australia, is an efficient test with strong dementia psychometric properties, which was specifically developed for use with people from diverse linguistic and cultural backgrounds [22]. The test is considered to have good accu-83 racy for detecting dementia in various socioeconomic 84 and educational settings, even for those without any 85 formal education [16,22]. The test can be used in dif-86 ferent languages without any adjustment or changes 87 in the test [16,21].…”