Validation of the Rowland Universal Dementia Assessment Scale for Multicultural Screening in Danish Memory Clinics

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.

Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians

“…Finally, the RUDAS has previously been evaluated in clinical settings - either specialist memory clinics or general aged care referrals. For those studies using a similar methodology to the current study (i.e., considering a diagnosis of dementia compared to no dementia, not excluding CIND or MCI), sensitivity ranged from 64 to 89% and specificity from 77 to 98% [7,14,15,19]. Our results for the RUDAS in a nonclinical community setting are within these ranges at 71.4% sensitivity and 90.3% specificity.…”

“…The RUDAS [7] is a cognitive screening tool that was specifically designed to minimize the impact of cultural differences on test performance. It has been validated in culturally diverse groups, both in Australia [14,15,16], where it was initially developed, and internationally [17,18,19]. RUDAS performance is not associated with cultural or language background in multicultural settings [14,15,19].…”

“…It has been validated in culturally diverse groups, both in Australia [14,15,16], where it was initially developed, and internationally [17,18,19]. RUDAS performance is not associated with cultural or language background in multicultural settings [14,15,19]. The RUDAS is also said to be less influenced by sociodemographic factors such as education [14,16,19,20], but this might not be the case in all populations [17,21].…”

“…RUDAS performance is not associated with cultural or language background in multicultural settings [14,15,19]. The RUDAS is also said to be less influenced by sociodemographic factors such as education [14,16,19,20], but this might not be the case in all populations [17,21]. In direct comparison with the MMSE, the RUDAS has generally been found to have similar accuracy for dementia screening [15,16,17,18,19,20].…”

Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

“…One study (n = 137) looked specifically at the immigrancy status of participants 26 and showed that test performance on the RUDAS was not significantly affected (p = 0.08), whereas it was on the MMSE (p = 0.02).…”