The Rowland Universal Dementia Assessment Scale is a good tool for diagnosing dementia in multicultural populations

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Populations become more and more multiethnic, and have growing groups with minority ethnic backgrounds, such as South Asians in the UK. For everyone to receive equal levels of access to dementia services, many things still need to be done (Giebel et al., 2015b).

One way to help people from ethnic minorities get diagnosed in the first place is to understand their perceptions of the condition (dementia) better (Giebel et al., 2015a; Mukadam et al., 2011a). Another way is to improve their assessment.

In this blog, I am going to look at how possibly the assessment of memory problems in dementia can be tailored to multiethnic populations. For this, I am looking at a systematic review and meta-analysis of the Rowland Universal Dementia Assessment Scale (RUDAS) (PDF) by Naqvi and colleagues (2015).

The freely available RUDAS instrument assesses memory, body orientation, praxis, drawing a 3D cube, judgement (crossing the street) and the ability to name as many animals as possible in one minute, which presumably includes frisbee playing tortoises.

The freely available RUDAS instrument assesses memory, body orientation, praxis, drawing a 3D cube, judgement (crossing the street) and the ability to name as many animals as possible in one minute, which presumably includes frisbee playing tortoises.

Methods

The RUDAS is a purposefully developed tool for multiethnic populations. Its six items can be administered within less than 10 minutes. Examples are recalling four shopping items or naming as many animals as possible within one minute.

  1. The first aim of the researchers was to evaluate whether studies support the strong psychometric properties of the RUDAS.
  2. Their second aim was to evaluate how the RUDAS compares to the Mini-Mental State Examination, a frequently used tool to assess cognition in dementia.

For this review and meta-analysis, the authors searched several databases for any studies assessing the RUDAS. Two independent reviewers found 148 studies, of which 8 were line with the first aim, and 9 addressed aim number two.

Results

Overall, the studies evaluating the RUDAS showed it had:

  • Pooled sensitivity 77.2% (95% Confi­dence Interval [CI] 67.4 to 84.5)
  • Pooled speci­ficity of 85.9% (95% CI 74.8 to 92.6)
  • Pos­itive likelihood ratio of 5.5 (95% CI 2.9 to 10.7)
  • Negative likelihood ratio of 0.27 (95% CI 0.17 to 0.40)

This means that the RUDAS is a good tool to rule in or out dementia, and is particularly good with immigrant populations.

Moreover, the RUDAS was similar to the MMSE, with a pooled estimate of the correlation between the two tools of 0.77 (95% CI 0.72 to 0.81). The RUDAS was also less affected by language and education level than the MMSE.

The reviewers found that the RUDAS was a good instrument for diagnosing dementia in people with multicultural backgrounds.

The reviewers found that the RUDAS was a good instrument for diagnosing dementia in people with multicultural backgrounds.

Limitations

There were few limitations to this review. One of the advantages of the review is the clear need to recognise and diagnose dementia better in ethnic minority groups, so that this review addresses an important topic also in recent policy (http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1583&pageNumber=2).

One limitation is the limited evidence on test-retest reliability. But also, given the sheer number of ethnic minority groups, most evaluated studies have used different groups, so that the results are not necessarily replicating those of one particular minority group. However, this is also a benefit, as the evidence shows that the RUDAS is beneficial in many ethnic minority groups.

Summary

  • In summary, the RUDAS is a good tool to assess cognition in dementia in multiethnic populations
  • It is particularly beneficial to the dementia assessment in that the RUDAS is freely available, whereas the MMSE has to be purchased
  • However, with an abundance of good diagnostic tools available, it becomes difficult to chose which one to use
  • It would be interesting to see how well the Montreal Cognitive Assessment (an equally short test of cognition) fairs in comparison with the RUDAS
Clinicians now have a lot of choice when it comes to diagnostic tools for dementia, so it's useful to know which work best in different populations.

Clinicians now have a lot of choice when it comes to diagnostic tools for dementia, so it’s useful to know which work best in different populations.

Links

Primary paper

Naqvi, RM, Haider, S, Tomlinson, G, & Alibhai, S. (2015). Cognitive assessments in multicultural pupolations using the Rowlands Universal Dementia Assessment Scale: a systematic review and meta-analysis. CMAJ, doi: 10.1503 [Abstract]

Other references

Giebel, C.M., Jolley, D., Zubair, M., Bhui, K.S., Challis, D., Worden, A., & Purandare, N. (2015b). Adaptation of the Bart’s Explanatory Model Inventory to Dementia Understanding in South Asian Ethnic Minorities. Aging Ment Health, DOI:10.1080/13607863.2015.1031637

Giebel, C.M., Zubair, M., Jolley, D., Bhui, K., Purandare, N., Worden, A., & Challis, D. (2015a). South Asian Older Adults with Memory Impairment: Improving Assessment and Access to Dementia Care. International Journal of Geriatric Psychiatry, 30(4), 345-356. [PubMed abstract]

Mukadam, N., Cooper, C., Basit, B., & Livingston, G. (2011). Why do ethnic elders present later to UK dementia services? A qualitative study. International Psychogeriatrics, 23, 1070–1077. [PubMed abstract]

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Clarissa Giebel

Clarissa is currently a Research Fellow at the University of Liverpool. Her research focuses on enabling people with dementia staying at home for as long as possible, whilst addressing potential health inequalities in accessing the right care. She is currently leading the first Covid-19 dementia study in the UK, exploring the effects of social service closures on the lives of people with dementia and unpaid carers. In her role as postdoctoral research associate at the NIHR ARC NWC, Clarissa is the Principal Investigator on a number of dementia and health inequalities projects. This includes a European Alzheimer's Society funded project into health inequalities in dementia care access in England and the Netherlands, also collecting Young Onset dementia specific data in Australia. Further funded international collaborations in dementia care include Colombia and Chile. She is also involved in the North West Coast Household Health Survey, looking at health inequalities in health service usage across the population. In addition, Clarissa is leading a care home collaboration, where she works jointly with colleagues from the Netherlands on implementing changes to a local Liverpool-based care home and developing a UK Dementia Village. Additional collaborations and projects include working with the Brain Charity evaluating social support groups for people with dementia, and with the Liverpool House of Memories to look into evaluating their intervention for family carers of people living with dementia and care professionals, and trying to roll the intervention out to other neighbourhoods.

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