The relationship between common cognitive screening tests (Standardised Mini-Mental State Examination and Rowland Universal Dementia Assessment Scale) and the Cognitive Functional Independence Measure.

OBJECTIVES: To assess whether the Cognitive Functional Independence Measure (Cog-FIM) is correlated with the Standardised Mini-Mental State Examination (SMMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) and whether there is agreement between the Cog-FIM and these two tests. METHODS: Functional Independence Measure assessments were undertaken on 98 subacute patients. Forty-eight (48) patients were administered the SMMSE, and 50 were administered the RUDAS. Agreement was examined using the Bland-Altman plot. RESULTS: Correlation was observed between the Cog-FIM and both the SMMSE and the RUDAS. The Bland-Altman analysis demonstrated agreement between the Cog-FIM and RUDAS, but not the Cog-FIM and SMMSE. The limits of agreement between the Cog-FIM and RUDAS were -13 to 13. CONCLUSIONS: The Cog-FIM is correlated with the RUDAS, but the agreement is unclear. Despite agreement of the means, the limits of agreement are large, which may suggest a clinically meaningful difference. The study should be repeated with a larger sample size.

Development of a questionnaire to assess clinician perspectives of the usefulness of the Functional Independence Measure (FIM) and cognitive screening tests.

OBJECTIVE: A pilot questionnaire was developed to investigate the cognitive tests that clinicians employ in their clinical practice and whether they perceive the Functional Independence Measure (FIM) to add clinical value. METHODS: A 10-item pilot questionnaire was created and distributed to 43 health professionals of a single health service in Australia. A snowballing approach to sampling was used. RESULTS: There were 39 respondents. Less than half of respondents thought the FIM added clinical value, and 15% stated that they would use the FIM to assess cognition on subacute wards. Ninety-seven per cent (97%) of respondents stated that they would rely more heavily on cognitive screening tests than the FIM. CONCLUSION: Participant responses to this survey of a single health service raise interesting questions about how useful clinicians perceive the FIM to be, beyond a costing and benchmarking role. Clinicians may prefer cognitive screening tests to the FIM, in clinical practice.

The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale.

OBJECTIVE: To develop and validate a simple method for detecting dementia that is valid across cultures, portable and easily administered by primary health care clinicians. DESIGN: Culture and Health Advisory Groups were used in Stage 1 to develop culturally fair cognitive items. In Stage 2, clinical testing of 42 items was conducted in a multicultural sample of consecutive new referrals to the geriatric medicine outpatient clinic at Liverpool Hospital, Sydney, Australia (n = 166). In Stage 3, the predictive accuracy of items was assessed in a random sample of community-dwelling elderly persons stratified by language background and cognitive diagnosis and matched for sex and age (n = 90). MEASUREMENTS: A research psychologist administered all cognitive items, using interpreters when needed. Each patient was comprehensively assessed by one of three geriatricians, who ordered relevant investigations, and implemented a standardized assessment of cognitive domains. The geriatricians also collected demographic information, and administered other functional and cognitive measures. DSM-IV criteria were used to assign cognitive diagnoses. Item validity and weights were assessed using frequency and logistic regression analyses. Receiver-operating characteristic (ROC) curve analysis was used to determine overall predictive accuracy of the RUDAS and the best cut-point for detecting cognitive impairment. RESULTS: The 6-item RUDAS assesses multiple cognitive domains including memory, praxis, language, judgement, drawing and body orientation. It appears not to be affected by gender, years of education, differential performance factors and preferred language. The area under the ROC curve for the RUDAS was 0.94 (95% CI 0.87-0.98). At a cut-point of 23 (maximum score of 30), sensitivity and specificity were 89% and 98%, respectively. Inter-rater (0.99) and test-retest (0.98) reliabilities were very high. CONCLUSIONS: The 6-item RUDAS is portable and tests multiple cognitive domains. It is easily interpreted to other languages, and appears to be culturally fair. However, further validation is needed in other settings, and in longitudinal studies to determine its sensitivity to change in cognitive function over time.

Accuracy of the clock drawing test for detecting dementia in a multicultural sample of elderly Australian patients.

OBJECTIVE: To assess the accuracy of clock drawing for detecting dementia in a multicultural, non-English-speaking-background population. DESIGN: A prospective cohort study. SETTING: A general geriatric medical outpatient clinic in southwest Sydney, Australia. PARTICIPANTS: Ninety-three consecutive new patients to the clinic who had a non-English-speaking-background country of birth (mean age 78.0 years). MEASUREMENTS: The clock drawing test was conducted at the beginning of each clinic visit by a blinded investigator. Each patient was then assessed by a geriatrician who collected demographic data, administered the Modified Barthel Index, the Geriatric Depression Scale, and the Folstein Mini-Mental State Examination, and categorized each patient as normal or demented, according to DSM-IV criteria. Interpreters were used for participants who spoke a language other than English or who requested them. Each clock drawing was scored according to the 4-point CERAD scale and the previously published methods of Mendez, Shulman, Sunderland, Watson, and Wolf-Klein. Scoring was evaluated for reliability and predictive accuracy, using receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to assess the potential interaction between level of education and each of the clock scoring methods. RESULTS: Using ROC curve analysis, there was no significant difference between the clock scoring methods (area under the curve varied from 0.60 to 0.72). The most sensitive was the Mendez scoring method (98%), with a specificity of 16%. Specificity above 50% was found only for the Wolf-Klein method, with an intermediate sensitivity of 78%. CONCLUSIONS: There were no significant differences in the clock scoring methods used to detect dementia. Performance of the clock drawing test was modest at best with low levels of specificity across all methods. Scored according to these methods, clock drawing was not a useful predictor of dementia in our multicultural population.