Cheuk Ni Kan1, Liwen Zhang2, Ching-Yu Cheng3, Tien Yin Wong4, Narayanaswamy Venketasubramanian5, Christopher Li-Hsian Chen1, Xin Xu6. 1. Memory Ageing and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore. 2. Memory Ageing and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore; Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Medical School, Singapore. 3. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. 4. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore. 5. Memory Ageing and Cognition Centre, National University Health System, Singapore; Raffles Neuroscience Centre, Raffles Hospital, Singapore. 6. Memory Ageing and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore. Electronic address: summer.xu@nus.edu.sg.
Abstract
OBJECTIVES: The informant-AD8 (i-AD8) was found to be reliable in detecting cognitive impairment and dementia in tertiary and primary health care settings. We evaluated the discriminability of the i-AD8, as compared to other brief cognitive measures, and its combination with the 5-minute Montreal Cognitive Assessment (MoCA) and Mini-Cog in detecting very mild dementia in an Asian older cohort. DESIGN: The Epidemiology of Dementia in Singapore (EDIS) study recruited participants from a population-based eye disease study who were of Chinese, Malay, and Indian ethnicities. SETTING AND PARTICIPANTS: Participants aged ≥60 years were clinically assessed and diagnosed using the Clinical Dementia Rating (CDR) scale. Of the 761 participants recruited, 526 (69.1%) had no dementia (CDR = 0), 193 (25.4%) had very mild dementia (CDR = 0.5), and 42 (5.5%) had dementia (CDR ≥ 1). MEASURES: Participants were administered the Mini-Mental State Examination, MoCA, Mini-Cog, and a local neuropsychological battery. Their informants were interviewed using the i-AD8. Receiver operating characteristic analyses were conducted to establish the optimal cut-off points, and all discriminatory indices were calculated. RESULTS: The i-AD8 was good and equivalent to other cognitive tools in detecting dementia [area under the curve (AUC) = 0.89, sensitivity = 0.76, and specificity = 0.94] but only fair in detecting very mild dementia (AUC = 0.69, sensitivity = 0.62, and specificity = 0.73). Combination of the i-AD8 with 5-minute MoCA or Mini-Cog in compensatory or in conjunction showed minimal improvement to the clinical utility for dementia or very mild dementia. All scales yielded a high rate of false positives (positive predictive value < 0.70). CONCLUSIONS AND IMPLICATIONS: The i-AD8 has good discriminatory power in detecting dementia (CDR ≥ 1) and is brief enough to be applied as an effective screening tool in the community. However, the i-AD8 and other cognitive tools lacked classification accuracy in detecting very mild dementia (CDR = 0.5).
OBJECTIVES: The informant-AD8 (i-AD8) was found to be reliable in detecting cognitive impairment and dementia in tertiary and primary health care settings. We evaluated the discriminability of the i-AD8, as compared to other brief cognitive measures, and its combination with the 5-minute Montreal Cognitive Assessment (MoCA) and Mini-Cog in detecting very mild dementia in an Asian older cohort. DESIGN: The Epidemiology of Dementia in Singapore (EDIS) study recruited participants from a population-based eye disease study who were of Chinese, Malay, and Indian ethnicities. SETTING AND PARTICIPANTS: Participants aged ≥60 years were clinically assessed and diagnosed using the Clinical Dementia Rating (CDR) scale. Of the 761 participants recruited, 526 (69.1%) had no dementia (CDR = 0), 193 (25.4%) had very mild dementia (CDR = 0.5), and 42 (5.5%) had dementia (CDR ≥ 1). MEASURES: Participants were administered the Mini-Mental State Examination, MoCA, Mini-Cog, and a local neuropsychological battery. Their informants were interviewed using the i-AD8. Receiver operating characteristic analyses were conducted to establish the optimal cut-off points, and all discriminatory indices were calculated. RESULTS: The i-AD8 was good and equivalent to other cognitive tools in detecting dementia [area under the curve (AUC) = 0.89, sensitivity = 0.76, and specificity = 0.94] but only fair in detecting very mild dementia (AUC = 0.69, sensitivity = 0.62, and specificity = 0.73). Combination of the i-AD8 with 5-minute MoCA or Mini-Cog in compensatory or in conjunction showed minimal improvement to the clinical utility for dementia or very mild dementia. All scales yielded a high rate of false positives (positive predictive value < 0.70). CONCLUSIONS AND IMPLICATIONS: The i-AD8 has good discriminatory power in detecting dementia (CDR ≥ 1) and is brief enough to be applied as an effective screening tool in the community. However, the i-AD8 and other cognitive tools lacked classification accuracy in detecting very mild dementia (CDR = 0.5).