Comparative analysis between the MMSE and the RUDAS for dementia screening in low educated people in a Spanish psychogeriatric clinic

  1. R. Mateos-Álvarez
  2. R. Ramos-Ríos
  3. J.D. López-Moríñigo
Revista:
European journal of psychiatry

ISSN: 0213-6163

Ano de publicación: 2017

Volume: 31

Número: 3

Páxinas: 119-126

Tipo: Artigo

DOI: 10.1016/J.EJPSY.2017.06.003 DIALNET GOOGLE SCHOLAR

Outras publicacións en: European journal of psychiatry

Resumo

Background and objectives The Mini-Mental State Examination (MMSE) remains the most widely used test for the screening of dementia, but its limitations in low educated people are well known. This justified the development of new scales aimed at rooting out any socio-cultural bias, such as the Rowland Universal Dementia Assessment Scale (RUDAS). The aim of this paper is to compare the accuracy of the Spanish RUDAS and the MMSE for the diagnosis of dementia in a population with low level of education. Methods In a Psychogeriatric Unit a total of 97 outpatients were administered the RUDAS (by blinded examiners) and the MMSE (by an expert clinician, blind to the RUDAS results). Results 35 of the 97 subjects received the diagnosis of dementia. The area under the ROC curve (AUC) for the RUDAS, 0.901 (IC 95% 0.84–0.96) was similar to MMSE AUC 0.889 (IC 95% 0.82–0.95). The ideal cut-off point for the RUDAS was 21/22 with 94.3% sensitivity and 72.6% specificity. The “best” cut point for the MMSE was 16/17, lower than the standard 23/24, with 85.7% sensitivity and 77.4% specificity. The MMSE correlated with educational level (r = 0.432, p < 0.01), but the RUDAS did not (r = 0.087; n.s.). Conclusions The RUDAS was not only as accurate as the MMSE for the screening of dementia, but also, it was found to be free of biases associated withed the education level. Hence, the RUDAS seems to be a more adequate test for dementia screening in our cultural context than the MMSE. These results should be replicated in a primary care setting

Información de financiamento

For this study, R. Ramos-Ríos and J. López-Moríñigo, medical students at the time of collecting the data, received financial support by a Collaboration-Grant from the Spanish Ministry of Education during the 2003–2004 and 2004–2005 academic years, respectively. Authors thank Jeff Rowland and Joella Storey for their support in the validation of the Spanish version of the RUDAS.

Financiadores

Referencias bibliográficas

  • M.F. Folstein, S.E. Folstein, P.R. McHugh. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 2 (1975), pp. 189-198
  • R. Mateos, A. Rodríguez. Estudio de Epidemiología Psiquiátrica en la Comunidad Gallega. Xunta de Galicia, Santiago de Compostela (1989)
  • P.H. Bertolucci, S.M. Brucki, S.R. Campacci, Y. Juliano. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr, 52 (1994), pp. 1-7
  • M. Prince, D. Acosta, H. Chiu, M. Scazufca, M. Varghese. 10/66 Dementia Research Group. Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361 (2003), pp. 909-917
  • R.N. Jones, J.J. Gallo. Education bias in the mini-mental state examination. Int Psychogeriatr/IPA, 13 (2001), pp. 299-310
  • R.M. Crum, J.C. Anthony, S.S. Bassett, M.F. Folstein. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA, 269 (1993), pp. 2386-2391
  • J.M. Manubens, P. Martinez-Lage, J.M. Martinex-Lage, R. Larumbe, J. Muruzabal, M.A. Martinez-Gonzalez, et al. Variation of Mini-Mental-State examination scores due to age and educational level. Normalized data in the population over 70 years of age in Pamplona. Neurologia (Barcelona, Spain), 13 (1998), pp. 111-119
  • H.C. Kraemer, D.J. Moritz, J. Yesavage. Adjusting Mini-Mental State Examination scores for age and educational level to screen for dementia: correcting bias or reducing validity? Int Psychogeriatr/IPA, 10 (1998), pp. 43-51
  • G. Xu, J.S. Meyer, Y. Huang, F. Du, M. Chowdhury, M. Quach. Adapting mini-mental state examination for dementia screening among illiterate or minimally educated elderly Chinese. Int J Geriatr Psychiatry, 18 (2003), pp. 609-616
  • S.M. Brucki, R. Nitrini, P. Caramelli, P.H. Bertolucci, I.H. Okamoto. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr, 61 (2003), pp. 777-781
  • C. Villanueva-Iza, F. Bermejo-Pareja, A. Berbel García, R. Trincado-soriano, J. Rivera-Navarro. Validación de un protocolo clínico para la detección de demencia en ámbito poblacional. Rev Neurol, 36 (2003), pp. 1121-1126
  • S. Borson, J.M. Scanlan, P. Chen, M. Ganguli. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc, 51 (2003), pp. 1451-1454
  • P.R. Solomon, A. Hirschoff, B. Kelly, M. Relin, M. Brush, R.D. De Veaux, et al. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol, 55 (1998), pp. 349-355
  • J.E. Storey, J.T. Rowland, D. Basic, D.A. Conforti, H.G. Dickson. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr, 16 (2004), pp. 13-31
  • J.T. Rowland, D. Basic, J.E. Storey, D.A. Conforti. The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. Int Psychogeriatr, 18 (2006), pp. 111-120
  • T. Iype, B.K. Ajitha, P. P Antony, N.B. Ajeeth, S. Job, K.S. Saji. Usefulness of the Rowland Universal Dementia Assessment Scale in South India. J Neurol Neurosurg Psychiatry, 77 (2006), pp. 513-514
  • T. Iype, B.K. Ajitha, K.S. Shaji. Towards education-fair dementia screening. Int Psychogeriatr, 18 (2006), pp. 757-758
  • R.M. Naqvi, S. Haider, G. Tomlinson, S. Alibhai. Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. CMAJ, 187 (2015), pp. E169-E175
  • R. Mateos-Alvarez. La asistencia en psiquiatría geriátrica. De la teoría a la praxis. L. Agüera, J. Cervilla, M. Martín Carrasco (Eds.), Psiquiatría geriátrica (2nd ed.), Masson, Madrid (2006), pp. 909-945
  • R. Mateos, R. Ramos-Ríos, J. López-Moríñigo. Screening dementia in low educated people: preliminary report of the validation of the Spanish RUDAS. Int Psychogeriatr, 17 (Suppl. 2) (2005), pp. 267-268
  • R. Ramos-Ríos, R. Mateos-Álvarez, J.D. López-Moríñigo. Cribado de demencia en una población con un bajo nivel de instrucción. Validación de la versión española del RUDAS (Rowland Universal Dementia Assessment Scale) en una muestra asistencial. Psicogeriatría, 1 (2009), pp. 89-99
  • R. Mateos, A. Droux, M. Páramo, F. Gonzalez, I. Carrera, J. Mazaira, et al. The Galicia study of mental health of the elderly II: the use of the Galician DIS. Int J Methods Psychiatry Res, 9 (2000), pp. 174-182
  • A. Droux, H. Meireles. The use of the DIS III in a study of prevalence of mental disorders in Gondomar Portugal. Book of abstracts of the V Congress of the International Federation of Psychiatric Epidemiology. Montreal (1990), p. 103
  • J.C. Morris. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43 (1993), pp. 2412-2414
  • J. Cohen-Mansfield, B. Reisberg, J. Bonnema, L. Berg, D.P. Dastoor, R.I. Pfeffer, et al. Staging methods for the assessment of dementia: perspectives. J Clin Psychiatry, 57 (1996), pp. 190-198
  • A. Lobo, J. Esquerra, F. Gomez Burgada, J.M. Sala, A. Seva. El Mini-Exámen Cognoscitivo: un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos. Actas Luso Esp Neurol Psiquiatr, 3 (1979), pp. 189-202
  • A. Lobo, P. Saz, G. Marcos, J.L. Dia, C. de la Camara, T. Ventura, et al. Revalidation and standardization of the cognition mini-exam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population. Med Clin (Barc), 112 (1999), pp. 767-774
  • R. Mateos, C. Garcı́a-Mahı́a, R. Ramos. The epidemiology of dementia in Galicia, Spain. Alzheimer's Dementia, 2 (2006), p. S172
  • A. Tarnopolsky, D.J. Hand, E.K. McLean, H. Roberts, R.D. Wiggins. Validity and uses of a screening questionnaire (GHQ) in the community. Br J Psychiatry, 1979 (1979), pp. 508-515