Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia

Abstract

Objectives: Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance.

Methods: A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs.

Results: At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis.

Conclusion: The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.

Keywords:

• RUDAS
• validation
• dementia
• Lebanon

Acknowledgement

The study was funded by the Fogarty International Center, American National Institute of Health and National Institute of Aging, grant number 1R21AG039333-01 under the program “Brain Disorders in the Developing World: Research Across Lifespan (BRAIN)”. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The recruitment was a community effort with contributions from institutions, organizations, and individuals. Above all, the researchers would like to express a deep gratitude to the participants in the study. They would also like to thank the Ministry of Social Affairs’ Social Center in Bourj Hammoud; The NGOs Restaurant du Coeur, the ladies from the Board of the Child & Mother Welfare Society, and Ayadina Social Center for the Elderly; Ain W Zein Hospital Geriatric Clinic; Neurology Clinic at AUB Medical Center; geriatric clinics from Al Saydeh Hospital in Antelias, Child & Mother Welfare Society, and Baytouna Nursing Home; primary care clinics from Maronite Nursing Home, Al Saydeh Church in Hamra, and Al Salib Church in Naaba; social workers Glady Farrah and Mona Saliby; Mrs. Dora Chaaya; Dean Iman Nuwayhid and Professor Jihad Makhoul from the Faculty of Health Sciences, AUB; Mrs. Helen Samaha, President of the Lebanese Order of Nursing; Dr Raja Sawaya and Dr Nazem Bassil; for their assistance with recruitment. The research group would also like to thank Dr Ibrahim Zeinaty, Dr Sandrine Salman, Dr Salem Hammoud, Dr Wael Radwan, and Dr Ali Al Ahmar for their work as interviewers in the study. We would also like to thank Alzheimer Association Lebanon for providing the educational materials about dementia for the patients and their caregivers in this study. Finally, we would like to thank Ms. Suzana Al Maali for her thorough literature review, Ms. Sarah Assaad for her rigorous work in finalizing the tables and the references and making the final corrections, and Ms. Yasmine Abou Taha for editing the paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Fogarty International Center, American National Institute of Health and National Institute of Aging: Brain Disorders in the Developing World: Research Across Lifespan (BRAIN) [grant number 1R21AG039333-01].