The ability to assess cognitive impairment in multicultural older populations will become more important as demographics change worldwide. A new study published in CMAJ (Canadian Medical Association Journal) reports that the Rowland Universal Dementia Assessment Scale (RUDAS) is particularly effective in multicultural populations where English is not a patient’s first language.
Dementia is on the rise worldwide, with numbers projected to triple by 2050 to over 100 million. More than half the patients (58%) are in low- and middle-income countries, many of which are sources of immigrants to countries like Canada and Australia.
“Given our aging immigrant population in Canada and the anticipated increase in dementia prevalence worldwide in coming decades, earlier and more accurate detection of dementia in these populations will become increasingly important,” writes Dr. Raza Naqvi, a geriatrician with the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada, with coauthors.
Current tools to assess cognitive health, such as the Mini-Mental State Examination and the Montreal Cognitive Assessment, are widely used but are challenging to use in patients with low education levels and those whose first language is not English.
Researchers undertook a systematic review and meta-analysis to determine whether the RUDAS, developed in Australia in 2004, is effective in a variety of settings. They also wanted to understand how it compares to other tools. The study included 1236 people from 11 previous studies conducted in 6 countries. The mean age of participants was 73.5 years, and almost two-thirds (61%) were female.
The RUDAS includes questions such as recall of four grocery items, what safety precautions should one take when crossing the street, and naming of animals in 1 minute; it also assesses coordinated movements. The test appeared to be effective in identifying cognitive impairment and ruling it out across various cultures because language and education had less effect on results than with the other assessment tools.
The authors noted that all studies included in the analysis used trained interpreters; this may be a limitation since interpreters will not always be available for tests in all settings.
“The RUDAS is a freely available, effective brief cognitive assessment tool that has shown strong psychometric properties in several countries. It shows particular advantage in culturally and linguistically diverse populations,” the authors conclude.
Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis, Raza M. Naqvi MD, Sehrish Haider MBBS, George Tomlinson PhD, Shabbir Alibhai MD MSc, CMAJ, DOI:10.1503/cmaj.140802, published 17 February 2015.
Podcast – interview with the author: https://soundcloud.com/cmajpodcasts/naqvi-multicultural-cognitive