A brief dementia screener suitable for use by non-specialists in resource poor settings-the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia

M. Prince, D. Acosta, C. P. Ferri, M. Guerra, Y. Huang, K. S. Jacob, J. J. Llibre Rodriguez, A. Salas, A. L. Sosa, J. D. Williams, Kathleen Hall

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objective Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity. Methods We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D. Results Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region. Conclusion A brief version of the full CSI-D appears to share the favourable culture- and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care.

Original languageEnglish
Pages (from-to)899-907
Number of pages9
JournalInternational Journal of Geriatric Psychiatry
Volume26
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

Dementia
Primary Health Care
Education
Latin America
ROC Curve
Area Under Curve
India
China
Sensitivity and Specificity
Population

Keywords

  • cognitive test
  • dementia
  • diagnosis
  • screening

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

A brief dementia screener suitable for use by non-specialists in resource poor settings-the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia. / Prince, M.; Acosta, D.; Ferri, C. P.; Guerra, M.; Huang, Y.; Jacob, K. S.; Llibre Rodriguez, J. J.; Salas, A.; Sosa, A. L.; Williams, J. D.; Hall, Kathleen.

In: International Journal of Geriatric Psychiatry, Vol. 26, No. 9, 09.2011, p. 899-907.

Research output: Contribution to journalArticle

Prince, M. ; Acosta, D. ; Ferri, C. P. ; Guerra, M. ; Huang, Y. ; Jacob, K. S. ; Llibre Rodriguez, J. J. ; Salas, A. ; Sosa, A. L. ; Williams, J. D. ; Hall, Kathleen. / A brief dementia screener suitable for use by non-specialists in resource poor settings-the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia. In: International Journal of Geriatric Psychiatry. 2011 ; Vol. 26, No. 9. pp. 899-907.
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abstract = "Objective Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity. Methods We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D. Results Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region. Conclusion A brief version of the full CSI-D appears to share the favourable culture- and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care.",
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AU - Ferri, C. P.

AU - Guerra, M.

AU - Huang, Y.

AU - Jacob, K. S.

AU - Llibre Rodriguez, J. J.

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AU - Sosa, A. L.

AU - Williams, J. D.

AU - Hall, Kathleen

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AB - Objective Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity. Methods We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D. Results Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region. Conclusion A brief version of the full CSI-D appears to share the favourable culture- and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care.

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