RUDAS What, Why & How?

1. RUDASWhat, Why & How? Dr Jeff Rowland

2. Demographics • Population of 65+ increase NESB > ESB • Still not reached peak demand

3. Language vs Culture • Language not = culture • Spain vs Argentina • Heterogeneity within cultures • North vs South Italy • Acculturation • Migration history

4. Education • Literate vs Illiterate • Any vs none • No. of yrs • Grade level

5. Responsibility of ACATS • Perform culturally appropriate assessments • Collect accurate / relevant data • Disseminate information • in a relevant form • Assess local needs/demographics for planning • Involve Ethnic communities • Enhance access to services/facilities • Identify/address Health needs • Collect and use resources • Use experienced interpreters • Language and culture

6. Problem • Current assessment tools • Translation difficulties • Conceptual relevance • Educational bias

7. Ethnospecific vs Cross-Cultural • Ethno-definition • Acculturation • Practicality

9. ITEMS Blinded to clinical diagnosis and history Items randomly ordered Trialed on all new patients Interpreters used DIAGNOSIS 3 Geriatricians Standardised History & Examination Relevant Investigations Standardised cognitive assessment Diagnosis Item Pilot - Outpatient Clinic

10. Dementia Diagnosis • DSM IV Criteria • Dementia vs Cognitive Impairment/AACD vs Normal

11. Country of Birth According to World Regions

12. Item - Diagnosis Correlations

13. MCMMSE • 6 items • 12 domains (Memory, Learning, Praxis, Judgment, Planning, Attention, Gnosis, Language, Visuo-spatial/Construction, Perseveration, Initiation, Orientation) • 10 mins

14. RUDAS Item 1: 4 Item Grocery List Item 2: Identify Body Parts Item 3: Hand/Fist Alternating Item 4: Cube Drawing Item 5: Crossing the Road Item 6: Animal Naming

15. Validation • 90 pts random • from AGS • 45 Demented • 15 ESB 15 NESB Asian 15 NESB other • 45 Normal • 15 ESB 15 NESB Asian 15 NESB other

16. Inter-Rater & Test re-Test • 6 pts from each of 6 groups • randomly selected • inter-rater by trained ACAT member simultaneous scoring • re-test from 1-2 weeks later by Research Mx

17. Scoring • Statistical Analysis • Relative Weights • Simple Calculation

18. Memory • 4 grocery items • repeat up to 5 times till learned • Tea • Cooking Oil • Eggs • Soap • Score 2 for each correct

19. Body Parts • Sit opposite patient • Right Foot • Left Hand • with Right Hand touch Left Shoulder • with Left Hand touch Right Ear • my Left Knee • my Right Elbow • with Right Hand indicate my Left Eye • with Left Hand indicate my Left Foot • Score 1 for each correct up to a maximum of 5

20. Fist Palm • Alternating hand movements • Walking pace • Score Normal = 2 Partially Adequate = 1 Failed = 0

21. Cube • Copy a drawing of a cube • Score Square = 1 Internal Lines = 1 External Lines = 1

22. Internal Lines

23. External Lines

24. Judgment • “You need to cross a busy Street. There is no pedestrian crossing or lights. How would you proceed safely? ” • Score Traffic Normal = 2 Prompted = 1 Safety Normal = 2 Prompted = 1

25. Animal Naming • Timed over 60 seconds • Only new animals counted • Foal vs horse • Score 1 for each new animal up to 8

26. Scoring • Memory 8 • Body Parts 5 • Fist Palm 2 • Cube 3 • Judgment 4 • Animals 8 • Total 30

27. Cut Point • 22 Or below • Sens 88.9 % • Spec 97.8 % • MMSE at 24 cut Sens 93.2% Spec 51.2% • cut point = 14 • Sens 79.5 % Spec 100 %

28. ROC Curve

29. ROC Curve

30. Inter-rater 0.99 Intra-rater 0.98 Repeatability

31. Thank-you