Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore.
10.47102/annals-acadmedsg.2024163
- Author:
Jun Pei LIM
1
;
Sabrina LAU
1
;
Penny LUN
2
;
Jia Ying TANG
2
;
Edwin Shih-Yen CHAN
3
;
Luming SHI
4
;
Liang GUO
3
;
Yew Yoong DING
1
;
Laura TAY
5
;
Reshma A MERCHANT
6
;
Wee Shiong LIM
1
Author Information
1. Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
2. Geriatric Education and Research Institute, Singapore.
3. Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore.
4. Health Economics and Outcomes Research, Singapore Clinical Research Institute, Singapore.
5. Department of Geriatric Medicine, Sengkang General Hospital, Singapore.
6. Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore.
- Publication Type:Review
- Keywords:
Singapore;
cognitive screening tools;
dementia;
diagnostic performance;
geriatrics;
older adults
- MeSH:
Humans;
Singapore;
Dementia/diagnosis*;
Aged;
Independent Living;
Mass Screening/methods*;
Middle Aged;
Aged, 80 and over
- From:Annals of the Academy of Medicine, Singapore
2024;53(12):742-753
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Timely detection of dementia enables early access to dementia-specific care services and interventions. Various stakeholders brought together to refine Singapore's dementia care strategy identified a lack of a standardised cognitive screening tool and the absence of a comparative review of existing tools. We hence conducted a rapid review to evaluate the diagnostic performance of brief cognitive screening tools in identifying possible dementia among community-dwelling older adults in Singapore.
METHOD:Brief cognitive screening tools were defined as interviews or tests administered in ≤5 minutes. Studies performed in Singapore on older adults ≥60 years, which used locally-validated comparators and reported outcomes of clinician-diagnosed dementia were included. Rapid review methodology was used in study screening and selection. Quality Assessment of Diagnostic Accuracy Studies version 2 tool was used for risk-of-bias assessment. A negative likelihood ratio (LR-) of ≤0.2 was defined a priori as having a moderate effect in shifting post-test probability.
RESULTS:Fourteen studies were included in qualitative synthesis: 3 studies evaluated self-/informant-based tools only, 4 evaluated performance-based measures only and 7 evaluated combination approaches. Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) was the most studied self-/ informant-based tool. One study found informant AD8 (iAD8) superior to self-rated AD8. Another study found iAD8 superior to Mini-Mental State Examination. Among performance-based measures, Abbreviated Mental Test, Visual Cognitive Assessment Test-Short form version 1 (VCAT-S1), VCAT-S2 and Mini-Cog had LR- <0.2. Minimal improvement of combination approaches compared to iAD8 alone was demonstrated.
CONCLUSION:Our review suggests the limited utility of dementia screening in communities with low dementia prevalence and supports a case-finding approach instead. With a reliable informant, iAD8 alone has sufficient discriminant ability. Further research is needed to specifically assess the diagnostic ability of performance-based tools in community settings.
