Background: The Ascertain Dementia 8-item Questionnaire (AD8) is a validated informant-based interview for early dementia detection. Research suggests the utility of self-rated AD8 to identify milder dementia forms in research settings. This study compares the factor structure, reliability, and diagnostic performance between AD8-Self and AD8-Informant for early cognitive impairment (ECI) in a clinical setting. Methods: Five hundreds fifteen patient-informant dyads (43 cognitively intact and 472 ECI) from a tertiary memory clinic completed both self-reported and informant AD8. We conducted exploratory factor analysis to determine the factor structure, Cronbach’s alpha for internal consistency, and receiver operating characteristic (ROC) curve analysis for ECI, including a subgroup analysis for mild cognitive impairment (MCI). Results: The mean age and education of ECI participants were 75.61 years (range, 51–95) and 5.6 years (range, 0–20), respectively, and 72.6 years (range, 51–89) and 6.8 years (range, 0–16) in the MCI subgroup. Unlike AD8-Informant’s one-factor structure, AD8-Self had a two-factor structure corresponding to memory and non-memory domains. AD8-Self demonstrated lower reliability (Cronbach’s alpha: ECI 0.666 vs. 0.764; MCI 0.663 vs. 0.709). In ECI, AD8-Informant (cutoff score ≥3) showed better diagnostic performance (sensitivity 89%, specificity 79%) than AD8-Self (cutoff score ≥4; sensitivity 27.1%, specificity 95.3%) (AUC 0.915 vs. 0.593; p<0.001). Similar results were found in MCI (sensitivity 64.7% vs. 26.5%; specificity 79.1% vs. 95.3%; AUC 0.745 vs. 0.600; p=0.002). Conclusion AD8-Self has a distinct factor structure, lower reliability, and inferior diagnostic performance compared to AD8-Informant for ECI/MCI detection. Our result do not support AD8-Self as a standalone tool for detecting ECI or MCI.

Background: To ascertain the construct validity and reliability of a self-administered web-based assessment of intrinsic capacity (IC). The study design was a cross-sectional analysis using data from a prospective cohort. Methods: We included data from 6,434 respondents (mean age 65.33±5.81 years; 52.4% women) of the Singapore Life Panel population study who participated in the online surveys in March 2022 and May 2022. Incremental nested factor structures of IC were modelled with confirmatory factor analysis (CFA) and their goodness-of-fit were assessed mainly with root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR). With the most parsimonious model as our eventual factor structure, we further evaluated IC and its domains with reliability indices. Results: CFA demonstrated construct validity for the second-order factor structure with acceptable overall model fit: χ2(147)=7,696.276, p<0.001; CLI=0.947; TLI=0.938; RMSEA=0.089; SRMR=0.051. Amongst the domains, vitality had highest factor loading (0.889), whereas locomotion and cognition (0.534 and 0.601, respectively) had lowest loadings with the second-order IC factor. All five IC domains and the general IC factor fulfilled reliability thresholds (construct validity [CR] or hierarchical omega ≥0.7; average variance extracted ≥0.5); psychological and locomotion domains have high CR (>0.9), whereas vitality and sensory domains have lower values of CR. Conclusion Our study provides proof-of-concept evidence regarding the construct validity and reliability of a self-administered web-based assessment of IC index that can potentially be scalable in other population settings.

Background: Functional dependency may serve as a marker for positive SARC-F screen (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) among older adults at the Emergency Department (ED). We compared functional dependency between SARC-F– (<4) and SARC-F+ (≥4) groups at the ED. Methods: A secondary analysis of cohorts from two quasi-experimental studies among patients aged ≥65 years old presenting to the ED of a 1,700-bed tertiary hospital. We compared both groups for baseline characteristics using univariate analyses, and performed multiple linear regression to examine the association between Modified Barthel Index (MBI) and Lawton’s instrumental activities of daily living (IADL) against SARC-F, and binary logistic regression to examine the associations between individual ADL domains and SARC-F+. We compared the area under receiver operating characteristic curves (AUC) to detect SARC-F+ for MBI, IADL, frailty, age, cognition and comorbidity. Results: SARC-F+ patients were older (86.4±7.6 years), predominantly female (71.5%) and frail (73.9%), more dependent on walking aids (77.2%), and had lower premorbid MBI (median 90.0 [interquartile range 71.0–98.0]) and IADL (4.0 [2.0–5.0]) (both p<0.001). MBI (β=–0.07, 95% confidence interval [CI] –0.086 to –0.055) and IADL (β=–0.533, 95% CI –0.684 to –0.381) were significantly associated with SARC-F. Dependency in finances (odds ratio [OR]=14.7, 95% CI 3.57–60.2, p<0.001), feeding (OR=12.4, 95% CI 1.45–106, p=0.022), and stair-climbing (OR=10.49, 95% CI 4.96–22.2, p<0.001) were the top three functional items associated with SARC-F. MBI (AUC=0.82, 95% CI 0.77–0.84) and IADL (AUC=0.78, 95% CI 0.72–0.84) showed superior discrimination for SARC-F+ compared to other measures (AUC=0.58–0.70). Conclusion Functional dependency is strongly associated with positive SARC-F screen among older adults at the ED. This highlights the need for increased vigilance, especially in the presence of dependency in relevant domains such as managing finances, feeding, and stair-climbing.

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.
Humans ; Singapore ; Dementia/diagnosis* ; Aged ; Independent Living ; Mass Screening/methods* ; Middle Aged ; Aged, 80 and over

Background: Functional dependency may serve as a marker for positive SARC-F screen (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) among older adults at the Emergency Department (ED). We compared functional dependency between SARC-F– (<4) and SARC-F+ (≥4) groups at the ED. Methods: A secondary analysis of cohorts from two quasi-experimental studies among patients aged ≥65 years old presenting to the ED of a 1,700-bed tertiary hospital. We compared both groups for baseline characteristics using univariate analyses, and performed multiple linear regression to examine the association between Modified Barthel Index (MBI) and Lawton’s instrumental activities of daily living (IADL) against SARC-F, and binary logistic regression to examine the associations between individual ADL domains and SARC-F+. We compared the area under receiver operating characteristic curves (AUC) to detect SARC-F+ for MBI, IADL, frailty, age, cognition and comorbidity. Results: SARC-F+ patients were older (86.4±7.6 years), predominantly female (71.5%) and frail (73.9%), more dependent on walking aids (77.2%), and had lower premorbid MBI (median 90.0 [interquartile range 71.0–98.0]) and IADL (4.0 [2.0–5.0]) (both p<0.001). MBI (β=–0.07, 95% confidence interval [CI] –0.086 to –0.055) and IADL (β=–0.533, 95% CI –0.684 to –0.381) were significantly associated with SARC-F. Dependency in finances (odds ratio [OR]=14.7, 95% CI 3.57–60.2, p<0.001), feeding (OR=12.4, 95% CI 1.45–106, p=0.022), and stair-climbing (OR=10.49, 95% CI 4.96–22.2, p<0.001) were the top three functional items associated with SARC-F. MBI (AUC=0.82, 95% CI 0.77–0.84) and IADL (AUC=0.78, 95% CI 0.72–0.84) showed superior discrimination for SARC-F+ compared to other measures (AUC=0.58–0.70). Conclusion Functional dependency is strongly associated with positive SARC-F screen among older adults at the ED. This highlights the need for increased vigilance, especially in the presence of dependency in relevant domains such as managing finances, feeding, and stair-climbing.

Background: Functional dependency may serve as a marker for positive SARC-F screen (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) among older adults at the Emergency Department (ED). We compared functional dependency between SARC-F– (<4) and SARC-F+ (≥4) groups at the ED. Methods: A secondary analysis of cohorts from two quasi-experimental studies among patients aged ≥65 years old presenting to the ED of a 1,700-bed tertiary hospital. We compared both groups for baseline characteristics using univariate analyses, and performed multiple linear regression to examine the association between Modified Barthel Index (MBI) and Lawton’s instrumental activities of daily living (IADL) against SARC-F, and binary logistic regression to examine the associations between individual ADL domains and SARC-F+. We compared the area under receiver operating characteristic curves (AUC) to detect SARC-F+ for MBI, IADL, frailty, age, cognition and comorbidity. Results: SARC-F+ patients were older (86.4±7.6 years), predominantly female (71.5%) and frail (73.9%), more dependent on walking aids (77.2%), and had lower premorbid MBI (median 90.0 [interquartile range 71.0–98.0]) and IADL (4.0 [2.0–5.0]) (both p<0.001). MBI (β=–0.07, 95% confidence interval [CI] –0.086 to –0.055) and IADL (β=–0.533, 95% CI –0.684 to –0.381) were significantly associated with SARC-F. Dependency in finances (odds ratio [OR]=14.7, 95% CI 3.57–60.2, p<0.001), feeding (OR=12.4, 95% CI 1.45–106, p=0.022), and stair-climbing (OR=10.49, 95% CI 4.96–22.2, p<0.001) were the top three functional items associated with SARC-F. MBI (AUC=0.82, 95% CI 0.77–0.84) and IADL (AUC=0.78, 95% CI 0.72–0.84) showed superior discrimination for SARC-F+ compared to other measures (AUC=0.58–0.70). Conclusion Functional dependency is strongly associated with positive SARC-F screen among older adults at the ED. This highlights the need for increased vigilance, especially in the presence of dependency in relevant domains such as managing finances, feeding, and stair-climbing.