RUDAS What, Why

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RUDASWhat, Why How?

• Dr Jeff Rowland

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Demographics

• Population of 65 increase
• NESB gt ESB
• Still not reached peak demand

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Language vs Culture

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

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Education

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

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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

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Standardised Assessment tools

• Content equivalence
• Semantic equivalence
• Translated meaning
• Technical equivalence
• Method ie pencil/paper
• Criterion equivalence
• Interpretation of measurement vs norm
• Conceptual equivalence
• Same theoretical construct

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Problem

• Current assessment tools
• Translation difficulties
• Conceptual relevance
• Educational bias

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Ethnospecific vs Cross-Cultural

• Ethno-definition
• Acculturation
• Practicality

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Development of Items

• Criteria for item inclusion in pilot
• good construct validity
• supported by interpreters
• culture fair
• relatively short easy to administer
• stand alone (avoid complex stimuli/cue cards)
• Operationalised
• Trialled on hospital inpatients

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Item Pilot - Outpatient Clinic

• 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

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Dementia Diagnosis

• DSM IV Criteria
• Dementia
• vs
• Cognitive Impairment/AACD
• vs
• Normal

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Country of Birth According to World Regions
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Data Analysis

• Assess item-diagnosis correlations (i.e.
  cognitive impairment vs no cognitive impairment)
• Exclude poor correlations (lt0.35)
• Minimise redundant items
• Construct logistic regression model

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Item - Diagnosis Correlations
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MCMMSE

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

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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

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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

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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

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Scoring

• Statistical Analysis
• Relative Weights
• Simple Calculation

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Memory

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

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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

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Fist Palm

• Alternating hand movements
• Walking pace
• Score Normal 2 Partially Adequate
  1 Failed 0

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Cube

• Copy a drawing of a cube
• Score Square 1 Internal Lines
  1 External Lines 1

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Internal Lines
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External Lines
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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

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Animal Naming

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

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Scoring

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

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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

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ROC Curve
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ROC Curve
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Repeatability
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Thank-you