The Usefulness of Rowland Universal Dementia Assessment Scale in Oman: A Cross Sectional Study

Abstract

Dementia is decline in multiple cognitive domains and considered as a major cause of disability among elderly. Cognitive assessment is an essential part in evaluating patients attending geriatric clinic such as Mini-Mental State Examination (MMSE). However, this tool requires, individual to be at certain level of education, which may be difficult to perform among illiterate people. Moreover, the illiteracy rate in Oman was estimated to be 6% of the population Aim: The aim of this study is to assess the usability of Rowland Universal Dementia Assessment Scale (RUDAS) as assessment tool for dementia in Oman. Objective To establish the usefulness of the Rowland universal dementia assessment scale (RUDAS) in comparison with Mini -Mental State Examination (MMSE ) and validating a simple and portable tool to screen for dementia among Omani population. Methods: Cross-Sectional study conducted at Al-Masarra hospital Geriatric unit OPD services from July 2020 to January 2021 to those who attending the OPD. Results: The RUDAS tool sensitivity was 95.3% and the specificity was 40.7%. While the MMSE sensitivity was 98% and the specificity was 32.7%. There is significant difference in both the sensitivity and specificity of both screening tools (p<0.05). RUDAS was more specific than the MMSE. Conclusion RUDAS is useful in assessing dementia in Omani population. International Journal of Geriatrics and Gerontology Al-Jadidi S, et al. Int J Geriatr Gerontol 6: 128. www.doi.org/10.29011/2577-0748.100028 www.gavinpublishers.com Introduction Dementia is decline in multiple cognitive domains and considered as a major cause of disability among elderly [1]. Cognitive assessment is an essential part in evaluating patients attending geriatric clinic. Folstein Mini-Mental State Examination (MMSE) is a widely used tool to screen for cognitive impairment and to assess the severity of dementia [2]. However, MMSE score is influenced by age, gender, educational level, country of birth and language of the interview [3]. Furthermore, literal translation of the MMSE may produce items of different connotations and levels of difficulties [4]. In Oman, the illiteracy rate was estimated Citation: Al-Jadidi S, Alharrasi M, Almaqbali M, Alkharusi F, Al Kharusi N, et al. (2022) The Usefulness of Rowland Universal Dementia Assessment Scale in Oman: A Cross Sectional Study. Int J Geriatr Gerontol 6: 128. DOI: 10.29011/2577-0748.100028 2 Volume 6; Issue 01 Int J GeriatrGerontol, an open access journal ISSN: 2577-0748 to be 6% of the population (UNESCO institute for statistics 2015). Moreover, in geriatric population in Oman is 6% more in females, with present more than 80%, while in elderly men equaled to 22% [5]. In Oman, increase presentation of illiteracy in elderly due to lack of schools and other education resources before 1970. Hence, cognitive assessment of this age group requires a good screening tool with cross-cultural, linguistic and psychometric properties. In Oman: AlMasarra Hospital, total number of Dementia requested to date are 3098 and those who actively attending in OPD are 1000+ cases. Moreover, dementia cases at AlMasarra Hospital Geriatric representing 76% of total patients seen in Geriatric unit [6]. Rowland universal dementia assessment scale RUDAS [7] is a simple tool to detect dementia that is valid across various cultures and can be translated easily to different languages [7]. There are positive studies conducted in Australia, European countries and India assessing the usefulness of RUDAS in dementia [8-10]. Moreover, up to our knowledge, this is the first study in Middle East study /Oman, assessing the usefulness of RUDAS in dementia. In a study done by Storey, et al. used the 6-item RUDAS show that the tools not affected by gender, years of education, differential performance factors and preferred language [7]. “The area under the ROC curve for the RUDAS was 0.94 (95% CI 0.87-0.98). At a cut-point of 23 (maximum score of 30), sensitivity and specificity were 89% and 98%, respectively. Inter-rater (0.99) and testretest (0.98) reliabilities were very high [8].” Another study title Usefulness of the Rowland Universal Dementia Assessment Scale in South India, which was done by Lype, et al. aim to compare the sensitivity and specificity of MMSE and RUDAS [11]. The conclusion shows that RUDAS had “a similar sensitivity but better specificity than MMSE, but did have an educational bias [9].” A prospective international cross-sectional multi-center study across five Western European countries done by Nielsen TR, et al. found the RUDAS have high diagnostic accuracy in multicultural sample (sensitivity 0.80, specificity 0.90) [5]. Up to our knowledge, this first study in Middle East / Oman to assess the usefulness of the Rowland Universal Dementia Assessment Scale (RUDAS) among Omani elderly population. Validating a simple and portable tool to screen for dementia and other cognitive disorders will help the treating doctors to monitor the progress of the disease and the response to medical intervention.