Comparison of the diagnostic accuracy of five cross-cultural cognitive screening instruments for dementia and mild cognitive impairment in a multicultural memory clinic sample.

Abstract

BackgroundWith the changing demographic landscape in most countries worldwide, early identification of cognitive impairment in multicultural populations is increasingly relevant.ObjectiveTo compare the diagnostic accuracy of the Brief Assessment of Impaired Cognition (BASIC), BASIC Questionnaire (BASIC-Q), Category Cued Memory Test (CCMT), Multicultural Cognitive Examination (MCE), and Rowland Universal Dementia Assessment Scale (RUDAS) for dementia and mild cognitive impairment (MCI) in a multicultural memory clinic sample.MethodsThe study was a cross-sectional multi-center study across six sites in five European countries. All cognitive screening instruments were available in the majority languages of the collaborating countries. Participants with immigrant status were generally assessed in their first language by multilingual researchers or through interpreter-mediated assessment. Correlation analysis was used to explore associations between scores on the cognitive screening instruments. Receiver operating characteristic curve (ROC) analysis was used to examine diagnostic accuracy for dementia and MCI as compared to specialist diagnosis.ResultsThe study included 187 participants (94 cognitively intact, 36 MCI, 57 dementia), of which 105 (56%) had immigrant background. All cognitive screening instruments were strongly correlated and had high diagnostic accuracy for dementia (areas under the ROC curve (AUCs) in the range 0.86-0.97) and moderate to high diagnostic accuracy for MCI (AUCs in the range 0.72-0.86), with the MCE, BASIC, and BASIC-Q showing the best diagnostic properties. Overall, diagnostic accuracy for cognitive impairment (dementia or MCI) did not significantly differ between European native-born and immigrant participants, or between participants with <7 compared to ≥7 years of formal schooling.ConclusionsIn the present study, the MCE, BASIC, and BASIC-Q showed better diagnostic properties than the RUDAS and CCMT for the diagnosis of dementia and MCI in a multicultural memory clinic sample.