Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore
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 revi...
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| Format: | Article |
| Language: | English |
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Academy of Medicine Singapore
2024-12-01
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| Series: | Annals, Academy of Medicine, Singapore |
| Online Access: | https://annals.edu.sg/optimising-dementia-screening-in-community-dwelling-older-adults-a-rapid-review-of-brief-diagnostic-tools-in-singapore/ |
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| author | Jun Pei Lim Sabrina Lau Penny Lun Jia Ying Tang Edwin Shih-Yen Chan Luming Shi Liang Guo Yew Yoong Ding Laura Tay Reshma A Merchant Wee Shiong Lim |
| author_facet | Jun Pei Lim Sabrina Lau Penny Lun Jia Ying Tang Edwin Shih-Yen Chan Luming Shi Liang Guo Yew Yoong Ding Laura Tay Reshma A Merchant Wee Shiong Lim |
| author_sort | Jun Pei Lim |
| collection | DOAJ |
| description |
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. |
| format | Article |
| id | doaj-art-e4d594a770644940a4dd421a8751f04a |
| institution | Kabale University |
| issn | 2972-4066 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Academy of Medicine Singapore |
| record_format | Article |
| series | Annals, Academy of Medicine, Singapore |
| spelling | doaj-art-e4d594a770644940a4dd421a8751f04a2025-01-13T02:51:52ZengAcademy of Medicine SingaporeAnnals, Academy of Medicine, Singapore2972-40662024-12-01531274275310.47102/annals-acadmedsg.2024163Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in SingaporeJun Pei LimSabrina LauPenny LunJia Ying TangEdwin Shih-Yen ChanLuming ShiLiang GuoYew Yoong DingLaura TayReshma A MerchantWee Shiong Lim 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.https://annals.edu.sg/optimising-dementia-screening-in-community-dwelling-older-adults-a-rapid-review-of-brief-diagnostic-tools-in-singapore/ |
| spellingShingle | Jun Pei Lim Sabrina Lau Penny Lun Jia Ying Tang Edwin Shih-Yen Chan Luming Shi Liang Guo Yew Yoong Ding Laura Tay Reshma A Merchant Wee Shiong Lim Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore Annals, Academy of Medicine, Singapore |
| title | Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore |
| title_full | Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore |
| title_fullStr | Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore |
| title_full_unstemmed | Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore |
| title_short | Optimising dementia screening in community-dwelling older adults: A rapid review of brief diagnostic tools in Singapore |
| title_sort | optimising dementia screening in community dwelling older adults a rapid review of brief diagnostic tools in singapore |
| url | https://annals.edu.sg/optimising-dementia-screening-in-community-dwelling-older-adults-a-rapid-review-of-brief-diagnostic-tools-in-singapore/ |
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