Yu, Ruan-Ching; (2023) The validation of brief cognitive assessment tools to evaluate suspected dementia in Chinese-speaking populations. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Around 20% of individuals living with dementia are from Chinese-speaking populations. Brief cognitive assessments can assist in the diagnosis of dementia, but it is unclear which are best for Chinese-speaking populations. Additionally, there is a pressing need to validate brief cognitive assessments in Taiwan. Aims I aimed, firstly, to critically examine evidence about brief (< 20mins) cognitive assessment tools used to assist in the diagnosis of dementia in Chinese-speaking populations. Secondly, I aimed to identify gaps in such instrument validation for Taiwanese populations and validate a brief cognitive test for use with all patients presenting with suspected dementia. An additional aim was to culturally adapt and test a cognitive assessment battery for acceptability in this group. Methods I conducted a systematic review and meta-analysis of brief cognitive assessments used for suspected dementia and mild cognitive impairment (MCI) among Chinese-speaking populations. I used quality criteria for instruments as > 75% for sensitivity and specificity and < 75% for heterogeneity. I validated the Taiwanese version of the Addenbrooke's Cognitive Examination, ACE-III (T-ACE-III) with 90 participants in a Taiwanese memory clinic. I culturally adapted a brief cognitive assessment battery and determined its acceptability in Taiwan. Results My meta-analysis results found that the ACE-III and ACE-R were the only tests that met quality criteria across clinical populations for dementia and MCI. My empirical study showed that the T-ACE-III detected dementia in a Taiwanese population with a specificity of 100.0%, a sensitivity of 89.5%, and a Youden Index of 0.895, using an optimal cut-off value of 73/74. Conclusions The ACE-III and ACE-R demonstrated satisfactory psychometric properties for suspected dementia and MCI in Chinese-speaking populations. The T-ACE-III is an effective tool to help diagnose dementia in a Taiwanese clinical population. Further Research Building on my thesis publication, further research could examine T-ACE-III in dementia subtypes.

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