The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons.

Objective: To compare the accuracy of the Rowland Universal DementiaAssessment Scale (RUDAS) and the Folstein Mini-mental State Examination (MMSE) for diagnosis of dementia in a multicultural cohort of elderly persons.Methods: A total of 129 community-dwelling persons were selected at randomfrom a database of referrals to an aged-care team. Subjects were stratifiedaccording to language background and cognitive diagnosis, and matched for ageand gender. The RUDAS and the MMSE were administered to each subjectin random order. Within several days, a geriatrician assessed each subject fordementia (DSM-IV criteria) and disease severity (Clinical Dementia RatingScale). All assessments were carried out independent and blind. The geriatricianalso administered the Modified Barthel Index and the Lawton InstrumentalActivities of Daily Living Scale, and screened all participants for non-cognitivedisorders that might affect instrument scores.Results: The area under the receiver operating characteristic curve (AUC) forthe RUDAS [0.92, 95% confidence interval (95%CI) 0.85–0.96] was similar tothe AUC for the MMSE (0.91, 95%CI 0.84–0.95). At the published cut-points(RUDAS < 23/30, MMSE < 25/30), the positive and negative likelihood ratiosfor the RUDAS were 19.4 and 0.2, and for theMMSE2.1 and 0.14, respectively.The MMSE, but not the RUDAS, scores were influenced by preferred language(p = 0.015), total years of education (p = 0.016) and gender (p = 0.044).Conclusions: The RUDAS is at least as accurate as the MMSE, and does notappear to be influenced by language, education or gender. The high positivelikelihood ratio for the RUDAS makes it particularly useful for ruling-in disease.