title: Feasibility and validity of dementia assessment by trained community health workers based on Clinical Dementia Rating.
abstract: OBJECTIVE
  To determine the level of agreement between dementia rating by trained community health workers (CHWs) based on the Clinical Dementia Rating (CDR) and the criterion standard: physician diagnosis.
  
  
  METHODS
  Cross-sectional validation study.
  
  
  METHODS
  Community gathering places such as ethnic churches, senior centers, low-income elderly apartments, and ethnic groceries in the Baltimore-Washington metropolitan area.
  
  
  METHODS
  Ninety community-dwelling Korean-American individuals aged 60 and older.
  
  
  METHODS
  The CDR is a standardized clinical dementia staging instrument used to assess cognitive and functional performance using a semistructured interview protocol. Six CHWs trained and certified as CDR raters interviewed and rated study participants. A bilingual geriatric psychiatrist evaluated participants independently for dementia status.
  
  
  RESULTS
  CHWs rated 61.1% of the participants as having mild cognitive impairment (MCI; CDR = 0.5) or dementia (CDR≥1), versus 56.7% diagnosed by the clinician. A receiver operating characteristic (ROC) curve analysis demonstrated good predictive ability of CDR rating by trained CHWs (area under the ROC curve = 0.86, 95% confidence interval = 0.78-0.93, sensitivity = 85.5%, specificity = 88.6%) in detecting MCI and dementia.
  
  
  CONCLUSIONS
  The findings provide preliminary evidence that trained CHWs can effectively identify community-dwelling elderly Korean adults with MCI and dementia for early follow-up assessment and care in a community with scarce bilingual caregivers and programs.
authors.affiliation: School of Nursing, The Johns Hopkins University, Baltimore, Maryland 21205, USA. hhan3@jhu.edu
authors.forename: Hae-Ra
authors.initials: HR
authors.lastname: Han
authors.forename: So-Youn
authors.initials: SY
authors.lastname: Park
authors.forename: Heejung
authors.initials: H
authors.lastname: Song
authors.forename: Miyong
authors.initials: M
authors.lastname: Kim
authors.forename: Kim B
authors.initials: KB
authors.lastname: Kim
authors.forename: Hochang Ben
authors.initials: HB
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D004219:District of Columbia / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007407:Interviews as Topic; D007723:Korea / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Korean; clinical dementia rating; community health worker; dementia; elderly adults