title: Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania.
abstract: BACKGROUND
  We have previously described the development of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen for use in populations with low levels of formal education. The IDEA cognitive screen was developed and field-tested in an elderly, community-based population in rural Tanzania with a relatively high prevalence of cognitive impairment. The aim of this study was to validate the IDEA cognitive screen as an assessment of major cognitive impairment in hospital settings in Nigeria and Tanzania.
  
  
  METHODS
  In Nigeria, 121 consecutive elderly medical clinic outpatients reviewed at the University College Hospital, Ibadan were screened using the IDEA cognitive screen. In Tanzania, 97 consecutive inpatients admitted to Mawenzi Regional Hospital (MRH), Moshi, and 108 consecutive medical clinic outpatients attending the geriatric medicine clinic at MRH were screened. Inter-rater reliability was assessed in Tanzanian outpatients attending St Joseph's Hospital in Moshi using three raters. A diagnosis of dementia or delirium (DSM-IV criteria) was classified as major cognitive impairment and was provided independently by a physician blinded to the results of the screening assessment.
  
  
  RESULTS
  The area under the receiver operating characteristic (AUROC) curve in Nigerian outpatients, Tanzanian outpatients and Tanzanian inpatients was 0.990, 0.919 and 0.917 respectively. Inter-rater reliability was good (intra-class correlation coefficient 0.742 to 0.791). In regression models, the cognitive screen did not appear to be educationally biased.
  
  
  CONCLUSIONS
  The IDEA cognitive screen performed well in these populations and should prove useful in screening for dementia and delirium in other areas of sub-Saharan Africa.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. stella-maria.paddick@ncl.ac.uk.|Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. stella-maria.paddick@ncl.ac.uk.
authors.forename: Stella-Maria
authors.initials: SM
authors.lastname: Paddick
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. wagray70@gmail.com.
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.affiliation: University College Hospital, University of Ibadan, Ibadan, Nigeria. LOgunjimi@yahoo.com.
authors.forename: Luqman
authors.initials: L
authors.lastname: Ogunjimi
authors.affiliation: Mawenzi Regional Hospital, Moshi, Tanzania. Bingileki.lwezuala@gmail.com.
authors.forename: Bingileki
authors.initials: B
authors.lastname: Lwezuala
authors.affiliation: University College Hospital, University of Ibadan, Ibadan, Nigeria. lyde18@yahoo.com.
authors.forename: Olaide
authors.initials: O
authors.lastname: Olakehinde
authors.affiliation: Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania. kisolialoyce@yahoo.com.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Kisoli
authors.affiliation: Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania. KissimaJ10@yahoo.co.uk.
authors.forename: John
authors.initials: J
authors.lastname: Kissima
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania. godfreymbowe81@yahoo.com.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbowe
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania. sarah.mkenda@yahoo.co.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mkenda
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. Catherine.dotchin@nhct.nhs.uk.|Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK. Catherine.dotchin@nhct.nhs.uk.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dotchin
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. richard.walker@nhct.nhs.uk.|Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. richard.walker@nhct.nhs.uk.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania. mushideclare65@gmail.com.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: The Medical School, Newcastle University, Newcastle upon Tyne, UK. cecilia.collingwood@newcastle.ac.uk.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Collingwood
authors.affiliation: University College Hospital, University of Ibadan, Ibadan, Nigeria. aogunniyi53@yahoo.com.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
mesh_terms: D000368:Aged; D044383:Black People; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening; D009549:Nigeria; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013636:Tanzania