title: Clinical utility of the informant AD8 as a dementia case finding instrument in primary healthcare.
abstract: The informant AD8 has excellent discriminant ability for dementia case finding in tertiary healthcare settings. However, its clinical utility for dementia case finding at the forefront of dementia management, primary healthcare, is unknown. Therefore, we recruited participants from two primary healthcare centers in Singapore and measured their performance on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a local formal neuropsychological battery, in addition to the AD8. Logistic regression was conducted to examine the associations between demographic factors and dementia. Area under the receiver operating characteristics (ROC) curve analysis was used to establish the optimal cut-off points for dementia case finding. Of the 309 participants recruited, 243 (78.7%) had CDR = 0, 22 (7.1%) CDR = 0.5, and 44 (14.2%) CDR ≥1. Age was strongly associated with dementia, and the optimal age for dementia case finding in primary healthcare settings was ≥75 years. In this age group, the AD8 has excellent dementia case finding capability and was superior to the MMSE and equivalent to the MoCA [AD8 AUC (95% CI): 0.95 (0.91-0.99), cut-off: ≥3, sensitivity: 0.90, specificity: 0.88, PPV: 0.79 and NPV: 0.94; MMSE AUC (95% CI): 0.87 (0.79-0.94), p = 0.04; MoCA AUC (95% CI): 0.88 (0.82-0.95), p = 0.06]. In conclusion, the AD8 is well suited for dementia case finding in primary healthcare settings.
authors.affiliation: Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.|Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Qun Lin
authors.initials: QL
authors.lastname: Chan
authors.affiliation: Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.|Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.|Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Muhammad Amin
authors.initials: MA
authors.lastname: Shaik
authors.affiliation: NHG Polyclinics, National Healthcare Group, Singapore.
authors.forename: Steven Shih Tsze
authors.initials: SS
authors.lastname: Chong
authors.affiliation: NHG Polyclinics, National Healthcare Group, Singapore.
authors.forename: Richard Jor Yeong
authors.initials: RJ
authors.lastname: Hui
authors.affiliation: Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.|Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Christopher Li-Hsian
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Pharmacology, National University of Singapore, Clinical Research Centre, Singapore.|Memory Aging and Cognition Centre, National University Health System, Singapore.|Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011320:Primary Health Care / Q000458:organization & administration*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012846:Singapore; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: AD8; case finding; dementia; primary healthcare