title: Community validation of the IDEA study cognitive screen in rural Tanzania.
abstract: The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly because of difficulties in screening for cognitive impairment in the community. As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, we aimed to validate the IDEA cognitive screen in a community-based sample in rural Tanzania METHODS: Study participants were recruited from people who attended screening days held in villages within the rural Hai district of Tanzania. Criterion validity was assessed against the gold standard clinical dementia diagnosis using DSM-IV criteria. Construct validity was assessed against, age, education, sex and grip strength and instrumental activities of daily living (IADLs). Internal consistency and floor and ceiling effects were also examined.
  
  
  
  During community screening, the IDEA cognitive screen had high criterion validity, with an area under the receiver operating characteristic curve of 0.855 (95% CI 0.794 to 0.915). Higher scores on the screen were significantly correlated with lower age, male sex, having attended school, better grip strength and improved performance in activities of daily living. Factor analysis revealed a single factor with an eigenvalue greater than one, although internal consistency was only moderate (Cronbach's alpha = 0.534).
  
  
  
  The IDEA cognitive screen had high criterion and construct validity and is suitable for use as a cognitive screening instrument in a community setting in SSA. Only moderate internal consistency may partly reflect the multi-domain nature of dementia as diagnosed clinically. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK. wagray70@gmail.com.
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.|Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: Stella Maria
authors.initials: SM
authors.lastname: Paddick
authors.affiliation: The Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Collingwood
authors.affiliation: Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Kisoli
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbowe
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mkenda
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lissu
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Jane
authors.initials: J
authors.lastname: Rogathi
authors.affiliation: Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Kissima
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.|Institute of Health and Society, Newcastle University, UK.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania.
authors.forename: Paul
authors.initials: P
authors.lastname: Chaote
authors.affiliation: University College Hospital Ibadan, Ibadan, Nigeria.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.|Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dotchin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D012372:ROC Curve; D015203:Reproducibility of Results; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania
keywords: Africa; Tanzania; cognitive impairment; dementia; developing countries; low- and middle-income countries; screening; screening tools; validation