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Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults
- Authors:
- MAO Hui-Fen, et al
- Journal article citation:
- Age and Ageing, 47(4), 2018, p.551–557.
- Publisher:
- Oxford University Press
Background: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. Objective: to examine whether the Lawton’s Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools—the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)—can identify older (≥ 65 years) adults with dementia. Design: population-based cross-sectional observational study. Setting: all 19 counties in Taiwan. Participants: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). Methods: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer’s Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. Results: 917 (8.9%) participants with dementia were identified, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. Conclusions: the findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity. (Edited publisher abstract)
Measuring Alzheimer's disease progression with transition probabilities in the Taiwanese population
- Authors:
- FUH Jong-Ling, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.266-270.
- Publisher:
- Wiley
The transition probability of Alzheimer's disease (AD) is defined as the likelihood that the disease progresses from one stage to another in a given time period. The purpose was to estimate the separate stage-to-stage and stage-to-death transition probabilities for Taiwanese patients with AD and to evaluate the hazard ratios of age, sex, behavioral symptoms, and medications on disease progression. The authors examined data (severity of dementia, hallucinations or delusions, use of cholinesterase inhibitors [CEIs], survival) in 365 patients with probable AD at baseline and at follow-Gup (mean ± SD 29 ± 17 months, range 3-109 months). Modified survival analysis revealed that transition probabilities of Taiwanese patients were similar to those of Western patients. The probability of dementia remaining at the same stage was higher in patients taking CEIs than in other. Men had a higher probability of dying in the mild stage. Transition probabilities can be used to measure AD progression. CEIs used to treat AD might alter the disease course.
Responding to dementia in East Asia: developments in Japan, China, Taiwan and South Korea
- Author:
- INEICHEN B.
- Journal article citation:
- Aging and Mental Health, 2(4), November 1998, pp.279-285.
- Publisher:
- Taylor and Francis
Countries of the Far East share a number of features in their response to the problem of dementia among the elderly. Research in Japan, China, Taiwan and South Korea finds a very rapid rate of growth in their elderly populations, with corresponding rises in the number of dementia sufferers. Official responses have been rather slow, due to the long-standing belief that families would provide care. Demographic and sociological trends - longer life span, smaller families, urbanisation, the growing opportunity for paid work (especially for women) - have contributed to the decline of filial piety. All these processes are more advanced in the cities. Reports that rural elderly people suffering from dementia may be especially vulnerable to isolation, and in need of non-familial sources of help.