Rowland Universal Dementia Assessment Scale is an accurate and cross-cultural and education-unbiased instrument to screen older persons: results from a meta-analysis

Memory problems and neurocognitive signs and symptoms are increasingly more frequent, as older persons continue to increase their numbers worldwide. Consequently, the total number of persons with dementia is also increasing, and this is a huge challenge to any institution and government (Alzheimer’s Disease International [ADI], 2015). The inequality in welfare, social, and economic situation in highand low-income countries brings along with its problems in the access to formal education. Cultural differences also pose some situations which impact on the cognitive evaluations to properly understand the impairments, as the performance of a given person may be biased by verbal and cognitive skills that are dependent on educational and cultural backgrounds. In multilingual societies, mainly in high-income countries, where minorities and immigrants also need to be assessed and treated for cognitive problems, there is a special need to use instruments that are free from such biases and may reflect the real status of impairment despite the level of education (Nielsen et al, 2018; de Araujo et al., 2018). Of course, this is not an easy task in clinical practice, and assessing cognitive problems and dementia is of paramount importance for designing public care policies, both at the overall population level and at the personal care level. The complexity of care giving to the person with dementia is highly dependent on the severity of the cognitive status and independence in daily living. Several scales have been designed and used to assess cognitive complaints and dementia, since the Mini Mental State Examination (MMSE) first came into use (Folstein et al., 1975). Also, some validated scales may serve well in certain environments but not in others, such as those designed for hospital patients versus those applied in large community samples for epidemiological purposes. What may be useful in a small and educationally homogeneous sample may not serve in different educational and cultural samples. This is definitely the case of MMSE, and studies have shown various cutoff scores to diagnose cognitive impairment suggestive of dementia according to education, for example. The level of clinical ascertainment of diagnoses is rather confusing for the clinician when education plays such a role in providing different scores. The Rowland Universal Dementia Scale (RUDAS) (Storey et al., 2004) has gained wide acceptability for use in clinical settings. A simple, short assessment scale seems to be rather immune to the bias of educational and cultural status. Having been validated in several languages throughout the world, it has been regarded as an efficient tool to bridge the gap in evaluating persons regardless of their cultural and educational background. The more one can rely on objective data without taking into account these factors, the nearer one may be of the core neurocognitive function. The manuscript presented by Nielsen and Jørgensen in this issue, “Cross-Cultural Dementia Screening Using the Rowland Universal Dementia Assessment Scale: A Systematic Review and Metaanalysis” (2020), shows that RUDAS has good diagnostic performance for detecting dementia in different sociocultural settings. They also state that, compared with other brief screening instruments, the advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language adaptation. The authors have been active in searching ways of assessing different groups and minorities in Scandinavia, mainly in Denmark, where they exert an outstanding work in neuropsychological evaluation. Members of the Danish Dementia Research Center have designed the European Cross-Cultural Neuropsychological Test Battery – a battery of tests to assess cognitive impairment in dementia disorders across ethnic groups and in people with limited or no education, which has also been validated in several other countries and languages (Nielsen et al., 2018). Compared with other brief screening instruments, advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language International Psychogeriatrics (2020), 32:9, 1011–1012 © International Psychogeriatric Association 2020