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Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania

BACKGROUND: The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the d...

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Autores principales: Paddick, Stella-Maria, Yoseph, Marcella, Gray, William K., Andrea, Damas, Barber, Robyn, Colgan, Aofie, Dotchin, Catherine, Urasa, Sarah, Kissima, John, Haule, Irene, Kisoli, Aloyce, Rogathi, Jane, Safic, Ssenku, Mushi, Declare, Robinson, Louise, Walker, Richard W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600584/
https://www.ncbi.nlm.nih.gov/pubmed/32964799
http://dx.doi.org/10.1177/0891988720957105
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author Paddick, Stella-Maria
Yoseph, Marcella
Gray, William K.
Andrea, Damas
Barber, Robyn
Colgan, Aofie
Dotchin, Catherine
Urasa, Sarah
Kissima, John
Haule, Irene
Kisoli, Aloyce
Rogathi, Jane
Safic, Ssenku
Mushi, Declare
Robinson, Louise
Walker, Richard W.
author_facet Paddick, Stella-Maria
Yoseph, Marcella
Gray, William K.
Andrea, Damas
Barber, Robyn
Colgan, Aofie
Dotchin, Catherine
Urasa, Sarah
Kissima, John
Haule, Irene
Kisoli, Aloyce
Rogathi, Jane
Safic, Ssenku
Mushi, Declare
Robinson, Louise
Walker, Richard W.
author_sort Paddick, Stella-Maria
collection PubMed
description BACKGROUND: The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire). METHODS: This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania. In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history. RESULTS: 3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment. CONCLUSIONS: The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.
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spelling pubmed-86005842021-11-19 Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania Paddick, Stella-Maria Yoseph, Marcella Gray, William K. Andrea, Damas Barber, Robyn Colgan, Aofie Dotchin, Catherine Urasa, Sarah Kissima, John Haule, Irene Kisoli, Aloyce Rogathi, Jane Safic, Ssenku Mushi, Declare Robinson, Louise Walker, Richard W. J Geriatr Psychiatry Neurol Original Articles BACKGROUND: The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire). METHODS: This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania. In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history. RESULTS: 3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment. CONCLUSIONS: The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized. SAGE Publications 2020-09-23 2021-11 /pmc/articles/PMC8600584/ /pubmed/32964799 http://dx.doi.org/10.1177/0891988720957105 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Paddick, Stella-Maria
Yoseph, Marcella
Gray, William K.
Andrea, Damas
Barber, Robyn
Colgan, Aofie
Dotchin, Catherine
Urasa, Sarah
Kissima, John
Haule, Irene
Kisoli, Aloyce
Rogathi, Jane
Safic, Ssenku
Mushi, Declare
Robinson, Louise
Walker, Richard W.
Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title_full Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title_fullStr Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title_full_unstemmed Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title_short Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania
title_sort effectiveness of app-based cognitive screening for dementia by lay health workers in low resource settings. a validation and feasibility study in rural tanzania
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600584/
https://www.ncbi.nlm.nih.gov/pubmed/32964799
http://dx.doi.org/10.1177/0891988720957105
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