Rowland Universal Dementia Assessment Scale

Last Updated

July 10, 2024

Purpose

The Rowland Universal Dementia Assessment Scale (RUDAS) is a 6-item objective screening measure designed to assess cognitive performance and detect dementia in older adults from diverse cultural backgrounds.

Link to Instrument

Acronym RUDAS

Area of Assessment

Apraxia
Attention & Working Memory
Cognition
Coordination
Language
Reasoning/Problem Solving

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Cost of equipment

Diabetes

Hematological Disorders

Older Adults and Geriatric Care

Brain Injury

6 items, including memory (possible score 0-8), body orientation (possible score 0-5), praxis (possible score 0-2), drawing (possible score 0-3), judgement (possible score 0-4), and language (possible score 0-8)
Item scores are summed into a total score, with higher scores indicating better cognitive performance
Minimum total score = 0, maximum total score = 30
A score of 22 or less should be considered as possible cognitive impairment and patient referred for further investigation

Number of Items

Stopwatch
Paper and pen/pencil

10 minutes

Required Training

Training Course

Required Training Description

Should be administered by relevant health care workers after approximately 40 minutes of training using videotape (https://www.swslhd.health.nsw.gov.au/acrs/RUDASvideo.html)

Adult

16 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Yunzhen (Judy) Huang, MS, University of Wisconsin-Madison, rehabilitation psychology student under the direction of Timothy Tansey, PhD, Rehabilitation Psychology and Special Education Department, School of Education, University of Wisconsin-Madison

Kevin Fearn, MS, Shirley Ryan ��ͷ��app

ICF Domain

Body Function

Measurement Domain

Cognition

Considerations

Before administration, make sure the test taker is as relaxed as possible, can hear clearly, and uses reading glasses as necessary, and make sure there is sufficient lighting in the testing room
Use a professional interpreter for non-English-speaking test takers
If the test taker has a physical disability that might affect their ability to perform certain items of the RUDAS, interpret any score below 22 with caution
The RUDAS has been examined mainly in Australia as well as several countries in Europe and Asia. Less is known about its psychometric properties in multicultural populations in the United States.
The RUDAS is available in various languages other than English: Arabic, Chinese, Italian, Malay, Malayalam (India), Spanish, Thai, Turkish

Standard Error of Measurement (SEM)

Geriatric Outpatient Clinic Patients: (Storey et al., 2004; n = 152; mean age = 77.9 (7.0) years; female = 68.7%; 21.7% no dementia, 30.7% questionable dementia, 22.3% mild dementia, 19.3% moderate dementia, 4.8% severe dementia; Australian sample)

SEM for entire group (n = 152): memory 0.31, body orientation 0.35, praxis 0.65, drawing 0.24, judgement 0.36, and language 0.06

(calculated from Ayan et al., 2019; n = 140; mean age = 79.7 (7.5) years; 50% healthy control, 50% major neurocognitive disorder; Turkish sample)

SEM for entire group (n = 140): 0.23

Community-Dwelling Older Adults: (Storey et al., 2004; n = 90; mean age = 79.8 (8.3) years; 45.6% no dementia, 8.9% questionable dementia, 10.0% mild dementia, 15.6% moderate dementia, 20% severe dementia; Australian sample)

SEM for entire group (n = 90): memory 0.28, body orientation 0.20, praxis 0.08, drawing 0.03, judgement 0.16, and language 0.25

Illiterate and Low-Educated Older Adults: (calculated from Custodio et al., 2020; n = 187; mean age = 70.1 (3.8) years; 64 (34.2%) healthy controls, 50 (32.1%) mild cognitive impairment, 63 (33.7%) dementia; Peruvian sample; Spanish translation of RUDAS)

SEM for entire group (n = 187): 0.68

Indigenous Care Center for the Elderly: (calculated from Daniel, et al., 2022; n = 116; age �� 60; mean age = 69.9 (8); male = 60 (51.7%); no formal education = 56 (48.3%); exclusion criteria = severe life threatening illnesses)

SEM for entire group (n = 116): 1.40

Elderly Living in Retirement Institutions: (calculated from Jaroshy & Alkabeya, 2024; n = 37 (15 with cognitive deficit per �� 20 cutoff value of RUDAS); no formal education = 59.5%; age �� 65; mean age = 74.6 (6.2); two week interval between assessments; Arabic version of RUDAS)

SEM for entire group (n = 37): 0.78

Minimal Detectable Change (MDC)

Geriatric Outpatient Clinic Setting: (calculated from Storey et al., 2004)

MDC for entire group (n = 152): memory 0.86, body orientation 0.97, praxis 1.80, drawing 0.67, judgement 1.00, and language 0.17
MDC for entire group (n = 140): 0.65 (calculated from Ayan et al., 2019)

Community-Dwelling Older Adults: (calculated from Storey et al., 2004)

MDC for entire group (n = 90): memory 0.78, body orientation 0.55, praxis 0.22, drawing 0.08, judgement 0.44, and language 0.69

Illiterate and Low-Educated Older Adults: (calculated from Custodio et al., 2020)

MDC for entire group (n = 187): 1.90

Indigenous Care Center for the Elderly: (calculated from Daniel, et al., 2022)

MDC for entire group (n = 37): 2.17

Elderly Living in Retirement Institutions: (calculated from Jaroshy & Alkabeya, 2024)

MDC for entire group (n = 116): 3.87

Cut-Off Scores

Geriatric Outpatient Clinic Patients:

(Ayan et al., 2019)

< 25 indicates major neurocognitive disorder based on DSM-5 criteria, sensitivity = 92.86%, specificity = 92.86%, positive predictive value (PPV) = 92.9%, negative predictive value (NPV) = 92.9%

(Limpawattana et al., 2012; n = 178; mean age = 71.0 (6.5) years; 50% healthy control, 50% dementia; Thai sample using RUDAS-Thai)

�� 24 indicates dementia based on DSM-IV criteria, sensitivity = 78.7%, specificity = 60.7%, PPV = 66.7%, NPV = 73.8%

(Shaaban et al., 2013; n = 49; mean age = 68.0 (5.0) years; female = 64.3%; 79.6% healthy controls, 20.4% dementia; Malaysian sample and version of RUDAS: M_RUDAS)

< 23 indicates dementia based on DSM-IV criteria, positive likelihood ratio (LR) = 4.3, negative LR = 0.57

(de Araujo et al., 2018; n = 135; age �� 60; mean age = 76.0 (7.4) years; 65 (48.1%) healthy controls, 70 (51.9%) Alzheimer��s Disease; Brazilian sample; Portuguese translation into RUDAS-BR)

< 23 indicates Alzheimer��s disease based on DSM-IV and Neurological and Communicative Disorders and Stroke/Alzheimer��s Disease and Related Disorders Association (NINCDS-ADRDA) criteria for entire group, sensitivity = 81.5%, specificity = 76.1%
< 23 indicates Alzheimer��s disease for low education group, sensitivity = 67.7%, specificity = 79.0%
< 24 indicates Alzheimer��s disease for high education group, sensitivity = 91.2%, specificity = 81.8%

(Chen et al., 2015; n = 130; age > 65 with reported deterioration in memory and activities of daily living; mean age = 76.2 (8.5) years; 22 (16.9%) healthy controls, 55 (42.3%) mild cognitive impairment, 53 (40.8%) dementia; Taiwanese sample; Chinese translation to RUDAS-C)

< 24 indicates mild cognitive impairment based on DSM-IV-R and National Institute on Aging and Alzheimer��s Association (NIA-AA) Diagnostic Guidelines, sensitivity = 79%, specificity = 91%
< 22 indicates dementia, sensitivity = 76%, specificity = 81%

Psychogeriatric Outpatient Clinic Patients:(Mateos-?lvarez et al., 2017; n = 97; age > 65 years; mean age = 77.9 (5.9) years; 62 (64%) healthy controls, 35 (36%) dementia; Spanish sample)

< 21/22 indicates dementia based on ICD-10 criteria, sensitivity = 94.3%, specificity = 72.6%

Outpatient Memory Clinic Patients: (Nielsen et al., 2013; n = 137; median age = 68.8 (12.5) years; 65 (47.4%) healthy controls, 72 (52.6%) dementia; Danish sample; 34 (25%) with immigrant background)

< 24 indicates dementia based on DSM-IV-TR criteria, sensitivity = 69%, specificity = 80%, PPV = 79%, NPV = 70%, positive LR = 3.47, negative LR = 0.38, diagnostic accuracy = 74%

Memory Clinics Multicultural Patients in Five Western European Countries: (Nielsen et al., 2019; n = 421; mean age = 66.7 (10.2) years; 341 (81.0%) healthy controls, 80 (19.0%) dementia; German, Belgian, Danish, Swedish, Norwegian, and Greek sample)

< 25 indicates dementia based on DSM-IV-TR criteria using RUDAS raw score, sensitivity = 80%, specificity = 90%, PPV = 75%, NPV = 92%, Youden index = .70, positive LR = 7.62, negative LR = 0.22
< 25 indicates dementia using education-adjusted RUDAS score, sensitivity = 79%, specificity = 95%

Positive (PPV) and Negative (NPV) Predictive Values at Optimal Cut-off Score (<25) for Different Base Rates of Dementia

Dementia Base Rate

10%

15%

30%

50%

70%

PPV

30%

47%

59%

77%

89%

95%

NPV

99%

98%

96%

91%

82%

66%

Tertiary Care Hospital Department of Neurology Patients: (Matias-Guiu et al., 2017; n = 160; mean age = 78.3 (6.5) years; 68 (42.5%) healthy controls, 92 (57.5%) mild Alzheimer��s disease; Spanish translation of RUDAS)

< 22 indicates mild Alzheimer��s disease based on NIA-AA 2011 criteria and Global Deterioration Scale (GDS) score, sensitivity = 83.70%, specificity = 85.29%, Youden index = .689, positive LR = 5.69, negative LR = 0.19, Cohen��s d = 1.72

Community-Dwelling Older Adults:

(Storey et al., 2004)

< 23 indicates dementia based on DSM-IV criteria, sensitivity = 89% (95% CI: 76%-96%), specificity = 98% (95% CI: 88%-97%)

(Cheung et al., 2015; n = 84; age �� 65; mean age = 78.7 (7.2) years; 47 (56.0%) healthy controls, 37 (44.0%) mild dementia; New Zealander sample)

< 23 indicates dementia, sensitivity = 75.68%, specificity = 91.49%, positive LR = 8.89, negative LR = 0.27

Illiterate and Low-Educated Older Adults: (Custodio et al., 2020)

< 23 indicates mild cognitive impairment based on DSM-5 criteria, sensitivity = 89.06%, specificity = 93.33%, Youden index = 0.82, percentage correctly classified = 91.13%, positive LR = 13.35, negative LR = 0.18
< 19 indicates dementia based on DSM-5 criteria, sensitivity = 95.00%, specificity = 96.83%, Youden index = .92, percentage correctly classified = 95.53%, positive LR = 29.93, negative LR = 0.05

Geriatric Inpatient and Outpatient Clinic Patients and Community-Dwelling Older Adults: (Chaaya et al., 2016; n = 232; mean age = 79.1 (8.1) years; n = 136 (58.6%) healthy controls, 51 (22.0%) mild dementia, 45 (19.4%) moderate dementia; Arabic sample and translation of RUDAS into A-RUDAS)

�� 22 indicates dementia in both general population and clinic settings with best balance between sensitivity (83%) and specificity (85%)
�� 23 indicates dementia in both general population and clinic settings with best overall discriminatory ability: Youden Index = 70, AUC = 84.8%

Older Urban and Regional Aboriginal Australians: (Radford et al., 2015; n = 235; age �� 60 years; mean age = 65.8 (5.8) years; female = 141 (63%); 181 (77.0%) healthy controls, 26 (11.1%) mild cognitive impairment, 28 (11.9%) dementia; Australian sample)

< 24 indicates dementia based on NIA-AA criteria, sensitivity = 71.4%, specificity = 90.3%, positive LR = 7.4, negative LR = 0.3

Indigenous Care Center for the Elderly: (Daniel, et al., 2022)

�� 22 indicates major neurocognitive disorder, sensitivity = 92.3%, specificity = 75.3%
The RUDAS correctly classified the cases 81.03% of the time.

Normative Data

Geriatric Outpatient Clinic Patients:

(Goudsmit et al., 2018; n = 144; median age = 75 years; 42 (29.1%) healthy controls, 44 (30.6%) mild cognitive impairment, 58 (40.3%) dementia; Dutch translation)

Median score for healthy control: 24
- 1^st to 3^rd quartile for healthy control: 21-27
Median score for mild cognitive impairment: 20
- 1^st to 3^rd quartile for mild cognitive impairment: 17-24
Median score for dementia: 17
- 1^st to 3^rd quartile for dementia: 12-20

(Limpawattana et al., 2012)

Median score for healthy control: 26
- 1^st to 3^rd quartile for healthy control: 24-28
Median score for dementia: 21
- 1^st to 3^rd quartile for dementia: 18-24

(de Araujo et al., 2018)

Median score for entire group: 23
- 1^st to 3^rd quartile for entire group: 19-26

Psychogeriatric Outpatient Clinic Patients: (Mateos-?lvarez et al., 2017)

Median score for entire group: 21
1^st to 3^rd quartile for entire group: 17-24.5
Median score for healthy control: 23
1^st to 3^rd quartile for healthy control: 21-25
Median score for dementia: 17
1^st to 3^rd quartile for dementia: 10-19
Mean score for males = 20.65, mean score for females = 19.80 (p = 0.67)

Outpatient Memory Clinic Patients: (Nielsen et al., 2013)

Median score for healthy control: 26
1^st to 3^rd quartile for healthy control: 24-28
Median score for dementia: 22
1^st to 3^rd quartile for dementia: 17.5-24

Memory Clinics Multicultural Patients in Five Western European Countries: (Nielsen et al., 2019)

Normative Data by Years of Education and Suggested Education-Adjustment of RUDAS Raw Scores in Individuals with Low Education (<7 years)

Percentile	0 years (n=35)	1-6 years (n=53)	7-10 years (n=78)	11-13 years (n=82)	��14 years (n=93)	Total (n=341)
50^th	26	27	28	28	29	28
25^th	25	25	26	27	28	26
10^th	23	24	25	25	26	25
5^th	20	23	23	25	25	24
Education adjustment*	+2	+1

*Number of points added to the RUDAS raw score to calculate an education-adjusted RUDAS score in individuals with low education

Tertiary Hospital Geriatric Rehabilitation Ward Residents: (Emerson et al., 2019; n = 102; median age = 84; 9 (8.8%) dementia, 4 (3.9%) Parkinson syndrome, 29 (28.4%) hyperlipidemia, 38 (37.3%) stroke, 68 (66.7%) hypertension, 30 (29.4%) diabetes, 30 (29.4%) ischemic heart disease, 11 (10.8%) peripheral vascular disease, 20 (19.6%) atrial fibrillation; Australian sample; 16 language groups included in addition to English)

Median score for English-speaking group: 24
- 1^st to 3^rd quartile for English-speaking group: 8-29
Median score for non-English-speaking group: 23
- 1^st to 3^rd quartile for non-English-speaking group: 15-28

Community-Dwelling Older Adults: (Basic et al., 2009; n = 151; mean age = 77.1 (8.9) years; 60 (39.7%) healthy control, 33 (21.9%) cognitive impairment not dementia, 58 (38.4%) dementia; Australian sample)

Median score for healthy control: 27
1^st to 3^rd quartile for healthy control: 25-28
Median score for cognitive impairment not dementia: 23
1^st to 3^rd quartile for cognitive impairment not dementia: 21-26
Median score for dementia: 18
1^st to 3^rd quartile for dementia: 13-20

Indigenous Care Center for the Elderly: (Daniel, et al., 2022)

Mean Scores on RUDAS by Educational Status

Educational Status	Frequency (%)	Mean (SD)
No formal education	56 (48.3)	18.21 (5.7)
Primary education	32 (27.6)	23.19 (4.1)
Secondary education	13 (11.2)	25.23 (2.5)
College and above	15 (12.9)	27 (2.5)
Total	116 (100)	21.5 (5.7)

Test/Retest Reliability

Geriatric Outpatient Clinic Patients:

Excellent test-retest reliability at 2 days: (ICC = 0.99) (Ayan et al., 2019)
Excellent test-retest reliability at 4 weeks: (ICC = 0.90) (Chen et al., 2015)

Community-Dwelling Older Adults: (Storey et al., 2004)

Excellent test-retest reliability at 1 week: (ICC = 0.98)

Illiterate and Low-Educated Older Adults: (Custodio et al., 2020)

Excellent test-retest reliability at <5 weeks: (ICC = 0.96)

Elderly Living in Retirement Institutions: (Jaroshy & Alkabeya, 2024)

Intraclass Correlation Coefficient of the RUDAS subtest scores and total RUDAS scores*

RUDAS subtests	Intraclass Correlation (95% CI)
Body orientation	0.670 (0.349; 0.833)
Praxis	0.640 (0.311; 0.815)
Drawing	0.953 (0.909; 0.976)
Judgment	0.926 (0.862; 0.961)
Memory	0.898 (0.811; 0.946)
Language	0.911 (0.811; 0.956)
Total score	0.971 (0.721; 0.991)

*All values p < 0.001

Cohen��s Kappa coefficient between the test and retest was 0.78, significantly different from zero (p < 0.001)

Interrater/Intrarater Reliability

Geriatric Outpatient Clinic Patients:

Adequate intrarater reliability: (ICC for total score = 0.71) (Shaaban et al., 2013)
Excellent interrater reliability: (Cohen��s kappa = 0.88) (Chen et al., 2015)

Community-Dwelling Older Adults: (Storey et al., 2004)

Excellent interrater reliability: (ICC = 0.99)

Indigenous Care Center for the Elderly: (Daniel, et al., 2022)

Excellent interrater reliability: (ICC = 0.94)

Internal Consistency

Geriatric Outpatient Clinic Patients:

Adequate internal consistency (Cronbach��s alpha = 0.70) (Goudsmit et al., 2018)
Poor internal consistency (Cronbach��s alpha = 0.69) (Ayan et al., 2019)
Poor internal consistency (Cronbach��s alpha = 0.54) (de Araujo et al., 2018)
Adequate internal consistency: (ICC = 0.71) (Chen et al., 2015)

Community-Dwelling Older Adults: (Nepal et al., 2019; n = 100; male = 54%; mean age = 67.7 (6.1) years; Nepali translation of RUDAS)

Adequate internal consistency (Cronbach��s alpha = 0.70)

Illiterate and Low-Educated Older Adults: (Custodio et al., 2020)

Poor internal consistency (Cronbach��s alpha = 0.65)

Geriatric Inpatient and Outpatient Clinic Patients and Community-Dwelling Older Adults: (Chaaya et al., 2016)

Excellent internal consistency (Cronbach��s alpha = 0.87)

Elderly Living in Retirement Institutions: (Jaroshy & Alkabeya, 2024)

Excellent internal consistency (Cronbach��s alpha = 0.87)

Criterion Validity (Predictive/Concurrent)

Geriatric Outpatient Clinic Patients:

(Goudsmit et al., 2018)

Adequate predictive validity for detecting dementia compared to healthy control, as well as detecting dementia compared to healthy control and mild cognitive impairment (ROC AUC = 0.89 and 0.82, respectively)
Excellent concurrent validity with MMSE score (r = 0.71)

(Ayan et al., 2019)

Excellent predictive validity for detecting major neurocognitive disorder (ROC AUC = 0.98, 95% CI: 94.1% - 99.6%, p < 0.0001)

(Limpawattana et al., 2012)

Adequate predictive validity for detecting dementia based on DSM-IV criteria (ROC AUC = 0.81, 95% CI: 74.8-87.2)
Excellent concurrent validity between RUDAS-Thai and MMSE-Thai score (r = 0.80, 95% CI: 0.745-0.85, p < 0.0001)

(de Araujo et al., 2018)

Adequate predictive validity for detecting Alzheimer��s disease based on DSM-IV and NINCDS-ADRDA criteria for entire group and low education group (ROC AUC = 0.87 and 0.82, respectively)
Excellent predictive validity for detecting Alzheimer��s disease in high education group (ROC AUC = 0.92)

(Shaaban et al., 2013)

Poor predictive validity for detecting dementia based on DSM-IV criteria (ROC AUC = 0.64, 95% CI: 0.41-0.86)
Adequate convergent validity with MMSE score (r = 0.63, p <0.001)
Poor convergent validity with the Elderly Cognitive Assessment Questionnaire (ECAQ) score (r = 0.21, p = 0.145)

(Iype et al., 2006; n = 116; mean age = 65.09 (11.1) years; 23 (39.6%) Alzheimer��s disease, 17 (29.3%) vascular dementia, 18 (31.1%) non-Alzheimer��s disease non-vascular dementia subtype; Indian sample)

Adequate to Excellent predictive validity for detecting overall dementia, as well as detecting dementia subtypes Alzheimer��s disease, vascular disease, and non-Alzheimer��s disease non-vascular dementia (sensitivity = 0.88, 1.0, 0.82, 0.77, respectively; specificity = 0.76, 0.74, 0.88, 0.72, respectively)

(Chen et al., 2015)

Adequate predictive validity for detecting mild cognitive impairment and dementia based on DSM-IV-R and National Institute on Aging and Alzheimer��s Association Diagnostic Guidelines (for mild cognitive impairment (n = 77): ROC AUC = 0.85, PPV = 0.99, NPV = 0.96; for dementia (n = 75): ROC AUC = 0.78, PPV = 0.83, NPV = 0.91)

Psychogeriatric Outpatient Clinic Patients:(Mateos-?lvarez et al., 2017)

Excellent predictive validity for detecting dementia based on ICD-10 criteria (ROC AUC = 0.90, 95% CI = 0.84-0.96)
Excellent concurrent validity with MMSE score, Clinical Dementia Rating Scale (CDR) score, and Reisberg��s Global Deterioration Scale (GDS) score (r = 0.71, -0.74, -0.72, respectively)

Outpatient Memory Clinic Patients: (Nielsen et al., 2013)

Adequate predictive validity for detecting dementia based on DSM-IV-TR criteria (ROC AUC = 0.838)
Excellent concurrent validity with MMSE score (r = 0.73, p < 0.001)

Memory Clinics Multicultural Patients in Five Western European Countries: (Nielsen et al., 2019)

Excellent predictive value for detecting dementia based on DSM-IV-TR criteria using RUDAS raw score in entire group (ROC AUC = 0.93, 95% CI: 0.84-0.96)
Excellent predictive value for detecting dementia using education-adjusted RUDAS score for entire group (ROC AUC = 0.95, 95% CI: 0.92-0.97)
Adequate predictive value for detecting milder dementia using RUDAS raw score (raw score > 19) in entire group (ROC AUC = 0.89, 95% CI: 0.84-0.94)
Excellent predictive value for detecting dementia using RUDAS raw score in native-born and immigrant participants (ROC AUC = 0.91, 95% CI: 0.85-0.96 and 0.95, 95% CI: 0.92-0.99, respectively)

Tertiary Care Hospital Department of Neurology Patients: (Matias-Guiu et al., 2017)

Adequate predictive validity for detecting mild Alzheimer��s disease based on NIA-AA 2011 criteria and GDS score in entire group using total score and memory subscale score (ROC AUC = 0.889 and 0.869, respectively)
Adequate predictive validity for detecting mild Alzheimer��s disease in participants with 7 or less years of formal education using total score and memory subscale score (ROC AUC = 0.874 and 0.842, respectively)
Excellent predictive validity for detecting mild Alzheimer��s disease in participants with at least 8 years of formal education using total score (ROC AUC = 0.913)
Adequate predictive validity for detecting mild Alzheimer��s disease in participants with at least 8 years of formal education using memory subscale score (ROC AUC = 0.895)
Adequate to Excellent correlations between the RUDAS memory subscale score and Addenbrooke��s Cognitive Examination III (ACE-III) total score, Memory Impairment Screen (MIS) total score, MMSE total score, and Montreal Cognitive Assessment (MoCA) total score (r = 0.702, 0.593, 0.468, 0.488, respectively)

Tertiary Hospital Geriatric Rehabilitation Ward Residents: (Emerson et al., 2019)

Poor predictive validity for predicting discharge to a nursing home with a cutoff score of 23 (AUC = 0.62, sensitivity = 52%, specificity = 70%)
Adequate to excellent concurrent validity with MoCA score in English-speaking and non-English-speaking groups (r = 0.57 and 0.61, respectively, p < 0.001))

Geriatric Inpatient Ward Residents: (Pang et al., 2009; n = 46; mean age = 81.7 (8.1) years; male = 18 (39%); 17 (37%) falls, 7 (15%) stroke or transient ischemic attack, 6 (13%) musculoskeletal complaints including back pain; Australian sample)

Excellent concurrent validity with Mini Mental State Exam (MMSE) score for entire group, English-speaking group, and culturally & linguistically diverse group (r = 0.83, 0.86, 0.85, respectively, p < 0.05)

Community-Dwelling Older Adults:

(Storey et al., 2004)

Excellent predictive validity for detecting dementia based on DSM-IV criteria (ROC AUC = 0.95, 95% CI: 0.88-0.98)

(Basic et al., 2009)

Excellent predictive validity for detecting dementia compared to healthy controls (ROC AUC = 0.94, sensitivity 87.7% and specificity 90.0% at published cut-off of < 23/30)

(Cheung et al., 2015)

Adequate predictive validity for detecting dementia (ROC AUC = 0.86)
Excellent correlation with Addenbrooke��s Cognitive Examination-III (ACE-III) score and Montrial Cognitive Assessment (MoCA) score (r = 0.70 and 0.65, respectively)

Illiterate and Low-Educated Older Adults: (Custodio et al., 2020)

Excellent concurrent validity with MMSE score, CDR score, INECO Frontal Screening Test (IFS) score, and Pfeffer Functional Activities Questionnaire (PFAQ) score (r = 0.86 (0.14), 0.86 (0.18), 0.87 (0.09), 0.83 (0.27), respectively)
Excellent predictive validity for discriminating mild cognitive impairment from healthy control based on DSM-5 criteria (ROC AUC = 0.98)
Excellent predictive validity for discriminating dementia from mild cognitive impairment based on DSM-5 criteria (ROC AUC = 0.98)

Geriatric Inpatient and Outpatient Clinic Patients and Community-Dwelling Older Adults: (Chaaya et al., 2016)

Adequate predictive validity for detecting dementia (AUC = 0.84)

Non-Demented Turkish Immigrants: (Nielsen et al., 2012; n = 76; mean age = 61.6 (7.3) years; selection criteria: immigrant from Turkey, lived in Denmark �� 10 years, age �� 50 years, current Copenhagen address, no registered dementia diagnosis; Danish sample)

Adequate correlation with MMSE score (r = 0.40, p < 0.001)

Older Urban and Regional Aboriginal Australians: (Radford et al., 2015)

Adequate predictive validity for detecting dementia based on NIA-AA criteria (ROC AUC = 0.89)
Adequate concurrent validity with MMSE score and modified Kimberly Indigenous Cognitive Assessment (mKICA) score (r = 0.50 and 0.55, respectively)

Indigenous Care Center for the Elderly: (Daniel, et al., 2022)

Adequate predictive validity for detecting major neurocognitive disorder (ROC AUC = 0.87, 95% CI: 0.81-0.93)

Construct Validity

Geriatric Outpatient Clinic Patients:

Poor convergent validity between RUDAS and illiteracy, years of education, sex, and age (only the correlation with age was significant and thus reported, r = -0.22) (Goudsmit et al., 2018)
Excellent convergent validity supported by confirmatory factor analysis; confirmatory factor weights were between 0.44 and 0.81, and all were above 40% (Ayan et al., 2019)
Adequate convergent validity between RUDAS and years of formal education (r = 0.45) (Iype et al., 2006)
Significant difference in the RUDAS scores between the patient group and the healthy control group (t = 11.4, p < .001) (Chen et al., 2015)

Psychogeriatric Outpatient Clinic Patients: (Mateos-?lvarez et al., 2017)

Adequate convergent validity with age (r = -0.38, p < 0.01)
Poor correlation with education level (r = 0.09, p = 0.39)

Outpatient Memory Clinic Patients: (Nielsen et al., 2013)

Adequate correlation with age (r = -0.38)
Poor correlations with immigrant background and years of education (the correlations were insignificant, therefore correlation coefficients were not reported)

Memory Clinics Multicultural Patients in Five Western European Countries: (Nielsen et al., 2019)

Hierarchical regression analysis showed that education (p < 0.001), age (p = 0.003), and gender (p = 0.05), each had a significant effect on RUDAS score (variance explained = 16%, 3%, 1%, respectively)
Immigrant status did not have a significant effect on RUDAS score (p = 0.19).

Tertiary Care Hospital Department of Neurology Patients: (Matias-Guiu et al., 2017)

Significant difference in RUDAS scores between mild Alzheimer��s disease group and healthy control group (mild Alzheimer��s disease group mean score = 18.10 (4.35), healthy control group mean score = 24.69 (3.21), p < .001)

Community-Dwelling Older Adults:

Poor convergent validity between RUDAS and gender, years of education, preferred language, and factors which may affect performance on a cognitive test (including vision and hearing impairment, psychiatric disease, dysarthria and dysphasia, and musculoskeletal, and neurological diseases); the correlations were not significant, therefore correlation coefficients were not reported) (Storey et al., 2004)
Poor convergent validity between RUDAS and both age and educational level (r = -0.11 and 0.22, respectively) (Nepal et al., 2019)

Illiterate and Low-Educated Older Adults: (Custodio et al., 2020)

Excellent ability to discriminate between dementia, mild cognitive impairment, and healthy controls, indicated by no overlap in the RUDAS scores for the three groups in the dispersion graph.

Non-Demented Turkish Immigrants: (Nielsen et al., 2012)

Adequate convergent validity with age, years of schooling, and acculturation score (r = -0.36, 0.42, & 0.38, respectively)

Older Urban and Regional Aboriginal Australians: (Radford et al., 2015)

Poor convergent validity with age, gender, years of education, and geographical location (urban vs. regional) (r = -0.21, 0.06, 0.17, -0.03, respectively)
Regression analysis showed that age and education did not impact the link between cognitive test scores and dementia or mild cognitive impairment diagnosis, nor were they independent predictors of dementia

Indigenous Care Center for the Elderly: (Daniel, et al., 2022)

Significant lower mean scores on RUDAS for those diagnosed (DSM-5) with dementia (mean difference = 7.02, t = 7.7, p < 0.001)
A single-year increase in attending formal education was associated with an 0.312 point increase in RUDAS scores (��: 0.312 [95% CI: 0.147-0.478], p < 0.001)
A diagnosis of dementia was associated with an 5 point reduction in RUDAS scores (��: -5.052 [95% CI: -6.819, -3.286], p < 0.001)
A one-point increase in Geriatrics Depression Scale scores resulted in an 0.39 point decrease in RUDAS scores (��: -0.395 [95% CI: -0.626, -0.164], p < 0.001)

Content Validity

Items were generated and selected by two advisory groups. The health group included ��professionals from a number of health disciplines (geriatric medicine, aged care psychiatry, neuropsychology, nursing, occupational therapy, physiotherapy, social work and speech therapy) whose role was to advise on the validity of culturally and linguistically modified items.�� The culture group included representatives from 22 cultural and linguistic groups to ��advise on the cultural and linguistic equivalence of proposed cognitive items, and to suggest modifications where relevant and appropriate�� (Storey et al., 2004, p. 17)
Analyzed by 7 specialists, the content validity ratio of all items was 100%, and the content validity index (CVI) was above 80% (Ayan et al., 2019)
The CVI of the RUDAS-C was 0.97 (Chen et al., 2015)
The item-level CVI (I-CVI) of the Visuo-constructional drawing item of the RUDAS was 80%. All other items scored at 100%. The scale-level CVI of the tool was 96.7% (Daniel et al., 2022).

Criterion Validity (Predictive/Concurrent)

Adults with Type-2 Diabetes: (Iype et al., 2009; n = 71; mean age = 64.9 (6.9) years; mean duration of diabetes = 8.8 (6.9) years; Indian sample)

Adequate concurrent validity with the performance on the delayed word list recall task from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) (r = 0.33, p = 0.005)
Poor negative correlation with the time taken for the Trail Making A Test (r = -0.26, p = 0.041)

Adults with Diabetes: (Alaama et al., 2016; n = 241; mean age = 59.6 (9.2) years; 171 (71%) w/diabetes; 70 (29.0%) healthy controls; Saudi Arabian sample)

Adequate correlation with Montreal Cognitive Assessment Test (MoCA) score (r = 0.52)
Significant predictors of RUDAS score included female gender (regression coefficient = -1.17, p = 0.0004), history of diabetes (-1.21, p = 0.0005), and high level of education (3.30, p = 0.0297). Together, these factors accounted for 28% of the total variance in RUDAS score.

Construct Validity

Adults with Type-2 Diabetes:

(Shanmugapriya et al., 2018; n = 202; mean age = 49.7 (7.1) years; 50% healthy controls, 50% type-2 diabetes; Indian sample and translation of RUDAS)

Poor convergent validity of RUDAS with duration of diabetes and glycated hemoglobin (HbA1c) level (r = .16 and -.17, respectively)
The RUDAS score did not differ between patients with duration of diabetes < 5 years and patients with duration of diabetes �� 5 years
The RUDAS score did not differ between the illiterate group and literate group

(Iype et al., 2009)

Poor convergent validity with years of formal education (r = 0.25, p = 0.035)
The RUDAS score was not associated with the duration of diabetes, hypertension, blood glucose level, or diabetic complications such as peripheral neuropathy, retinopathy and postural hypotension

Adults with Diabetes: (Alaama et al., 2016)

Adequate correlation with level of education (r = 0.44)
Poor correlation with age, duration of diabetes, and glycemic control (HbA1C) level (r = -0.24, -0.04, 0.12, respectively)

Normative Data

Adults with Sickle Cell Disease: (Fort�� et al., 2019; n = 252; median age = 31.5 years (IQR = 25-44); sickle cell genotype: 138 (55%) SS subtype, 80 (32%) SC subtype, 34 (13%) other sickle genotypes; 2-4 month interval between RUDAS administrations; Canadian sample; patient-preferred French or English version of RUDAS)

Mean score: 26 (2.9)
Median score: 26
1^st to 3^rd quartile: 24-28

Construct Validity

Adults with Sickle Cell Disease: (Fort�� et al., 2019)

Highest level of education was a significant predictor of RUDAS score (beta = 0.395, p < .001)
Age and language of administration were not predictors of RUDAS score

Cut-Off Scores

Traumatic Brain Injury (TBI): (Cheng et al., 2021; TBI group: 86 inpatients with TBI, mean age = 51.7 (16.5), male = 61 (70.9%), mean years of education = 9.3 (4.1); control group: 40 healthy individuals, mean age = 53.2 (13.9), male = 28 (70.0%), mean years of education = 9.9 (3.7) matched by age, sex, and education level; simplified Chinese version of RUDAS)

< 24 indicated cognitive impairment (sensitivity = 0.651; specificity = 0.700)

Traumatic Brain Injury (TBI): (Cheng et al., 2022; TBI group: 50 inpatients with TBI, mean age = 51.9 (19.1), male = 39 (78.0%), mean years of education = 10.4 (4.0); control group: 32 healthy individuals, mean age = 50.9 (17.7), male = 22 (68.8%), mean years of education = 11.7 (3.6) matched by age, sex, and education level; Chinese version of RUDAS)

< 23.5 indicated TBI (sensitivity = 60.0%; specificity = 100.0%)

Normative Data

Traumatic Brain Injury (TBI): (Cheng et al., 2021)

Mean total score (SD) of RUDAS for TBI and control groups

Group	n	RUDAS (SD)
TBI	86	22.15 (4.56)
Control	40	25.32 (2.60)
p	--	< 0.001

Traumatic Brain Injury (TBI): (Cheng et al., 2022)

Mean total score (SD) of RUDAS for TBI and control groups

Group	n	RUDAS (SD)
TBI	50	21.00 (5.44)
Control	32	26.41 (1.52)
p	--	< 0.001

Test/Retest Reliability

Traumatic Brain Injury (TBI): (Cheng et al., 2022)

Acceptable test-retest reliability for Total score and subtest scores (all ICCs > 0.83 except for Memory subtest = 0.746)

Interrater/Intrarater Reliability

Traumatic Brain Injury (TBI): (Cheng et al., 2022)

Excellent: Cronbach��s alpha for Total score and subtest scores range from 0.910 to 1.000

Internal Consistency

Traumatic Brain Injury (TBI): (Cheng et al., 2022)

Excellent: Cronbach��s alpha for Total score = 0.733

Criterion Validity (Predictive/Concurrent)

Traumatic Brain Injury (TBI): (Cheng et al., 2021)

Adequate predictive validity for detecting major neurocognitive disorder (ROC AUC = 0.711)

Construct Validity

Convergent validity:

Traumatic Brain Injury (TBI): (Cheng et al., 2021)

Excellent correlation between RUDAS and MMSE in the TBI group (r = 0.611, p < 0.001)
Significant negative affect of age on RUDAS scores (B = -0.096, t = -3.323, p = 0.001), with older age associated with lower scores. There was no affect for education (p = 0.089)

Traumatic Brain Injury (TBI): (Cheng et al., 2022)

Excellent convergent validity in the TBI group between the RUDAS total score and the total scores for the MMSE (r = 0.701, p < 0.001) and the Montreal Cognitive Assessment (MoCA) (r = 0.778, p < 0.001)
Excellent convergent validity in the control group between the RUDAS total score and the total score for the MMSE (r = 0.631, p < 0.001)g
Adequate convergent validity in the control group between the RUDAS total score and the total score for the MoCA (r = 0.527, p < 0.002)
Excellent correlations (p < 0.01) between total scores and subtest scores:
- Behavior (r = 0.715)
- Drawing (r = 0.724)
- Memory (r = 0.768)
- Language (r = 0.601)
Poor to Adequate correlations (p < 0.01) between total scores and subtest scores:
- Body Orientation (r = 0.363)
- Judgment (r = 0.507)

Bibliography

Alaama, T., Basheikh, M., Khiyami, A., Mutwalli, M., Batawi, S., & Watfa, G. (2016). Diabetes status is associated with poor cognitive performace in Saudi population at high metabolic risk. Journal of Aging Research and Clinical Practice, 5(4), 170-174.

Ayan, G., Afacan, C., Poyraz, B. C., Bilgic, O., Avci, S., Yavuzer, H., ... & Doventas, A. (2019). Reliability and validity of Rowland Universal Dementia Assessment Scale In Turkish population. American Journal of Alzheimer's Disease & Other Dementias, 34(1), 34-40.

Basic, D., Rowland, J. T., Conforti, D. A., Vrantsidis, F., Hill, K., LoGiudice, D., ... & Prowse, R. J. (2009). The validity of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural cohort of community-dwelling older persons with early dementia. Alzheimer Disease & Associated Disorders, 23(2), 124-129.

Chaaya, M., Phung, T. K. T., El Asmar, K., Atweh, S., Ghusn, H., Khoury, R. M., ... & Waldemar, G. (2016). Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging & Mental Health, 20(8), 880-887.

Chen, C. W., Chu, H., Tsai, C. F., Yang, H. L., Tsai, J. C., Chung, M. H., ... & Chou, K. R. (2015). The reliability, validity, sensitivity, specificity and predictive values of the Chinese version of the Rowland Universal Dementia Assessment Scale. Journal of Clinical Nursing, 24(21-22), 3118-3128.

Cheng, Y., Wang, Y-Z, Zhang, Y., Wang, Y., Xie, F., Zhang, Y., Wu, Y-H, Guo, J., & Fei, X. (2021). Comparative analysis of Rowland Universal Dementia Assessment Scale and Mini-Mental State Examination in cognitive assessment of traumatic brain injury patients. NeuroRehabilitation, 49, 39-46.

Cheng, Y., Zhang, Y., Zhang, Y., Wu, Y-H, & Zhang, S. (2022). Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. Applied Neuropsychology: Adult, 29(5), 1160-1166.

Cheung, G., Clugston, A., Croucher, M., Malone, D., Mau, E., Sims, A., & Gee, S. (2015). Performance of three cognitive screening tools in a sample of older New Zealanders. International Psychogeriatrics, 27(6), 981-989.

Custodio, N., Montesinos, R., Lira, D., Herrera-Perez, E., Chavez, K., Reynoso-Guzman, W., ... & Metcalf, T. (2020). Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru. Frontiers in Neurology, 11, 374.

Daniel, B., Agenagnew, L., Workicho, A., Abera, M. (2022). Validation of the Rowlands Universal Dementia Assessment Scale (RUDAS) to detect major neurocognitive disorder among elderly people in Ethiopia, 2020. PLoS ONE, 17(1): e0262483. .

de Araujo, N. B., Nielsen, T. R., Engedal, K., Barca, M. L., Coutinho, E. S., & Laks, J. (2018). Diagnosing dementia in lower educated older persons: Validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Brazilian Journal of Psychiatry, 40(3), 264-269.

Emerson, A., Muruganantham, P., Park, M. Y., Pillay, D., Vasan, N., Park, S. J., ... & Yau, S. M. (2019). Comparing the Montreal Cognitive Assessment and Rowland Universal Dementia Assessment Scale in a multicultural rehabilitation setting. Internal Medicine Journal, 49(8), 1035-1040.

Fort��, S., Blais, F., Castonguay, M., Fadiga, N., Ward, R., S��bastien, B., ... & Kuo, K. H. (2019). Predictors of the Rowland Universal Dementia Assessment Scale (RUDAS) Performance in adults with sickle cell disease. Blood, 134(Supplement_1): 2294.

Goudsmit, M., van Campen, J., Schilt, T., Hinnen, C., Franzen, S., & Schmand, B. (2018). One size does not fit all: comparative diagnostic accuracy of the Rowland Universal Dementia Assessment Scale and the Mini Mental State Examination in a memory clinic population with very low education. Dementia and Geriatric Cognitive Disorders Extra, 8(2), 290-305.

Iype, T., Ajitha, B. K., Antony, P., Ajeeth, N. B., Job, S., & Shaji, K. S. (2006). Usefulness of the Rowland universal dementia assessment scale in South India. Journal of Neurology, Neurosurgery & Psychiatry, 77(4), 513-514.

Iype, T., Shaji, S. K., Ajitha Balakrishnan, D. C., Varghese, A. A., & Antony, T. P. (2009). Cognition in type 2 diabetes: Association with vascular risk factors, complications of diabetes and depression. Annals of Indian Academy of Neurology, 12(1), 25-27.

Jaroshy, A. & Alkabeya, H. A. (09 Feb 2024). Test-Re-Test Reliability and Internal Consistency of Rowland Universal Dementia Assessment Scale (RUDAS) among Palestinian Older Adults. Occupational Therapy in Mental Health,

Komalasari, R., Chang, H. C., & Traynor, V. (2019). A review of the Rowland Universal Dementia Assessment Scale. Dementia, 18(7-8), 3143-3158.

Limpawattana, P., Tiamkao, S., Sawanyawisuth, K., & Thinkhamrop, B. (2012). Can Rowland Universal Dementia Assessment Scale (RUDAS) replace Mini-mental State Examination (MMSE) for dementia screening in a Thai geriatric outpatient setting? American Journal of Alzheimer's Disease & Other Dementias, 27(4), 254-259.

Mateos-?lvarez, R., Ramos-R��os, R., & L��pez-Mor��?igo, J. D. (2017). Comparative analysis between the MMSE and the RUDAS for dementia screening in low educated people in a Spanish psychogeriatric clinic. The European Journal of Psychiatry, 31(3), 119-126.

Matias-Guiu, J. A., Valles-Salgado, M., Rognoni, T., Hamre-Gil, F., Moreno-Ramos, T., & Mat��as-Guiu, J. (2017). Comparative diagnostic accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for screening of Alzheimer disease. Dementia and Geriatric Cognitive Disorders, 43(5-6), 237-246.

Naqvi, R. M., Haider, S., Tomlinson, G., & Alibhai, S. (2015). Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: A systematic review and meta-analysis. CMAJ, 187(5), E169-E175.

Nepal, G. M., Shrestha, A., & Acharya, R. (2019). Translation and cross-cultural adaptation of the Nepali version of the Rowland universal dementia assessment scale (RUDAS). Journal of Patient-Reported Outcomes, 3(1), 38.

Nielsen, T. R., Andersen, B. B., Gottrup, H., L��tzh?ft, J. H., H?gh, P., & Waldemar, G. (2013). Validation of the Rowland Universal Dementia Assessment Scale for multicultural screening in Danish memory clinics. Dementia and Geriatric Cognitive Disorders, 36(5-6), 354-362.

Nielsen, T. R., & J?rgensen, K. (2020). Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: A systematic review and meta-analysis. International Psychogeriatrics, 32(9), 1031-1044.

Nielsen, T. R., Segers, K., Vanderaspoilden, V., Bekkhus-Wetterberg, P., Bj?rkl?f, G. H., Beinhoff, U., ... & Waldemar, G. (2019). Validation of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample across five Western European countries: Diagnostic accuracy and normative data. International Psychogeriatrics, 31(2), 287-296.

Nielsen, T. R., Vogel, A., Gade, A., & Waldemar, G. (2012). Cognitive testing in non-demented Turkish immigrants �C comparison of the RUDAS and the MMSE. Scandinavian Journal of Psychology, 53(6), 455-460.

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Pang, J., Yu, H., Pearson, K., Lynch, P., & Fong, C. (2009). Comparison of the MMSE and RUDAS cognitive screening tools in an elderly inpatient population in everyday clinical use. Internal Medicine Journal, 39(6), 411-414.

Radford, K., Mack, H. A., Draper, B., Chalkley, S., Delbaere, K., Daylight, G., ... & Broe, G. A. (2015). Comparison of three cognitive screening tools in older urban and regional Aboriginal Australians. Dementia and Geriatric Cognitive Disorders, 40(1-2), 22-32.

Shaaban, J., Aziz, A. A., Abdullah, Z., & Ab Razak, A. (2013). Validation of the Malay Version of Rowland Universal Dementia Assessment Scale (MRUDAS) among Elderly Attending Primary Care Clinic. International Medical Journal, 20(5), 555-558.

Shanmugapriya, S., Dhandapani, N., & Saravanan, T. (2018). A study comparing cognitive function assessment in type-2 diabetes mellitus using Rowland Universal Dementia Assessment Scale and Mini Mental State Examination. International Journal of Health & Allied Sciences, 7(3), 184-190.

Storey, J. E., Rowland, J. T., Conforti, D. A., & Dickson, H. G. (2004). The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16(1), 13-31.

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Bibliography

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