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. 2019 Mar 4;3(3):CD011121.
doi: 10.1002/14651858.CD011121.pub2.

AD-8 for detection of dementia across a variety of healthcare settings

Kirsty Hendry  1 , Claire Green, Rupert McShane, Anna H Noel-Storr, David J Stott, Sumayya Anwer, Alex J Sutton, Jennifer K Burton, Terry J Quinn
Affiliations

AD-8 for detection of dementia across a variety of healthcare settings

Kirsty Hendry et al. Cochrane Database Syst Rev. .

Abstract

Background: Dementia assessment often involves initial screening, using a brief tool, followed by more detailed assessment where required. The AD-8 is a short questionnaire, completed by a suitable 'informant' who knows the person well. AD-8 is designed to assess change in functional performance secondary to cognitive change.

Objectives: To determine the diagnostic accuracy of the informant-based AD-8 questionnaire, in detection of all-cause (undifferentiated) dementia in adults. Where data were available, we described the following: the diagnostic accuracy of the AD-8 at various predefined threshold scores; the diagnostic accuracy of the AD-8 for each healthcare setting and the effects of heterogeneity on the reported diagnostic accuracy of the AD-8.

Search methods: We searched the following sources on 27 May 2014, with an update to 7 June 2018: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), BIOSIS Previews (Thomson Reuters Web of Science), Web of Science Core Collection (includes Conference Proceedings Citation Index) (Thomson Reuters Web of Science), CINAHL (EBSCOhost) and LILACS (BIREME). We checked reference lists of relevant studies and reviews, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on the AD-8 to try to find additional studies. We developed a sensitive search strategy and used standardised database subject headings as appropriate. Foreign language publications were translated.

Selection criteria: We selected those studies which included the AD-8 to assess for the presence of dementia and where dementia diagnosis was confirmed with clinical assessment. We only included those studies where the AD-8 was used as an informant assessment. We made no exclusions in relation to healthcare setting, language of AD-8 or the AD-8 score used to define a 'test positive' case.

Data collection and analysis: We screened all titles generated by electronic database searches, and reviewed abstracts of potentially relevant studies. Two independent assessors checked full papers for eligibility and extracted data. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies. We then created summary estimates of sensitivity, specificity and likelihood ratios using the bivariate approach and plotting results in receiver operating characteristic (ROC) space. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool.

Main results: From 36 papers describing AD-8 test accuracy, we included 10 papers. We utilised data from nine papers with 4045 individuals, 1107 of whom (27%) had a clinical diagnosis of dementia. Pooled analysis of seven studies, using an AD-8 informant cut-off score of two, indicated that sensitivity was 0.92 (95% confidence interval (CI) 0.86 to 0.96); specificity was 0.64 (95% CI 0.39 to 0.82); the positive likelihood ratio was 2.53 (95% CI 1.38 to 4.64); and the negative likelihood ratio was 0.12 (95% CI 0.07 to 0.21). Pooled analysis of five studies, using an AD-8 informant cut-off score of three, indicated that sensitivity was 0.91 (95% CI 0.80 to 0.96); specificity was 0.76 (95% CI 0.57 to 0.89); the positive likelihood ratio was 3.86 (95% CI 2.03 to 7.34); and the negative likelihood ratio was 0.12 (95% CI 0.06 to 0.24).Four studies were conducted in community settings; four were in secondary care (one in the acute hospital); and one study was in primary care. The AD-8 has a higher relative sensitivity (1.11, 95% CI 1.02 to 1.21), but lower relative specificity (0.51, 95% CI 0.23 to 1.09) in secondary care compared to community care settings.There was heterogeneity across the included studies. Dementia prevalence rate varied from 12% to 90% of included participants. The tool was also used in various different languages. Among all the included studies there was evidence of risk of bias. Issues included the selection of participants, conduct of index test, and flow of assessment procedures.

Authors' conclusions: The high sensitivity of the AD-8 suggests it can be used to identify adults who may benefit from further specialist assessment and diagnosis, but is not a diagnostic test in itself. This pattern of high sensitivity and lower specificity is often suited to a screening test. Test accuracy varies by setting, however data in primary care and acute hospital settings are limited. This review identified significant heterogeneity and risk of bias, which may affect the validity of its summary findings.

PubMed Disclaimer

Conflict of interest statement

KH: none known

CG: none known

RM: none known

ANS: none known

DJS: none known

SA: none known

AJS: none known

JKB: none known

TJQ: none known

Figures

1
1
Study flow diagram.
2
2
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
3
3
Summary ROC plot of AD‐8 informant cut‐off score 2. The dark point is a summary point, the other points individual studies; the broken line represents 95% confidence region.
4
4
Summary ROC plot of AD‐8 informant cut‐off score 3. The dark point is a summary point, the other points individual studies; the broken line represents 95% confidence region.
5
5
Summary ROC plot of AD‐8 informant cut‐off score 2 comparing test accuracy in community versus secondary care settings. Red diamonds represent community studies and black circles those in secondary care. The dark point is a summary point, the other points individual studies; the broken line represents 95% confidence region. No confidence region calculable for secondary care due to lack of available data.
6
6
Summary ROC plot of sensitivity analysis removing low average age. The dark point is a summary point, the other points individual studies; the broken line represents 95% confidence region.
1
1. Test
AD‐8 informant cutpoint 1.
2
2. Test
AD‐8 informant cutpoint 2.
3
3. Test
AD‐8 informant cutpoint 3.
4
4. Test
AD‐8 informant cutpoint 7.
5
5. Test
Sensitivity analysis removing low average age.
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6. Test
Sensitivity analysis removing disease‐specific study.
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7. Test
English language studies ‐ cutpoint 2.
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8. Test
English language studies ‐ cutpoint 3.
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9. Test
Sensitivity analysis removing CDR 0.5 ‐ cutpoint 2.
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10. Test
Sensitivity analysis removing CDR 0.5 ‐ cutpoint 3.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

Basalo 2017 {published data only}
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