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Tip Sheet 3 - Cognitive assessment and

people from Culturally and Linguistically


Diverse (CALD) background
Cognitive assessments help determine the Training: The RUDAS requires
cognitive ability of an individual. A cognitive administrator’s to be trained in its use. An
assessment should include assessment of easy to access DVD (and guidelines) is
function using standardised and validated available on the Alzheimer’s Australia
assessment tools and information gathered website:
from family or informant.
http://www.alzheimers.org.au/understandi
There are a range of cognitive assessment ng-dementia/rowland-universal-dementia-
tools that have been developed. The RUDAS assessment-scale.aspx
is a cognitive assessment tool which has
The RUDAS consists of a series of questions
been validated for use with people from
aimed at assessing memory, visuospatial
CALD backgrounds and is the tool
orientation, praxis, visuoconstructional
recommended by the 2010 Expert Clinical
drawing, memory recall and language.
Reference Group (ECRG) (Sansoni et al.,
2010) for use by ACAS staff. Cut off score: 22 or less (lower scores
indicate greater impairment); 23-30
considered normal, and needs to be
RUDAS considered in the clinical context.

What is the RUDAS: The


Rowland Universal Dementia SMMSE
Assessment Scale (RUDAS) is
a scale that assesses cognitive The Standardised Mini Mental State
impairment in people from all Examination (SMMSE) was the tool
educational, cultural and recommended for use with non-CALD
linguistic backgrounds. The RUDAS clients by the 2010 Expert Clinical
was developed in 2004 by Storey, Rowland, Reference Group (Sansoni et al., 2010).
Basic, Conforti, and Dickson. Each item was However, ACAS staff may wish to use the
reviewed by a cultural advisory group for SMMSE to supplement the RUDAS with
cultural relevance and ease of translation. It some CALD clients. Care should be taken
has also been validated in multicultural when interpreting the SMMSE scores when
populations in Australia. used with people from CALD backgrounds.

Benefits of the RUDAS: The RUDAS seems What is the SMMSE: The SMMSE is an
likely to have less cultural and educational adaptation of the Mini Mental State
bias and appears suitable for assessing Examination (MMSE). The MMSE is a
clients from CALD backgrounds. It takes cognitive screening tool that has commonly
approximately 10 minutes to administer. been reported to have cultural and
educational biases (Basic et al, 2009;
Rowland et al, 2006). The SMMSE was
developed by Molloy and Standish in 2007

1
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)
to provide a systematic approach to the Culture:
administration of the MMSE. Repeating “no ifs, ands or buts”
Benefits of the SMMSE: The SMMSE has (replaced with a more common
detailed instructions with time limits on phrase/tongue twister).
questions and takes approximately 10 Orientation to time and place (replaced
minutes to administer. with regional names of places or
terminology and accepting traditional
Cut off score: Lower scores indicate greater calendar systems responses; and season
impairment (range: 0-30) removed or replaced with time of day).
Scoring guidelines for assessing cognitive Accepting regional language differences
impairment (Vertesi, Lever, & Molley, in responses.
2001): Education:
Spelling world backward (replaced with
30 = No impairment;
days of the week backwards).
26 – 30 = Considered normal; Counting backward by 7s (replaced with
20 – 25 = Mild; a subtraction task).
Writing a sentence (replaced with tell
10 – 19 = Moderate;
me something about…).
0 – 9 = Severe.

Translated Tools
Things to be aware of
RUDAS
RUDAS:
The RUDAS seems likely to
Although the RUDAS has consistently have less cultural and
been found to be free of cultural and educational bias so it is easily interpreted
educational bias in multicultural samples in by an interpreter during an assessment.
Australia, one study in South India did find Some translated (written) versions are
education impacted on the RUDAS score. available but are not validated.
Sansoni et al (2007) suggest that question 5
(judgement -traffic lights and busy street)
SMMSE
may reflect a degree of acculturation to
dominant Western and urban based There are no formal translations known of
cultures. the SMMSE, however the MMSE has similar
questions to the SMMSE. The MMSE and its
translations are copyrighted by
SMMSE Psychological Assessment Resources (PAR)
Questions most commonly modified in and can be purchased online
overseas studies to make the MMSE more www.parinc.com/.
culturally and linguistically relevant or Some studies which have translated the
relevant to those less educated include: MMSE and provided psychometric
properties are listed in the references
below.

2
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)
Further Resources RUDAS References

and References RUDAS Reference: Storey, J., Rowland,


J., Basic, D., Conforti, D., & Dickson, H.
Cognitive Assessment (2004). The Rowland Universal
Dementia Assessment Scale (RUDAS): A
Victorian Transcultural
multicultural cognitive assessment
Psychiatry Unit: www.vtpu.org.au/
scale. International Psychogeriatrics,
16(1), 13-31.
References Rowland, J.T., Basic, D., Storey, J.E.,
Conforti, D.A. (2006). The Rowland
Sansoni, J., Marosszeky, N., Jeon, Y.-H.,
Universal Dementia Assessment Scale
Chenoweth, L., Hawthorne, G., King M,
(RUDAS) and the Folstein MMSE in a
Budge M, Zapart S, Sansoni E, Senior K,
multicultural cohort of elderly persons.
Kenny, P., Low, L. (2007). Final Report:
International Psychogeriatrics, 18,111-
Dementia Outcomes Measurement Suite
120.
Project. Centre for Health Service
Development, University of Wollongong.
Sansoni, J., Marosszeky, N., Fleming, G., SMMSE
& Sansori, E. (2010). Selecting Tools for International Psychogeriatric Association:
ACAT Assessment: A Report for the Aged
Care Assessment Program (ACAP) Expert This website contains administration
Clinical Reference Group. Centre for guidelines and a copy of the SMMSE
Health Service Development, University http://www.ipa-
of Wollongong. Report for the Aged Care online.org/ipaonlinev3/ipaprograms/guide
Assessment Program. Department of toaddiagnosis/appendix3.asp
Health and Ageing, Canberra.

Psychological Assessment Resources (PAR):


RUDAS Permission to use/reproduce the SMMSE
This Alzheimer’s Australia website contains and obtain a copy of the guidelines can be
a DVD, administration and scoring obtained by contacting Dr. D William Molloy
guidelines, scoring sheets and translations (Published by New Grange Press)
in Chinese and Italian: www.parinc.com/
http://www.alzheimers.org.au/understandi
ng-dementia/rowland-universal-dementia-
assessment-scale.aspx SMMSE/MMSE References
The RUDAS can also be found on the SMMSE Reference: Molloy, D.W., &
Dementia Collaborative Research Centre Standish, T.I.M. (1997). A guide to the
website: http://www.dementia- Standardized Mini-Mental State
assessment.com.au/measures.html Examination. International
Psychogeriatrics, 9(Supplement 1), 87-
94.

3
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)
Basic, D., Khoo, A., Conforti, D.A., Greek MMSE: Tsolaki, M., V. Iakovidou,
Rowland, J.T., Vrantsidis, F., LoGiudice, et al. (2000c). "Hindi Mental State
D., Hill, K., Harry, J., Lucero, K., Prowse, Examination (HMSE) as a screening test
R.J. (2009) Rowland Universal Dementia for illiterate demented patients."
Assessment Scale, Mini- Mental State EΓKEΦΑΛΟΣ 37: 119-138. Tool available
Examination and General Practitioner in article (in Greek).
Assessment of Cognition in a
multicultural cohort of community-
dwelling older persons with early Italian MMSE: Frisoni, G.B., Rozzini, R.,
dementia. Australian Psychologist, 44, Bianchetti, A., & Trabucchi, M. (1993).
40-53. Principal lifetime occupation and MMSE
score in elderly persons. Journal of
Gerontology, 48(6):S310-4. Note:
Chinese MMSE: Chiu, H. F. K., Lee, H. C., validity data not available.
Chung, W. S., & Kwong, P. K. (1994).
Reliability and validity of the Cantonese
version of Mini-Mental State Vertesi, A., Lever, J. A., Molloy, D.,
Examination – A preliminary Study. The W.Sanderson, B., Tuttle, I., Pokoradi, L.,
Hong Kong Journal of Psychiatry, 4(2), & Principi, E. (2001). Standardized Mini-
25-28. (Tool attached as an appendix in Mental State Examination. Use and
the article, but copyrighted by PAR - interpretation. Canadian Family
education based cut off scores Physician, 47, 2018-2023.
recommended by the authors).

Arabic MMSE: Wrobel, N.H. & Farrag,


Chinese MMSE: Katzman, R., M. Y. M.F. (2004). Identification of dementia
Zhang, et al. (1988). "A Chinese version and mental health symptoms in an
of the Mini-Mental State Examination; elderly Arab American sample: Final
impact of illiteracy in a Shanghai report. Wayne County Senior Citizens
dementia survey." Journal of Clinical Services, Detroit. (Various tools,
Epidemiology 41(10): 971-978. including the MMSE are included in
Arabic as an appendix - education based
cut off scores)
Greek MMSE: Tsolaki, M., V. Iakovidou,
et al. (2000b). "Hindi Mental State
Arabic MMSE: Wrobel, N.H., & Farrag,
Examination (HMSE) as a screening test
M.F. (2008). Preliminary validation of
for illiterate demented patients." Int.
an Arabic version of the MMSE in the
Journal of Geriatric Psychiatry 15: 662-
elderly. Clinical Gerontologist, 31(3),
665.
75-93.

4
The Assessment of Older People with dementia and depression of Culturally and Linguistically Diverse Backgrounds: A
review of current practice and the development of guidelines for Victorian Aged Care Assessment Services (funded by the
Victorian Department of Health; undertaken by the National Ageing Research Institute, 2011)