Skip to main content Accessibility help

Validation of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample across five Western European countries: diagnostic accuracy and normative data

  • T. Rune Nielsen (a1), Kurt Segers (a2), Valérie Vanderaspoilden (a2), Peter Bekkhus-Wetterberg (a3), Guro Hanevold Bjørkløf (a4), Ulrike Beinhoff (a5), Lennart Minthon (a6), Anna Pissiota (a6), Magda Tsolaki (a7), Mara Gkioka (a7) and Gunhild Waldemar (a1)...



With increasing cultural diversity and growing elderly immigrant populations in Western European countries, the availability of brief cognitive screening instruments adequate for assessment of dementia in people from diverse backgrounds becomes increasingly important. The aim of the present study was to investigate diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample and to calculate normative data as a basis for demographic adjustment of RUDAS scores.


The study was a prospective international cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine diagnostic accuracy. Regression analysis was used to assess the impact of demographic variables.


Data was collected from 341 cognitively intact participants and 80 people with dementia with a wide age- and educational range. Of the 421 included participants, 239 (57%) had immigrant background. The RUDAS had high diagnostic accuracy with an area under the curve (AUC) of 0.93. The optimal cut-off score was <25 (sensitivity 0.80, specificity 0.90). Regression analysis revealed that RUDAS scores were mainly affected by education and were unrelated to data collection site and immigrant status. Education-adjusted normative data was calculated as a basis for education adjustment of RUDAS scores. Applying education-adjusted RUDAS scores slightly but significantly improved diagnostic accuracy with an AUC of 0.95.


We found the RUDAS to have excellent diagnostic properties in our multicultural sample. However, we suggest that RUDAS scores should be adjusted for education to increase diagnostic accuracy and that the choice of cut-off score should be considered based on the clinical context and expected base rate of dementia.


Corresponding author

Correspondence should be addressed to: T. Rune Nielsen, Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, University of Copenhagen, Rigshospitalet, section 6922, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Phone: +45 35 45 71 18. Email:


Hide All
Alzheimer's Disease International (2015). World Alzheimer Report 2015: The Global Impact of Dementia. An analysis of prevalence, incidence, cost and trends.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Araujo, N. B., Engedal, K., Barca, M. L., Nielsen, T. R., Coutinho, E. S. and Laks, J. (2018). Diagnosing dementia in lower educated older persons: validation of a Brazilian portuguese version of the Rowland Universal Dementia Assessment scale (RUDAS). Revista Brasileira de Psiquiatria. Epublished ahead of print,
Basic, D. et al. (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 and Associated Disorders, 23, 124129.10.1097/WAD.0b013e31818ecc98
Chaaya, M. et al. (2016). Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging & Mental Health, 20, 880887.10.1080/13607863.2015.1043620
Cheung, G. et al. (2015). Performance of three cognitive screening tools in a sample of older New Zealanders. International Psychogeriatrics, 27, 981989.10.1017/S1041610214002889
DeLong, E. R., DeLong, D. M. and Clarke-Pearson, D. L. (1988). Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics, 44, 837845.10.2307/2531595
Dingwall, K. M., Gray, A. O., McCarthy, A. R., Delima, J. F. and Bowden, S. C. (2017). Exploring the reliability and acceptability of cognitive tests for Indigenous Australians: a pilot study. BMC Psychology, 5, 26.10.1186/s40359-017-0195-y
Dubois, B. et al. (2007). Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurology, 6, 734746.10.1016/S1474-4422(07)70178-3
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.10.1016/0022-3956(75)90026-6
Goncalves, D. C., Arnold, E., Appadurai, K. and Byrne, G. J. (2011). Case finding in dementia: comparative utility of three brief instruments in the memory clinic setting. International Psychogeriatrics, 23, 788796.10.1017/S1041610210002292
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E. and Hodges, J. R. (2013). Validation of the Addenbrooke's cognitive examination III in frontotemporal dementia and Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 36, 242250.10.1159/000351671
International Test Commission (2017). The ITC Guidelines for Translating and Adapting Tests, 2nd edn.
Iype, T., Ajitha, B. K., Antony, P., Ajeeth, N. B., Job, S. and Shaji, K. S. (2006). Usefulness of the Rowland universal dementia assessment scale in South India. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 513514.10.1136/jnnp.2005.069005
Limpawattana, P., Tiamkao, S. and Sawanyawisuth, K. (2012). The performance of the Rowland Universal Dementia Assessment Scale (RUDAS) for cognitive screening in a geriatric outpatient setting. Aging Clinical and Experimental Research, 24, 495500.
Maruta, C., Guerreiro, M., de, M. A., Hort, J. and Scheltens, P. (2011). The use of neuropsychological tests across Europe: the need for a consensus in the use of assessment tools for dementia. European Journal of Neurology, 18, 279285.10.1111/j.1468-1331.2010.03134.x
Mateos-Alvarez, R., Ramos-Rios, R. and López-Morinigo, 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, 119126.10.1016/j.ejpsy.2017.06.003
Matias-Guiu, J. A., Valles-Salgado, M., Rognoni, T., Hamre-Gil, F., Moreno-Ramos, T. and Matias-Guiu, J. (2017). Comparative diagnostic accuracy – the ACE-III, MIS, MMSE, MoCA, and RUDAS for screening of alzheimer disease. Dementia and Geriatric Cognitive Disorders, 43, 237246.10.1159/000469658
McKeith, I. G. et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 11131124.10.1212/WNL.47.5.1113
McKhann, G. M., Albert, M. S., Grossman, M., Miller, B., Dickson, D. and Trojanowski, J. Q. (2001). Clinical and pathological diagnosis of frontotemporal dementia: report of the work group on frontotemporal dementia and pick's disease. Archives of Neurology, 58, 18031809.10.1001/archneur.58.11.1803
Mirza, N., Panagioti, M., Waheed, M. W. and Waheed, W. (2017). Reporting of the translation and cultural adaptation procedures of the Addenbrooke's Cognitive Examination version III (ACE-III) and its predecessors: a systematic review. BMC Medical Research Methodology, 17, 141.10.1186/s12874-017-0413-6
Naqvi, R. M., Haider, S., Tomlinson, G. and Alibhai, S. (2015). Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. Canadian Medical Association Journal, 187, E169E175.10.1503/cmaj.140802
Nasreddine, Z. S. et al. (2005). The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatric Society, 53, 695699.10.1111/j.1532-5415.2005.53221.x
Nielsen, T. R. et al. (2011). Assessment of dementia in ethnic minority patients in Europe: a European alzheimer's disease consortium survey. International Psychogeriatric, 23, 8695.10.1017/S1041610210000955
Nielsen, T. R. et al. (2015). Dementia care for people from ethnic minorities: a Nordic perspective. International Journal of Geriatric Psychiatry, 30, 217218.10.1002/gps.4206
Nielsen, T. R., Andersen, B. B., Gottrup, H., Lutzhoft, J. H., Hogh, P. and Waldemar, G. (2013). Validation of the rowland universal dementia assessment scale for multicultural screening in Danish memory clinics. Dementia and Geriatric Cognitive Disorders, 36, 354362.10.1159/000354375
Nielsen, T. R., Phung, T. K., Chaaya, M., Mackinnon, A. and Waldemar, G. (2016). Combining the rowland universal dementia assessment scale and the informant questionnaire on cognitive decline in the elderly to improve detection of dementia in an arabic-speaking population. Dementia and Geriatric Cognitive Disorders, 41, 4654.10.1159/000441649
Nielsen, T. R., Vogel, A., Gade, A. and Waldemar, G. (2012). Cognitive testing in non-demented Turkish immigrants–comparison of the RUDAS and the MMSE. Scandinavian Journal of Psychology, 53, 455460.10.1111/sjop.12018
O'Driscoll, C. and Shaikh, M. (2017). Cross-cultural applicability of the montreal cognitive assessment (MoCA): a systematic review. Journal of Alzheimer's Disease, 58, 789801.10.3233/JAD-161042
Roman, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.10.1212/WNL.43.2.250
Rosselli, M. et al. (2000). Verbal fluency and repetition skills in healthy older Spanish-English bilinguals. Applied Neuropsychology, 7, 1724.10.1207/S15324826AN0701_3
Rowland, J. T., Basic, D., Storey, J. E. and Conforti, D. A. (2006). The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. International Psychogeriatrics, 18, 111120.10.1017/S1041610205003133
Segers, K., Benoit, F., Colson, C., Kovac, V., Nury, D. and Vanderaspoilden, V. (2013). Pioneers in migration, pioneering in dementia: first generation immigrants in a European metropolitan memory clinic. Acta Neurologica Belgica, 113, 435440.10.1007/s13760-013-0245-z
Shaaban, J., Aziz, A., Abdullah, Z. and 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, 555.
Steis, M. R. and Schrauf, R. W. (2009). A review of translations and adaptations of the mini-mental state examination in languages other than english and spanish. Research in Gerontological Nursing, 2, 214224.10.3928/19404921-20090421-06
Storey, J. E., Rowland, J. T., Basic, D., Conforti, D. A. and Dickson, H. G. (2004). The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16, 1331.10.1017/S1041610204000043
Weeks, S. K., Kenney, S., Paul, E. M., Teresa, K. M. and Brenda, W. J. H. P. (2003). Comparing various short-form geriatricdepression scales leads to the GDS-5/15. Journal of Nursing Scholarship, 35, 133137.10.1111/j.1547-5069.2003.00133.x
Yesavage, J. A., Rose, T., Lum, O., Huang, V., Adey, M. and Leirer, V. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.10.1016/0022-3956(82)90033-4



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed