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The reliability and validity of the informant AD8 by comparison with a series of cognitive assessment tools in primary healthcare

Published online by Cambridge University Press:  22 October 2015

Muhammad Amin Shaik
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
Xin Xu
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
Qun Lin Chan
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
Richard Jor Yeong Hui
NHG Polyclinics, National Healthcare Group, Singapore
Steven Shih Tsze Chong
NHG Polyclinics, National Healthcare Group, Singapore
Christopher Li-Hsian Chen
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore
YanHong Dong*
Department of Pharmacology, National University of Singapore, Singapore Memory Aging and Cognition Centre, National University Health System, Singapore Centre for Healthy Brain Ageing (CHeBa) and Dementia Collaborative Research Centre – Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia
Correspondence should be addressed to: Dr YanHong Dong, Department of Pharmacology, National University Health System Clinical Research Centre, MD11, Level 5, #05-09, 10 Medical Drive, Singapore 117597, Singapore. Phone: +65 66011977; Fax: +65 68737690. Email:



The validity and reliability of the informant AD8 in primary healthcare has not been established. Therefore, the present study examined the validity and reliability of the informant AD8 in government subsidized primary healthcare centers in Singapore.


Eligible patients (≥60 years old) were recruited from primary healthcare centers and their informants received the AD8. Patient-informant dyads who agreed for further cognitive assessments received the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a locally validated formal neuropsychological battery at a research center in a tertiary hospital.


1,082 informants completed AD8 assessment at two primary healthcare centers. Of these, 309 patients-informant dyads were further assessed, of whom 243 (78.6%) were CDR = 0; 22 (7.1%) were CDR = 0.5; and 44 (14.2%) were CDR≥1. The mean administration time of the informant AD8 was 2.3 ± 1.0 minutes. The informant AD8 demonstrated good internal consistency (Cronbach's α = 0.85); inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.85); and test–retest reliability (weighted κ = 0.80). Concurrent validity, as measured by the correlation between total AD8 scores and CDR global (R = 0.65, p < 0.001), CDR sum of boxes (R = 0.60, p < 0.001), MMSE (R = −0.39, p < 0.001), MoCA (R = −0.41, p < 0.001), as well as the formal neuropsychological battery (R = −0.46, p < 0.001), was good and consistent with previous studies. Construct validity, as measured by convergent validity (R ≥ 0.4) between individual items of AD8 with CDR and neuropsychological domains was acceptable.


The informant AD8 demonstrated good concurrent and construct validity and is a reliable measure to detect cognitive dysfunction in primary healthcare.

Research Article
Copyright © International Psychogeriatric Association 2015 

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Borson, S. et al. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer's & Dementia, 9, 151159.Google Scholar
Boustani, M. et al. (2005). Implementing a screening and diagnosis program for dementia in primary care. Journal of General Internal Medicine, 20, 572577.CrossRefGoogle ScholarPubMed
Brenner, H. and Kliebsch, U. (1996). Dependence of weighted kappa coefficients on the number of categories. Epidemiology, 7, 199202.CrossRefGoogle ScholarPubMed
Brodaty, H., Low, L. F., Gibson, L. and Burns, K. (2006). What is the best dementia screening instrument for general practitioners to use? The American Journal of Geriatric Psychiatry, 14, 391400.CrossRefGoogle ScholarPubMed
Budd, D., Burns, L. C., Guo, Z., L’Italien, G. and Lapuerta, P. (2011). Impact of early intervention and disease modification in patients with predementia Alzheimer's disease: a Markov model simulation. Clinicoeconomics and Outcomes Research, 3, 189195.CrossRefGoogle ScholarPubMed
Chan, Q. L. et al. (in press). Clinical utility of the informant AD8 as a dementia case finding instrument in primary healthcare. Journal of Alzheimer's Disease.Google Scholar
Correia, C. C. et al. (2011). AD8-Brazil: cross-cultural validation of the ascertaining dementia interview in Portuguese. Journal of Alzheimer's Disease, 27, 177185.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082308.Google Scholar
Diller, L., Weinberg, J., Gordon, W., Goodkin, R., Gerstman, L. J. and Ben-Yishay, Y. (1974). Studies in Cognition and Rehabilitation in Hemiplegia. New York: University Medical Center, Rehabilitation Monograph.Google Scholar
Dong, Y., Cheng, T. S., Tsou, K. Y. K., Chan, Q. L. and Chen, C. L. H. (2014). Feasibility and acceptability of the informant AD8 for cognitive screening in primary healthcare: a pilot study. The Scientific World Journal, 2014, 17.Google ScholarPubMed
Dong, Y. et al. (2013). The informant AD8 is superior to participant AD8 in detecting cognitive impairment in a memory clinic setting. Journal of Alzheimer's Disease, 35, 159168.Google Scholar
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55, 16211626.Google Scholar
Fleiss, J. L. and Chilton, N. W. (1983). The measurement of interexaminer agreement on periodontal disease. Journal of Periodontal Research, 18, 601606.Google Scholar
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.Google Scholar
Galvin, J. E., Fagan, A. M., Holtzman, D. M., Mintun, M. A. and Morris, J. C. (2010). Relationship of dementia screening tests with biomarkers of Alzheimer's disease. Brain, 133, 32903300.CrossRefGoogle ScholarPubMed
Galvin, J. E., Roe, C. M., Xiong, C. and Morris, J. C. (2006). Validity and reliability of the AD8 informant interview in dementia. Neurology, 67, 19421948.Google Scholar
Galvin, J. E. et al. (2005). The AD8 A brief informant interview to detect dementia. Neurology, 65, 559564.Google Scholar
Iliffe, S. et al. (2009). Primary care and dementia: 1. diagnosis, screening and disclosure. International Journal of Geriatric Psychiatry, 24, 895901.Google Scholar
Isaacs, B. and Kennie, A. T. (1973). The set test as an aid to the detection of dementia in old people. The British Journal of Psychiatry, 123, 467470.Google Scholar
Ismail, Z., Rajji, T. K. and Shulman, K. I. (2010). Brief cognitive screening instruments: an update. International Journal of Geriatric Psychiatry, 25, 111120.CrossRefGoogle ScholarPubMed
Koski, L., Xie, H., Konsztowicz, S. and Tetteh, R. (2010). French-English cross-linguistic comparison and diagnostic impact of the AD-8 dementia screening questionnaire in a geriatric assessment clinic. Dementia and Geriatric Cognitive Disorders, 29, 265274.Google Scholar
Lewis, R. F. and Rennick, P. M. (1979). Manual for the Repeatable Cognitive-Perceptual-Motor Battery, Gross Point, MI: Axon.Google Scholar
Lin, J. S., O’Connor, E., Rossom, R. C., Perdue, L. A. and Eckstrom, E. (2013). Screening for cognitive impairment in older adults: a systematic review for the US preventive services task force. Annals of Internal Medicine, 159, 601612.Google Scholar
Mack, W. J., Freed, D. M., Williams, B. W. and Henderson, V. W. (1992). Boston naming test: shortened versions for use in Alzheimer's disease. Journal of Gerontology, 47, 154158.CrossRefGoogle ScholarPubMed
Morris, J. C. (1997). Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173176.CrossRefGoogle ScholarPubMed
Mukadam, N., Cooper, C. and Livingston, G. (2011). A systematic review of ethnicity and pathways to care in dementia. International Journal of Geriatric Psychiatry, 26, 1220.CrossRefGoogle ScholarPubMed
Nasreddine, Z. S. et al. (2005). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.Google Scholar
Porteus, S. D. (1959). The Maze Test and Clinical Psychology. Palo Alto, CA: Pacific Books.CrossRefGoogle Scholar
Ryu, H. J., Kim, H. J. and Han, S. H. (2009). Validity and reliability of the Korean version of the AD8 informant interview (K-AD8) in dementia. Alzheimer Disease & Associated Disorders, 23, 371376.CrossRefGoogle ScholarPubMed
Sahadevan, S., Tan, N. J., Tan, T. C. and Tan, S. (1997). Cognitive testing of elderly Chinese from selected community clubs in Singapore. Annals of the Academy of Medicine, Singapore, 26, 271277.Google ScholarPubMed
Smith, A. (1982). Symbol Digit Modalities Test (SDMT) Manual (Revised), Los Angeles, CA: Western Psychological Services.Google Scholar
Stopford, C. L., Thompson, J. C., Neary, D., Richardson, A. M. and Snowden, J. S. (2012). Working memory, attention, and executive function in Alzheimer's disease and frontotemporal dementia. Cortex, 48, 429446.CrossRefGoogle ScholarPubMed
Sunderland, T. et al. (1989). Clock drawing in Alzheimer's disease: a novel measure of dementia severity. Journal of the American Geriatrics Society, 37, 725729.CrossRefGoogle ScholarPubMed
Tanboga, I. H., Ekinci, M., Isik, T., Kurt, M., Kaya, A. and Sevimli, S. (2011). Reproducibility of syntax score: from core lab to real world. Journal of Interventional Cardiology, 24, 302306.Google Scholar
Tucker, A. M. and Stern, Y. (2011). Cognitive reserve in aging. Current Alzheimer Research, 8, 354360.Google Scholar
Van Marwijk, H. W., Wallace, P., de Bock, G. H., Hermans, J., Kaptein, A. A. and Mulder, J. D. (1995). Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. British Journal of General Practice, 45, 195199.Google Scholar
Verma, M. and Howard, R. J. (2012). Semantic memory and language dysfunction in early Alzheimer's disease: a review. International Journal of Geriatric Psychiatry, 27, 12091217.CrossRefGoogle ScholarPubMed
Wechsler, D. (1981). Wechsler Adult Intelligence Scale-Revised. New York: Harcourt Brace Jovanovich.Google Scholar
Wechsler, D. (1997). Wechsler Memory Scale-Revised (WMS-III). San Antonio, TX: The Psychological Corporation.Google Scholar
Wong, A. et al. (2009). The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dementia and Geriatric Cognitive Disorders, 28, 8187.CrossRefGoogle Scholar
Wortmann, M. (2012). Dementia: a global health priority-highlights from an ADI and world health organization report. Alzheimers Research & Therapy, 4, 40. doi: 10.1186/alzrt143.CrossRefGoogle ScholarPubMed
Yang, Y. H., Galvin, J. E., Morris, J. C., Lai, C. L., Chou, M. C. and Liu, C. K. (2011). Application of AD8 questionnaire to screen very mild dementia in Taiwanese. American Journal of Alzheimer's Disease and other Dementias, 26, 134138.CrossRefGoogle ScholarPubMed
Yeo, D., Gabriel, C., Chen, C., Lee, S., Loenneker, T. and Wong, M. (1997). Pilot validation of a customized neuropsychological battery in elderly Singaporeans. Neurology Journal of South East Asia, 2, 123.Google Scholar