Background:

The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire).

Methods:

This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania.

In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history.

Results:

3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment.

Conclusions:

The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.

中文翻译：

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低资源环境中非专业卫生工作者基于应用程序的痴呆症认知筛查的有效性。坦桑尼亚农村地区的验证和可行性研究。

背景：

大多数痴呆症患者生活在低收入和中等收入国家 (LMIC)。在撒哈拉以南非洲 (SSA)，心理健康和老年医学方面的人力资源短缺是众所周知的。使用技术解决方案可能会改善获得诊断的机会。我们旨在评估针对坦桑尼亚农村非专业工人的简短痴呆筛查移动应用程序 (app) 的诊断准确性，以对抗 DSM-5 痴呆的盲法黄金标准诊断。该应用程序包括 2 个先前经过验证的文化上适当的低识字率认知筛查工具（IDEA 认知筛查）和功能障碍（缩写 IDEA-IADL 问卷）。

方法：

这是一项基于社区的上门研究，分为两阶段。在第一阶段，农村初级卫生工作者在坦桑尼亚乞力马扎罗山海区的 12 个村庄接触了所有 60 岁以上的人进行基于应用程序的痴呆症筛查。

在第 2 阶段，对分层的子样本进行临床评估，对应用筛选评分不知情的痴呆症。评估包括临床病史、神经和床边认知评估以及旁系病史。

结果：

3011（3122 名符合条件的）老年人同意筛查。其中 610 人在第 2 阶段进行了评估。 对于 IDEA 认知筛查，DSM-5 痴呆诊断的接受者操作特征 (AUROC) 曲线下面积为 0.79（95% CI 0.74-0.83）（敏感性 84.8%，特异性 58.4） %）。对于完成完整应用程序的 358 人 (44%)，AUROC 的综合认知和线人报告功能评估为 0.78。

结论：

试点痴呆筛查应用程序具有良好的敏感性，但在由非专业农村社区工作者管理时缺乏痴呆症的特异性。这种技术方法在资源匮乏的环境中可能是一种很有前途的方法，可以优先考虑专家转诊。