Objective: To determine cut-off values of the Blessed Dementia Rating Scale (BDRS) for identifying elderly Chinese as normal, having mild cognitive impairment (MCI) or demented.
Design: Multi-step stratified random sampling was applied to 4015 people aged 65 and over from the general community in southern Taiwan. A two-phase cross-sectional study was conducted by well-trained interviewers, psychologists, and senior neurologists, respectively.
Materials and Methods: 2891/4015 (72 %) participants completed the study. Trained interviewers administered BDRS, Mini-Mental State Examination (MMSE), and detailed background data. Low scoring individuals in MMSE were recruited for second phase study by senior neurologists using a package of comprehensive neurobehavioral examination. Data were subjected to receiver operating characteristic curve (ROC) analysis. Dementia was diagnosed by DSM-IV criteria and Alzheimer's disease by the National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Clinical dementia rating scale (CDR) was used to rate subjects as normal, MCI, and dementia with CDR=0, CDR=0.5, and CDR³ 1, respectively.
Results: In distinguishing MCI from normal, a 0.5 BDRS cut-off score yielded 74.75 % sensitivity, 55.98 % specificity and 0.5075 minimum distance to point (0, 1); area under curve (AUC) values for BDRS and MMSE were 0.6958 and 0.9105, respectively. In distinguishing MCI from dementia, a 2.5 BDRS cut-off yielded 90.00 % sensitivity, 77.78 % specificity and 0.2437 minimum distance to point (0, 1); AUC values for BDRS and MMSE were 0.8833 and 0.8237, respectively.
Conclusion: In elderly Chinese population, cut-off scores of 0.5 and 2.5 for BDRS were most appropriate for distinguishing normal from MCI and MCI from dementia, respectively. MMSE differentiated normal from MCI much better than BDRS. BDRS differentiated dementia from MCI better than MMSE. It also implied that cognitive function test may be much more sensitive than daily activities detecting instrument in telling normal from MCI. The daily activities detecting instrument may be more suitable in distinguishing MCI from dementia than cognitive function test.
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