Validity and reliability of a Taiwan Chinese version of the community screening instrument for dementia.

OBJECTIVE: The Community Screening Instrument for Dementia (CSI-D) has been reported to be sensitive. The authors examined the reliability and validity of a Chinese (Taiwanese) version of the CSI-D for elderly patients. METHODS: Four groups were tested with the CSI-D: 31 with mild or moderate dementia; 32 non-dementia, depressed subjects; and 34 low-education, and 30 high-education normal-comparison subjects. Patients with dementia or depression were selected from outpatients of two hospitals. Testing was carried out in either the community or outpatient setting. RESULTS: The internal consistency, interrater reliability, and test-retest reliability of the CSI-D were good. The CSI-D was highly correlated with scores on the Mini-Mental State Examination and 10-word-list-learning task. Correlation with the Montgomery-Asberg Depression Rating Scale was not significant. Receiver Operating Characteristic analysis suggested that the CSI-D was a good instrument in differentiating dementia from depression and normal subjects with low education. It had good sensitivity and specificity. Education was related to the cognitive scores but not related to informant scores. The combination of an informant interview with a cognitive test enhanced the performance of the CSI-D. CONCLUSIONS: The Taiwan Chinese version of the CSI-D is psychometrically sound, brief, easy to complete, and therefore suitable as a screening instrument for dementia in Taiwan. The study reinforces earlier suggestions that the informant interview yields improved validity for detecting dementia.     

The development of a valid and reliable scale for rating anxiety in dementia (RAID)

A rating scale to measure anxiety in dementia sufferers was developed and evaluated in a sample of 51 inpatients and 32 day-hospital patients. Anxiety scores were not related to sex, age, accommodation or DSM-IV diagnosis of the type of dementia. However, both subjects with physical illnesses and subjects with insight into their memory problems had significantly higher anxiety scores.The kappa values for inter-rater reliability ranged from 0.51 to 1 and for test-retest reliability from 0.53 to 1, which indicates moderate to good reliability.The overall agreement on individual items ranged from 82-100% (inter-rater) and 84-100% (test-retest).The professionals working in the care of the elderly and carer groups felt that the scale was comprehensive and all the items in the scale were important, thereby confirming that it has good content validity. The scale significantly correlated with other anxiety scales and also with independent ratings both by a consultant psychiatrist and also nursing staff, indicating good concurrent validity. Anxiety scores were significantly higher in dementia patients who fulfilled modified DSM-IV criteria for anxiety and clinical diagnosis of anxiety disorder.This showed evidence of good criterion validity. Factor analysis showed five factors, including all items of the scale. Scores of 11 and above on the scale indicated significant clinical anxiety. Overall, the scale had good reliability and validity. It should be a useful clinical and research instrument for assessing anxiety in dementia sufferers.     

Cognitive Assessment and Reference Diagnosis System: development of a neuropsychological and clinical examination for clinic and population use

Background: Recent therapeutic advances to delay the progression of dementia have renewed calls to improve the early detection and management of individuals with dementia. A new computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS) was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia (its subtype, depression and delirium), to present reference diagnoses following the completion of tests and to detect early dementia. This study aims to verify the validity and reliability of CARDS. Methods: The CARDS was administered to 70 dementia patients (51 Alzheimer's disease, 19 vascular dementia) and 34 healthy (control) subjects. Three aspects of reliability (internal consistency reliability, inter‐rater and test–retest reliability) were tested. Correlations with the Alzheimer's Disease Assessment Scale, Korean version (ADAS‐K), the Cambridge Cognitive Examination, Korean version (CAMCOG‐K) and the Mini‐Mental State Examination, Korean version (MMSE‐K) were used to estimate the concurrent validity of CARDS. To evaluate the sensitivity of CARDS, mean scores from CARDS, ADAS‐K, CAMCOG‐K and MMSE‐K were compared between dementia patients and control subjects. Results: The CARDS demonstrated high levels of reliability. Mean CARDS scores for dementia patients were significantly different from the control group (P < 0.001). Furthermore, CARDS was significantly correlated with other tests and scales (P < 0.01). Conclusion: We demonstrated that CARDS is a reliable and valid instrument not only for dementia diagnosis, but also for the evaluation of impaired cognitive domains. A regression equation, derived from nationwide population surveys for norm data from CARDS, will be applied for individualized cutoff scores of five domains of dementia to eliminate the influence of age, sex and educational attainment on test scores.     

CAMCOG as a screening instrument for dementia: the Odense study. Cambridge Cognitive Examination

OBJECTIVE: The Cambridge Cognitive Examination (CAMCOG) score is correlated with age and sociodemographic variables. The aim of the study was to determine an individualized CAMCOG cut-off score for dementia, taking such correlates into account. METHOD: From the general population 150 people aged 65-84 years were examined with CAMDEX which includes CAMCOG, and a neuropsychological test battery. Data from 130 non-demented people were entered in setwise multiple regression analyses to identify variables predicting the CAMCOG score. RESULTS: The variables age, social class, matrimonial status, general knowledge and intellectual level explained 66% of the variance of the CAMCOG scores. A cut-off defined as a difference between actual and predicted CAMCOG score < or = -4.41 resulted in a sensitivity of 88.2% and a specificity of 89.2% for very mild to moderate dementia. CONCLUSION: It is possible to determine an individualized CAMCOG cut-off score for dementia in its early stages.     

A short screening instrument for poststroke dementia : the R-CAMCOG

BACKGROUND AND PURPOSE: The CAMCOG is a feasible cognitive screening instrument for dementia in patients with a recent stroke. A major disadvantage of the CAMCOG, however, is its lengthy and relatively complex administration for screening purposes. We therefore developed the Rotterdam CAMCOG (R-CAMCOG), based on the original version. Our aim was to reduce the estimated administration time to 15 minutes or less and to retain or perhaps even improve its diagnostic accuracy. METHODS: We analyzed the item scores on the CAMCOG of 300 consecutive stroke patients, after exclusion of patients with a severe aphasia or lowered consciousness level, who were entered in the Rotterdam Stroke Databank. The diagnosis of dementia was made independent of the R-CAMCOG score, on the basis of clinical examination and neuropsychological test results. The R-CAMCOG was constructed in 3 steps. First, items with floor and ceiling effects were removed. Next, subscales with no additional diagnostic value were excluded. Finally, we removed items that did not contribute to the homogeneity of the subscales. The diagnostic accuracy of the R-CAMCOG and the original CAMCOG was determined by means of the area under the receiver operating characteristic (ROC) curve. RESULTS: In the 3 steps, the number of items was reduced from 59 to 25, divided over the subscales orientation, memory (recent, remote, and learning), perception, and abstraction. The subscale orientation did not reach significance in a logistic regression model but was included in the R-CAMCOG because of its high face validity in dementia screening. Internal validation with ROC analysis suggests that the R-CAMCOG and the CAMCOG are equally accurate in screening for poststroke dementia (area under the curve was 0.95 for both tests). CONCLUSIONS: The R-CAMCOG has overcome the disadvantages of the original CAMCOG. It is a promising, short, and easy-to-administer screening instrument for poststroke dementia. It seems to be sufficiently accurate for this purpose, but the test has yet to be validated in a separate, independent study.     

The Alzheimer's Disease Assessment Scale: findings from a low-education population.

We constructed a Chinese version of the cognitive component of the Alzheimer's Disease Assessment Scale (ADAS-Cog). In order to accommodate illiteracy, the Chinese version used pictures instead of words for assessing recall and recognition. The Chinese ADAS-Cog was administered to 125 individuals with no dementia, 127 with questionable dementia, and 77 with Alzheimer's disease (AD). Their age range was 51-92 years and their education range was 0-20 years. The Chinese ADAS-Cog had high internal consistency (Cronbach's alpha = 0.87) and very high interrater reliability (intraclass correlation coefficient, or ICC, = 0.99) and test-retest reliability (ICC = 0.96). It had high correlations with scores on the Clinical Dementia Rating Scale (Pearson's r = 0.85), the Cognitive Abilities Screening Instrument (CASI, Pearson's r = -0.88), and CASI-estimated scores on the Mini-Mental State Examination (Pearson's r = -0.85). Performance on the Chinese ADAS-Cog was uninfluenced by age or gender, nor by education level except within the low education range of 0-6 years. Its memory items were best for early detection of dementia; its language items were best for monitoring the progression of dementia. This study found that the Chinese ADAS-Cog is a good instrument for use with Chinese AD patients.     

Characteristics of elderly who develop Alzheimer's disease during the next two years-a neuropsychological study using CAMCOG. The Odense Study

OBJECTIVE: The aim of the study was to determine which cognitive functions first deteriorate in Alzheimer's disease (AD) and to identify persons who would become demented 2 years following an initial examination.PARTICIPANTS: A total of 2452 initially non-demented persons, aged 65-84 years and randomly drawn from the population, who were examined 2 years apart.MEASURES: CAMCOG, the cognitive section of CAMDEX (The Cambridge Mental Disorders of the Elderly Examination). Fourteen composite measures were constructed of the 60 CAMCOG items.RESULTS: During the 2-year period, 102 developed AD; this group had significantly lower scores on all of the 14 composite measures at baseline examination than the subjects who remained non-demented. The incident demented were significantly older than the non-demented, had less formal schooling, were more often unskilled and had lower verbal intellectual level. Logistic regression analyses showed that especially higher age, together with reduced recent and remote memory, low category verbal fluency and attentional deficiency, characterized incident demented 2 years before the diagnosis was made.CONCLUSIONS: Cognitive changes, which develop years before the AD diagnosis, can be identified by means of CAMCOG, but this instrument does not allow identification of persons who later develop AD with sufficient precision.     

Korean Version of Mini Mental Status Examination for Dementia Screening and Its' Short Form

Objective

We developed a Korean version of Mini-Mental Status Examination (MMSE) optimized for screening dementia (MMSE-DS) and its'' short form (SMMSE-DS).

Methods

We constructed the MMSE-DS using the items of the two current Korean versions of MMSE and then construct the SMMSE-DS consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. We investigated reliability and validity of MMSE-DS and SMMSE-DS on 1,555 subjects (1,222 nondemented controls, 333 dementia patients). We compared the diagnostic accuracy of the SMMSE-DS with that of the three full Korean versions of MMSE, and examined its'' age- and education-specific optimal cutoff scores for dementia.

Results

The internal consistency obtained by Cronbach''s coefficient alpha was 0.826. The inter-rater reliability and test-retest reliability were 0.968 (p<0.001) and 0.825 (p<0.001), respectively. It showed significant correlation with the Clinical Dementia Rating (CDR) (r=-0.698, p<0.05) and the three full Korean versions of MMSE (r=0.839-0.938, p<0.001). The area under the receiver operator curve for dementia of the SMMSE-DS was larger than those of the three full Korean versions of MMSE (p<0.001). Age, education and gender explained 19.4% of the total variance of SMMSE-DS scores. The optimal cutoff scores for dementia of the SMMSE-DS were estimated differently by age and educational attainment of the subjects.

Conclusion

The SMMSE-DS was found to be accurate, brief and portable instrument for screening dementia in Korean elders, and may be particularly useful for screening dementia in elderly populations with wide variation in educational levels.     

Utility of TICS-M for the assessment of cognitive function in older adults

BACKGROUND: Routine screening of high-risk elderly people for early cognitive impairment is constrained by the limitations of currently available cognitive function tests. The Telephone Interview of Cognitive Status is a novel instrument for assessment of cognitive function that can be administered in person or by telephone. OBJECTIVE: To evaluate the determinants and utility of TICS-M (13-item modified version) for assessment of cognitive function in healthy elderly people. METHODS: The utility of TICS-M was compared with more widely used MMSE and CAMCOG in a cross-sectional survey of 120 older (62 to 89 years) UK adults. RESULTS: The TICS-M cognitive test scores (27.97, SD 4.15) were normally distributed in contrast with those for MMSE and CAMCOG that had a negatively skewed distribution. TICS-M scores were inversely correlated with age (r = -0.21) and with the NART fullscale IQ (r = -0.35), but were independent of years of education in this cohort. TICS-M was highly correlated with MMSE (r = 0.57) and with CAMCOG (r = 0.62) scores. The time required to complete the test is comparable to MMSE and substantially less than CAMCOG. CONCLUSIONS: The normal distribution of TICS-M test scores suggest that this test is less constrained by the ceiling effect which limits the utility of MMSE and CAMCOG test scores in detecting early cognitive impairment. TICS-M is an appropriate instrument to assess cognitive function in both research and in clinical practice.     

Motivational symptoms of depression mask preclinical Alzheimer's disease in elderly subjects

BACKGROUND: Althoughthe relationship between depressive disorders and Alzheimer's disease (AD) is debated, there is evidence that depression may be an early symptom of dementia. OBJECTIVE: To evaluate depression features prospectively in elderly subjects with a view to identifying a subgroup affected by preclinical AD. METHODS: We performed a cohort study on cognitive performances with a 12-month follow-up in out-patients referred to the local Neuropsychology Clinic complaining of memory problems. Two hundred and twenty-two consecutive non-demented subjects were studied using a neuropsychological battery and the Beck Depression Inventory (BDI) and assessed again 1 year later for the possible onset of cognitive impairment. Multivariate analysis was performed to detect independent predictors of dementia development among age, education, neuropsychological test scores and BDI scores and subscores. BDI subscores were obtained by dividing items into three domains corresponding to mood-related, somatic and motivation-related symptoms. RESULTS: At the time of the first evaluation, 124 of the 222 subjects were depressed according to DSM-III-R criteria. At 1 year, 31 of the 124 depressed subjects and 2 non-depressed ones had AD according to NINCDS-ADRDA criteria. Stepwise logistic regression analysis indicated that the subjects who went on to develop dementia had significantly higher total BDI scores and motivational BDI subscores. Among depressed subjects, the probability of being diagnosed with dementia during follow-up was significantly associated with a motivational BDI subscore > or = 7 (odds ratio: 3,885, 95% Cl 154-97,902). COMMENT: Close neuropsychological follow-up of depressed elderly subjects complaining of memory failure and showing apathy is recommended to detect the early stage of AD.     

Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

BACKGROUND: Although the Sri Lankan population is ageing rapidly, dementia has not been systematically investigated here. The Mini Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly. OBJECTIVE: This study aimed to develop and validate a Sinhalese translation of the MMSE, which could be used as a screening instrument to detect impaired cognition in an epidemiological investigation of dementia in Sri Lanka. METHODS: Due to the high literacy rate in the country, the MMSE was translated and modified slightly without having to make major changes to the original version. 380 randomly selected subjects over 65 years in a semi-urban area were screened with the translated version of the MMSE. The cut-off score for cognitive impairment was taken as 17. Of the 380 subjects screened, 33 scored < or = 17, and were thus considered cases of suspected dementia. All 33 who scored < or = 17 and 24 randomly selected subjects who scored>17 on the MMSE, thus considered cognitively normal, underwent a brief clinical examination and neuropsychological assessment with the more comprehensive neuropsychiatric test battery, Cambridge Cognitive Score (CAMCOG), to determine the presence of dementia. RESULTS: Evaluated against the performance at the CAMCOG, the sensitivity and specificity of the translated MMSE were 93.5% and 84.6% respectively. CONCLUSION: Therefore, the Sinhalese translation of the MMSE described here is a sensitive instrument to screen for dementia in Sri Lanka.     

Adaptive cognitive testing in dementia

The objective of this study was to investigate whether the Cambridge Cognitive Examination (CAMCOG), a widely used screening test for dementia, can be tailored to the individual patient with Computerized Adaptive Testing (CAT). CAT accomplishes this by only using items that are appropriate for the level of ability of the patient under investigation. Potential advantages of CAT for clinical practice and research are efficient cognitive testing and a reduction of the test burden in elderly patients and consequently less measurement error during testing. In a two step method with previously collected CAMCOG data (n = 797) (1) patient abilities and CAMCOG item difficulties were estimated with the One Parameter Logistic Model (OPLM), a Rasch type of model. CAT was then used (2) to re‐estimate the patient abilities. Despite an average test reduction of 60%, CAT estimates were in excellent agreement (intra‐class correlation >0.98) with the results based on the entire CAMCOG and they also had similar accuracy for the diagnosis of dementia (area under the curve 0.91) as the original CAMCOG. These results were replicated in an independent sample (n = 170). We conclude that tailored testing with CAT enables much more efficient screening for dementia than testing with an extensive instrument. Copyright © 2009 John Wiley & Sons, Ltd.     

Adapting mini-mental state examination for dementia screening among illiterate or minimally educated elderly Chinese

BACKGROUND: Illiteracy is prevalent among current elderly Chinese. There are few brief cognitive tests in Chinese designed to screen those possibly demented for more detailed evaluation in a clinical setting. OBJECTIVES: The present study adapted the Mini-Mental State Examination (MMSE) for screening dementia among illiterate or less educated elderly Chinese. METHODS: Literacy-dependent items of the MMSE were modified or substituted by equivalent items that are not literacy-dependment. Some items were modified to provide socio-cultural compatibility. After developing it, the Chinese adapted MMSE (CAMSE) was administered to 370 elderly outpatients from Xijing hospitals located in Xi'an, China, 93 of whom were found to be demented and 277 non-demented. Sensitivities and specificities for detecting dementia were evaluated by adjusting for different CAMSE cut-off points. The optimal cut-off points of 22 for literates and 20 for illiterates yielded a sensitivity of 83.87% and a specificity of 84.48%. Corresponding positive predictive value (PPV) was 0.65, and negative predictive value (NPV) was 0.94. The impact of literacy on CAMSE and individual test items was also evaluated. Illiterate subjects got a higher CAMSE total score than literate subjects (p < 0.05). Only one out of 12 test items, serial sevens, was negatively influenced by illiteracy (p < 0.01). After an interval of 4-6 weeks, 32 randomly selected subjects were retested with CAMSE. The test-retest reliability for total scores was 0.75 (p < 0.01). CONCLUSIONS: Results suggest that in the socio-cultural context for Chinese, irrespective of their literacy skills, CAMSE proved feasible for use in clinical settings for dementia screening.     

Agitated behaviours among the institutionalized elderly with dementia: validation of the Korean version of the Cohen-Mansfield Agitation Inventory

OBJECTIVES: To analyze the factor structure, the criterion validity, the internal consistency, inter-rater reliability and test-retest reliability of the Korean version of Cohen-Mansfield Agitation Inventory, to provide data on the frequency and distribution of agitated behaviours, and to compare patterns of agitated behaviours among the institutionalized elderly with Alzheimer's disease (AD) or Vascular dementia (VaD). METHODS: The Korean version of the Cohen-Mansfield Agitation Inventory (CMAI-K) was administered to a total of 257 elderly with AD or VaD in a nursing home in Seoul, Korea. Three kinds of reliability and criterion validity were tested. Factor analysis using principal component analysis with the varimax rotation was performed. To identify different patterns of agitated behaviours, multiple logistic regression analysis was used. RESULTS: This study demonstrated satisfactory reliability and validity for the CMAI-K as an instrument measuring agitation in Korean dementia sufferers in nursing homes. Eighty-three percent of the subjects manifested one or more agitated behaviours at least once a week. Factor analysis yielded four subtypes of agitation: physically aggressive behaviours, physically nonaggressive behaviours, verbally agitated behaviours, and hiding/hoarding behaviours. CONCLUSION: These results indicate that the CMAI-K is a reliable and valid instrument to measure agitated behaviours in Korean elderly with AD or VaD. These results validate and expand previous research on the agitation in dementia, and guide in the development of interventions.     

Are the clock-drawing test and the MMSE combined interchangeable with CAMCOG as a dementia evaluation instrument in a specialized outpatient setting?

This study examines whether the Clock-Drawing Test (CDT) combined with the Mini-Mental State Examination (MMSE) is interchangeable with the more detailed and lengthy Cambridge Cognitive Examination (CAMCOG) as a dementia evaluation instrument in a specialized psychogeriatric outpatient setting: 114 outpatients (88 with dementia, 26 with depressive and anxiety disorders) were included. Each subject underwent a comprehensive evaluation in which the CAMCOG (MMSE included) was administered. DSM-IV diagnoses were independently established. CAMCOG-derived clock drawings were blindly scored according to Freedman's method. The authors found that a combination of CDT and MMSE enhanced the psychometric properties of the above scales approximating them to CAMCOG's. They conclude that CDT in combination with the MMSE is valid for differentiation of dementia sufferers from nondemented psychiatric controls in a specialistic setting and might replace CAMCOG. However, the generalizability of these findings (a wider range of diagnoses, primary care settings) still needs to be verified.     

Decline across different domains of cognitive function in normal ageing: results of a longitudinal population-based study using CAMCOG

Dementia is an important cause of disability in the elderly. There is evidence that cognitive impairment in dementia is on a continuum with cognitive impairment in the non-demented elderly. In order to investigate this possibility, we need detailed knowledge about the population distribution of cognitive function and change in cognitive function. The aim of this study is to describe the change in different domains of cognitive function over 4 years in a population-based sample of non-demented elderly people, and to investigate the effect of sociodemographic variables and baseline cognitive function on change in each of the cognitive domains. Respondents from two group general practice lists (n = 503) were interviewed using the Cambridge Cognitive Examination (CAMCOG) at the incidence wave of the Cambridge City Over-75 Cohort Study and after a mean time period of 3.9 years. One hundred and thirty five of 212 non-demented subjects seen at follow-up completed the CAMCOG at both interviews. The annual rate of change in total CAMCOG score was -1.6 points per year (p < 0.001). There was statistically significant decline in all of the CAMCOG subscales. Greater decline in the Memory subscale was associated with less education (p = 0.03). Greater decline in the Attention/Calculation subscale was associated with manual social class (p = 0.05). Greater decline in the Perception subscale was associated with older age (p = 0.03). Decline in specific cognitive domains may indicate a reversible phase of cognitive impairment and deserves further investigation.     

'Yes' ifs, ands or buts: examining performance and correlates of the repetition task in the mini-mental state examination.

The aim of this study was to examine whether the type of sentence used in the repetition task included in the Mini-Mental State Examination (MMSE) affected performance in a group of 79 demented and 19 non-demented Hebrew-speaking elderly persons. The cognitive functioning of the participants was assessed using the MMSE and CAMCOG examinations. The performance of the repetition task was evaluated by using three sentences: the literal translation of the English language expression used in the original MMSE; a well-known Hebrew proverb consisting of monosyllabic words and rhythmic effects; and another well-known Hebrew proverb without such attributes. Only a third of the participants successfully repeated the literally translated expression. It showed low predictive value and was highly affected by education. The well-known Hebrew monosyllabic proverb showed moderate predictive value but no discriminatory ability. The other well-known Hebrew proverb performed the best. The translation of the repetition task in the MMSE to other languages is problematic. Strict adherence to the original language proved to be the least desirable choice.     

Unequal distribution of cognitive deficits in vascular dementia – is this a valid criterion in the ICD‐10?

OBJECTIVE: To investigate the appropriateness of the ICD-10 criterion for vascular dementia which requires unequal distribution of deficits between different domains of cognitive function. DESIGN: Cross-sectional comparative study. SETTING: Referrals to a specialist memory clinic in Sheffield and a community sample of patients from a general practice population in Melton Mowbray. METHOD: The CAMCOG part of the Cambridge mental disorders of the elderly examination (CAMDEX) was assessed for 131 Sheffield subjects and 396 Melton Mowbray subjects to examine both total variability and differences between individual subscale items. Depression was also examined as this was a potential confounding factor. RESULTS: After adjustment for age, sex and depression scores, there were no significant differences between vascular dementia subjects and Alzheimer's disease subjects at either centre for total variability of cognitive deficits and little difference between diagnoses for individual subscale items. In Sheffield, subjects with vascular dementia had significantly higher depression scores compared to those with Alzheimer's disease. CONCLUSIONS: The usefulness of the concept of unequal deficits as a diagnostic criterion for vascular dementia in routine clinical practice is doubtful.     

Is caring for elderly relatives with depression as stressful as caring for those with dementia? a pilot study in melbourne

The 30-item General Health questionnaire (GHQ-30) scores of the primary carers of 31 elderly patients with depression were compared with the GHQ-30 scores of 30 primary carers of dementia sufferers. Carers of dementia sufferers who lived with their demented relative had GHQ-30 scores almost four times higher than those carers who lived apart from a dementia sufferer. There was no difference in the GHQ-30 scores of carers of depressed subjects living with or apart from their affected relative. Carers of demented patients tended on average to have higher GHQ-30 scores than carers of depressed patients, but this difference was almost entirely accounted for by the fact that more carers of demented patients lived with their ill relatives. Patient and carer age and sex and severity of patients' depression were not related to the GHQ-30 scores of their carers.     

Diagnosing ADHD in Israeli adults: the psychometric properties of the adult ADHD Self Report Scale (ASRS) in Hebrew

This paper argues for the importance of diagnosing ADHD in adults, while acknowledging the many attendant difficulties. The paper presents results from two studies implementing the Adult ADHD Self Report Screen (ASRS) in Hebrew. The Hebrew version of the ASRS as approved by the World Health Organization is appended to this paper. The first of the two studies used a paper and pencil version of the ASRS (ASRS_PP) and the second used a computer administered version (ASRS_C). A subset of the participants in the two studies was given both versions. The Hebrew ASRS had excellent test-retest reliability. It had good internal consistency in both forms. Support for the validity of the Hebrew ASRS is given by the significantly higher scores of adults with ADHD versus those without, on both versions of the ASRS and on all of its subscales. The sensitivity of the raw sum of all 18 items was significantly higher than that of the 6-item screen suggested by the authors of the ASRS. The sensitivity and specificity of the ASRS in Hebrew should be further examined in future studies including clinically referred participants. The benefit of using the ASRS as part of the diagnostic process for adult ADHD is discussed.