Conversion Between the Mini-Mental State Examination and the Montreal Cognitive Assessment for Patients With Different Forms of Dementia

ObjectivesThe Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are 2 frequently used brief cognitive screening tasks. Here, we provide a conversion method from MMSE to MoCA for patients with Alzheimer's dementia, frontotemporal dementia, and Parkinson dementia/Lewy body dementia, as well as for patients with dementia and with or without previous stroke. This conversion is needed as everyday clinical practice varies in their use of the 2 scales, which makes comparisons between studies, meta-analysis, and patient cohorts difficult.DesignObservational cohort study.Setting and ParticipantsA total of 387 patients with recently diagnosed dementia in memory clinics from the Swedish registry for cognitive/dementia disorders (SveDem) from 2007 to 2018.MethodsOverall, 387 patients of the Swedish registry for cognitive/dementia disorders with both MMSE and MoCA scores were evaluated. An equipercentile equating method was used to convert MMSE to MoCA scores in the different patient populations. Furthermore, receiver operating curves were used to examine whether MMSE or MoCA scores can distinguish between patients with different dementia types.ResultsMMSE scores were converted to MoCA scores for all dementia types and depicted in a conversion table. Results show that the equipercentile equating method and log-linear smoothing allow the creation of a conversion table in which for each test score of the MMSE, the equivalent score of the MoCA for each investigated group can be looked up (and vice-versa).Conclusions and ImplicationsThis study reports a reliable and easy conversion for transforming MMSE to MoCA scores (and vice-versa) in patients with Alzheimer's dementia, frontotemporal dementia, Parkinson dementia or Lewy body dementia, as well as patients with dementia with and without previous stroke.     

Correlates of mini-mental status examination scores among elderly demented patients: The influence of race-ethnicity

Data on 1888 patients seen at Alzheimer's Disease Diagnostic and Treatment Centers in California were used to examine possible differences in Mini-Mental State Examination (MMSE) results for different racial-ethnic groups. White patients had scores less indicative of dementia than Black and Hispanic patients using the standard 23 cutting point on the MMSE. However, there were no differences among these groups in the percentages clinically diagnosed as demented. The difference in the percentage of Whites vs Blacks and Hispanics categorized as demented by the MMSE was not accounted for by education, occupation, age, sex, or other variables tested, even though these variables were correlated with MMSE scores. Our data suggest that clinicians should consider MMSE scores for Black and Hispanic patients an underestimate of their cognitive capabilities relative to that of White patients.     

A cognitive screening battery for dementia in the elderly

The objective of this study is to propose a screening instrument for dementia based on a reduced number of neuropsychological tests. The sample consists in the pooled data of the five follow-up visits of the Paquid cohort study on cerebral aging: the estimation sample included 2792 subjects (8830 observations) and the validation sample included 985 subjects (2643 observations). Among scores significantly associated with dementia, we retained only those that increased the specificity of the model for a sensitivity of one. Seven neuropsychological tests and the MMSE subscores were considered. The most discriminant combination of tests included the MMSE and the subscores "orientation to time" and "recall three objects," the Benton Visual Retention Test, and Isaacs' Set Test of verbal fluency. The specificity of this screening instrument was 0. 77 for a sensitivity of 1.     

Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia

OBJECTIVES: This study assesses the properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. A specific purpose was to determine whether an abbreviated version would be as accurate as the original MMSE in predicting dementia. STUDY DESIGN AND SETTING: A population-based post hoc examination of the performance characteristics of the MMSE for detecting dementia in an existing data set of 243 elderly persons. RESULTS: Sensitivity, specificity, and predictive values were computed for the original MMSE as well as new MMSE scale models derived from a Rasch model item analysis. The optimal threshold for the original MMSE screen yielded sensitivity and specificity estimates of 72.5% and 91.3%, respectively. The use of a subscale resulted in a slightly lower sensitivity (71.0%), specificity (88.4%), and positive predictive value (71.0%) but equal area under the receiver operating characteristic curve. Cross-validation on follow-up data confirmed the results. CONCLUSION: A short, valid MMSE, which is as sensitive and specific as the original MMSE for the screening of cognitive impairments and dementia is attractive for research and clinical practice, particularly if predictive power can be enhanced by combining the short MMSE with neuropsychological tests or informant reports.     

Toward constructing a system for detecting and coping with senile dementia in early stages among community-dwelling older people

OBJECTIVES: To establish a community health care system for screening community-dwelling older people with mild cognitive decline (MCD) and early diagnosis by a medical specialist. METHODS: Out of all the elderly residents aged 65 years and over living in Yoita town in 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent a Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires covering socio-demographic, psychological, physical and medical, and social activity items (2000/11). We defined cognitive decline as an MMSE < or = 1 SD below the age-specific mean (n = 371). Out of a total eligible population of 332, 158 pairs of subjects and their proxies participated in a follow-up survey (2001/11). The subjects themselves underwent MMSE again, and were asked for complaints of memory-related problems. Proxies answered about functional capacity and memory-related problems of subjects, for which we assessed the level of dementia with the Clinical Dementia Rating (CDR). We established criteria for encouragement to undergo detailed examination by a medical specialist as follows. 1) MMSE scores < or = 1 SD below age-specific means at both baseline and follow-up surveys, or 2) CDR > or = 0.5, and 3) not due to mental retardation. RESULTS: Non-participants had significant higher MMSE scores but were younger in the follow-up survey. Out of 96 subjects eligible for the detailed examination, 47 participants showed a tendency for older age with lower MMSE scores or younger age with higher MMSE scores than the average in the follow-up survey. The detailed examinations confirmed dementia of Alzheimer's type in 22 and vascular dementia in 13 on DSM-IV or magnetic resonance imaging. During our screening, 8 community care saloons were opened and the number of facilities for older people with cognitive decline is increasing. CONCLUSIONS: To establish a community health care system to screen and cope with community-dwelling older people with MCD in earlier stages, increased awareness of residents with slight MCD is especially important. Our attempt also suggested the importance of educational lectures, methods for testing cognitive function, and dementia care activity.     

A combination of tests for the diagnosis of dementia had a significant diagnostic value

OBJECTIVE: To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in general practice and the added diagnostic value of these tests. STUDY DESIGN AND SETTING: Cross-sectional diagnostic research in general practice. Participants: 152 persons aged 65 plus. The Mini-Mental State Examination (MMSE), the Clock Drawing Test, the ADMP scale, the Timed Up and Go Test, the Extrapyramidal Sign Scale, the Behavior Observation Scale, the Poon-Baro-Wens computer battery, and the Cognitive Drug Research Computerized Assessment System were evaluated against the Dutch version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX-N). Diagnostic characteristics were calculated with their 95% CI. Using forward stepwise logistic regression analysis, a model was built with CAMDEX-N as the dependent variable and the tests under study as independent variables. Area under the curve was the main parameter for the comparisons. RESULTS: The main diagnostic gain results from age and ADMP, followed by the Clock Drawing Test. Subsequent addition of the MMSE and computer tests results in modest additional gain only. The final model including five tests has an area under the curve of 0.95. CONCLUSION: Sophisticated neuropsychological computerized tests have little added value in the diagnostic work-up of dementia in general practice. Basic clinical tests used in an appropriate sequence can be very valuable in establishing the diagnosis of dementia.     

Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report

This study sought to determine whether the augmentation of cognitive testing with an informant report questionnaire could improve accuracy in screening for dementia in a community setting. The sample consisted of 646 subjects aged 70-93 years. Cognitive state was assessed using the Mini-Mental State Examination (MMSE). Informants completed the 16-item short form of the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Dementia was diagnosed according to DSM-III-R criteria. Combination of the IQCODE with the MMSE resulted in more accurate prediction of caseness than either test alone. Receiver Operating Characteristic analysis demonstrated the superior screening performance of a logical "or" rule and a weighted sum of scores on the two tests over other methods of combination, replicating previous clinically based research. The findings also suggest that the appropriate combination of existing tests may be a fruitful method of improving screening accuracy in a variety of situations.     

Validation of the neurobehavioral cognitive status examination and the Rivermead Behavioural Memory Test in investigations of dementia

The aim of this retrospective study was to validate two commonly used instruments, Cognistat and the Rivermead Behavioural Memory Test, RBMT, for detection of MCI and mild dementia. Two different diagnosis groups, mild cognitive impairment (MCI) and Alzheimer's disease combined with mixed dementia representing mild dementia (MD), were compared with a group of patients who did not receive a diagnosis of dementia. All patients were assessed at a specialized outpatient memory clinic in a university hospital in Sweden using the Mini Mental State Examination (MMSE), Cognistat, and RBMT. Sensitivity, specificity, predictive value, and likelihood ratio were calculated for the tests. The Cognistat and RBMT have moderate validity in the detection of MCI and mild dementia. On their own, none of the tests used is sufficient for diagnosing MCI or mild dementia. A combination of the Cognistat and RBMT provides additional information in early stage dementia; in this regard the RBMT is better than the Cognistat, which also has other limitations. The RBMT can be helpful for distinguishing between MCI and mild dementia. There is a need for a more sensitive screening test to capture early cognitive impairment related to patients' occupational performance and problems in daily life.     

Adaptation of dementia screening for vision-impaired older persons: administration of the Mini-Mental State Examination (MMSE)

In epidemiologic field studies on the prevalence and incidence of dementia the problems associated with the cognitive testing of visually impaired individuals are rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the Mini-Mental State Examination for the visually impaired (MMSE-blind) was employed from which all items requiring image processing had been omitted. To be able to interpret the test results and include vision-impaired individuals in the field study, the scores for the full MMSE were estimated by conducting linear transformation of the scores obtained on the MMSE-blind. The method of linear transformation is based on certain theoretical assumptions that are examined in this article. Linear transformation of scores has proved to be a valid procedure only for individuals with very high or very low cognitive performance. Thus, evaluation of the estimated full MMSE scores based on the norms for the original MMSE is not recommended. A blind version of the MMSE with age- and education-specific norms that has been validated as a screening tool for dementia is therefore presented.     

Mini-Cog: a simple method for very brief screening of mental decline

INTRODUCTION: Physicians do not detect majority of the demented people, and many patients appear only in an advanced stage of their mental decline at the first medical visit. Role of general practitioner is crucial; a brief and effective screening method can basically change the present situation. Borson et al (2000) has investigated a new, very brief method named Mini-Cog that consists of the combination of the 3-word recall and the clock-drawing test. AIM: of the present study was to evaluate this method in Hungarian patient population. METHODS: Authors have analysed the charts of patients examined by the first author in the outpatient part of the Memory clinic of the National Institute of Psychiatry and Neurology in a 2-year interval (between 11.01. 1999 and 31.10.2001). Data of 186 patients were analysed. From the Mini-Mental State the total score, score of three-word recall (possible scores between 0-3), serial counting backward with 7 from 100 were taken into consideration; the clock-drawing test was analysed quantitatively (1 = failure, 2 = borderland, 3 = acceptable solution). RESULTS: The algorithm which considers the patient demented if she or he does not remember of any word, or remembers only of 1-2 and the clock-drawing is pathologic, has a high sensitivity (100%) and specificity (80.9%) in cases using the < or = 24 Mini-Mental State value, while the sensitivity and specificity is 98.8% and 88.0% respectively if drawing the limit at < or = 26 points. Combination of the two tests (word-recall, clock drawing) gives a better value than either of them alone. Based on their experiences they propose to apply in a short test the serial backwards with seven from 100 too, while patients with very high Mini-Mental State scores (29-30) not infrequently can not perfectly solve this subtest (7/11 = 64 p.c.). CONCLUSION: In agreement with the Hungarian Protocol for diagnosing and treating dementias (1999) authors stress the importance of the consultation with a specialist (neurologist or psychiatrist) in cases of suspected dementia to reveal the underlying disease.     

Prediction of probable Alzheimer disease in patients with symptoms suggestive of memory impairment. Value of the Mini-Mental State Examination

BACKGROUND: The Mini-Mental State Examination (MMSE) is a widely used diagnostic tool for dementia. Its use as a predictive indicator of probable Alzheimer disease (AD) has not been established. OBJECTIVES: To determine the accuracy of the MMSE in predicting emergent AD in a sample of patients who were referred because of symptoms suggestive of memory problems and to determine whether an abbreviated version of the MMSE could be developed that would be as accurate as the full MMSE in predicting emergent AD. DESIGN: Inception cohort of participants with symptoms suggestive of memory impairment by their family physicians were given baseline assessments, including MMSE. After 2 years, the participants' conditions were diagnosed following the standard criterion for AD. Diagnosticians were blind to baseline scores. SETTING AND PARTICIPANTS: One hundred eighty-three community-residing participants were referred by their family physicians to a university teaching hospital research investigation. After baseline screening, 165 participants were included in the study who did not have dementia and had no identifiable cause for memory impairment. After 2 years, 29 participants met criteria for AD, 98 did not develop dementia, 18 developed vascular lesions or non-AD dementia, and 20 did not return. MAIN OUTCOME MEASURE: Diagnostic classification of AD or no evidence of dementia. RESULTS: Logistic regression model was significant. At a cutoff score of 24 or less, sensitivity was 31%; specificity, 96%; with a likelihood ratio of 7.75. A reduced model of 2 subtests was identified with a sensitivity of 41%; specificity, 98%; with a likelihood ratio of 20.70. CONCLUSIONS: Results suggest that the full or abbreviated MMSE is useful in predicting emergent AD in patients with positive test results. However, it is not recommended for use as a screening or diagnostic instrument since a negative test result did not rule out emergent AD. It is recommended as a tool to identify those needing closer monitoring.     

Group screening for cognition disorders in elderly persons

Prevalence rates of cognitive impairment in persons aged 75 to 85 years are in the range of 10 to 19 percent, and 20 to 47 percent after the age of 85 years. Screening for dementia in persons aged 75 years and older would therefore identify a significant number of impaired persons. When screening for dementia, group testing would be more cost-effective than individual testing. We modified the Folstein Mini-Mental State examination (MMSE) for screening in a group setting. Community volunteers were tested at a geriatric health fair and at a special exercise class for the elderly. Subjects were subsequently tested individually using the standard Folstein MMSE. Analysis using Pearson correlation and a paired t-test indicates a high degree of concurrent validity between the two methods of administering the MMSE. This pilot study suggests that when screening elderly persons for dementia, a group-administered instrument can be a useful method to obtain a preliminary sample of cognitively impaired individuals.     

Dementia Screening and Surveillance

The prevalence of dementia, and in particular Alzheimer’s disease, is expected to increase dramatically in the elderly population over the next few decades. Because of the possibilities of pharmacological and psychosocial interventions, which aim to slow down or even prevent progress of the disease, early detection of dementia is of the utmost importance. The screening of patients at risk is the first step in the detection of dementia and should be undertaken at the primary healthcare level. A history and mental state examination is necessary for all patients, and in particular for elderly patients, who have had cognitive complaints and/or reports of cognitive decline. Useful screening tests for dementia are either the Mini-Mental State Examination (MMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); an MMSE score <27 and an IQCODE score >3.31 indicate a possible dementia and should be further investigated. However, neither MMSE nor IQCODE should be used as a diagnostic tool.Because of the heterogeneity of the deficits and the absence of a biological marker, the diagnosis of early degenerative dementias can be very complex and requires a multidisciplinary approach. Basic routine investigations carried out at the general practitioner (GP) level include physical and neurological examinations, a laboratory screen and a computerised tomography or magnetic resonance imaging examination. A neuropsychological examination is necessary to establish the diagnosis and there is promising evidence for the predictive value of some specific tests for Alzheimer’s disease. Complementary investigations such as functional neuroimaging, electroencephalogram and CSF investigations, may be indicated in some cases.Efficient management programmes can only be effective if they are implemented as early as possible and adapted regularly to the changing needs of patients with dementia and their caregivers. The creation of health teams working in the community under the supervision of a GP seems to be a promising model for the care of the patient with dementia living in the community.     

Influence of educational status on a screening test for dementia, the Mini-Mental State Examination]

This study aimed to examine the relationships between the educational level and the Mini-Mental State Examination (MMSE) total scores and its different items. In a survey dealing with cerebral aging, the MMSE administered 2,792 subjects aged 65 years and over, who continued to live at home. The total score decreased with age and increased markedly when the educational level rose. The proportion of failures was higher than or equal to 10% for 12 of the 30 MMSE items, including the 5 items designed to measure attention ability (serial subtractions) and the 3 ones exploring delayed memory. Regarding these 12 items, the percentage of failures increased homogeneously with age, but the relationship with educational level was heterogeneous: it was very strong for the calculation items, weaker for the delayed memory items. These results pointed to the complex relationships between MMSE scores and educational level, and suggested a possible bias related to the screening tool in dementia surveys.     

Cognition and Screening for Hearing Loss in Nursing Home Residents

ObjectivesTo compare hearing screening results using pure tones and distortion product otoacoustic emissions (DPOAEs) with nursing home residents who have dementia and explore the relationship of hearing impairment and cognitive function using the Mini- Mental Status Evaluation (MMSE).Design and SettingA correlational design was implemented to evaluate residents in a large inner city nursing home.ParticipantsOne hundred one nursing home residents 65–108 years.MeasurementsDPOAEs and pure tone screenings were conducted at 30 dB HL and 40 dB HL at 1, 2, and 3 kHz. Pure tone thresholds at 1, 2, and 3 kHz were obtained. The MMSE was administered to all participants.ResultsResults showed that all residents failed the DPOAE screen, 97.1% failed at 30 dB HL, and 90.0% failed at 40 dB HL. Kendall’s tau, phi correlation, linear by linear association, and χ² results indicated no significant relationship for any of the screening protocols and cognitive status other than a significant finding with left ear screening at 40 dB HL. Logistic regression analysis indicated that individuals who passed the screen had better MMSE scores. Results of the t test and Mann-Whitney U test revealed a significant difference in cognitive function for residents with a mild hearing loss compared with those with a more significant hearing loss.ConclusionFor screening nursing home residents, 40 dB HL screening level or DPOAEs can be used. The significant finding that residents with greater than a mild hearing loss have poorer cognitive function reinforces the importance of identifying residents with a hearing loss and providing rehabilitation and follow-up.     

Prevalence of dementia among elderly people in Troina,Sicily

We performed a two-stage survey on the prevalence of dementia among people aged over 74 in Troina, northern Sicily, Italy. During the first stage people were screened by the Mini Mental Status Examination (MMSE), previously validated in our population for the cut-off score with 100% sensitivity and the best specificity to diagnose dementia. During the second stage people scoring 19 or less at the MMSE test were invited to be examined by a neurologist who diagnosed dementia according toDSM-III R. Out of 365 subjects of the initial sample 347 were screened by MMSE test and 163 scored 19 or less. Of these, 135 were neurologically and neuropsychologically examined in the second stage, and 80 proved to be demented. The minimal estimate of prevalence of dementia in our sample was 21.9% (21.9% men, 21.8% women). The poor education and psychosocial life may be the underlying condition favoring dementia in this sample of elderly people.     

北京市宣武区社区老年糖尿病患者认知功能障碍调查

目的 评价社区老年糖尿病与认知功能障碍之间的关系及影响因素.方法 在宣武区社区居民健康体检管理档案中,随机抽取符合2型糖尿病诊断标准的糖尿病患者308例,其中单纯糖尿病144例,糖尿病合并高血压164例,作为研究对象,并随机抽取了225例高血压病和186例相同年龄段及性别的社区健康老人作为对照组,进行MMSE测查,根据DSM-IV痴呆诊断标准及轻度认知功能障碍（MCI）诊断标准分为认知功能正常组、MCI组及痴呆组.结果 单纯糖尿病组MMSE评分低于正常对照组（25.87±3.33 vs 26.86±2.82,F=9.62,P〈0.01）,糖尿病合并高血压组MMSE评分（24.68±4.36）明显低于正常对照组（F=37.16,P〈0.01）.结论 老年糖尿病与认知功能障碍之间存在正相关,糖尿病是老年人痴呆的危险因素.糖尿病合并高血压时,可加重认知功能障碍.     

Nutritional predictors of cognitive impairment severity in demented elderly patients: The key role of BMI

Introduction

The body mass index (BMI) is commonly used to assess nutritional status and the Mini Mental State Examination (MMSE) is a validated tool for assessing cognitive status in elderly people. Nutritional and cognitive aspects are closely related in dementia.

Objectives

To establish whether BMI predicts cognitive decline in demented patients and whether an ??alarm?? BMI cut-off exists for declining MMSE scores.

Subjects and methods

82 elderly demented patients underwent clinical, bio-chemical and functional assessment.

Design

Transversal study.

Results

The mean BMI was 26.08±4.48 kg/m₂ and the mean MMSE 18.68±5.38. Patients with BMI<25 kg/m₂ had significantly lower MMSE scores (16.5±5.53 vs 20.38±4.64; p 0.001), fat-free mass (FFM; 27.76±8.99 vs 37.38±10.58 kg; p<0.001), fat-free mass index (FFMI; 11.52±3.03 vs 14.67±2.89 kg/m₂; p<0.001), and fat mass (FM; 24.90±6.89 vs 36.86±6.77 kg; p<0.001), as well as lower Mini Nutritional Assessment (MNA) scores (23.80±2.50 vs 25.00±2.29; p=0.03) and higher vitamin B12 levels (460.95±289.80 vs 332.43±82.07 pg/ml; p=0.01). In the sample as a whole, MMSE scores significantly correlated with scores for MNA (r=0.27, p=0.01), FFM (r=0.27, p=0.01), BMI (r=0.19, p=0.05), ADL (r=0.28, p=0.01) and instrumental activities of daily living (IADL; r=0.34, p=0.002). On multiple logistic regression, BMI<25 kg/m₂ was independently associated with the risk of moderate-severe cognitive impairment (OR=2.96; 95% CI; 1.16?C7.55) and female gender was independently associated with severity of dementia (OR=3.14; 95% CI; 1.09?C9.03).

Conclusion

BMI seems to indicate global health status in elderly demented people and a BMI of 25 kg/m² can be considered an ??alarm?? cutoff, lower values coinciding with a worse cognitive status based on MMSE scores.     

Mini-Mental Status Examination: mixed Rasch model item analysis derived two different cognitive dimensions of the MMSE

OBJECTIVES: This study published in two companion papers assesses properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. STUDY DESIGN AND SETTING: An item analysis by conventional and mixed Rasch models was used to explore empirically derived cognitive dimensions of the MMSE, to assess item bias, and to construct diagnostic cut-points. The scores of 1,189 elderly residents were analyzed. RESULTS: Two dimensions of cognitive function, which are statistically and conceptually different from those obtained in previous studies, were derived. The corresponding sum scales were (1) age-correlated MMSE scale (A-MMSE scale: orientation to time, attention/calculation, naming, repetition, and three-stage command) and (2) non-age-correlated MMSE scale (B-MMSE scale: orientation to place, registration, recall, reading, and copying). The "writing" item was not included due to differential effects of age and sex. The analysis also showed that the study sample consisted of two cognitively different groups of elderly. CONCLUSIONS: The findings indicate that a two-scale solution is a stable and statistically supported framework for interpreting data obtained by means of the MMSE. Supplementary analyses are presented in the companion paper to explore the performance of this item response theory calibration as a screening test for dementia.     

A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview

ObjectivesBrief screening scales for caregiver burden are much needed in routine dementia services to efficiently identify caregivers of persons with dementia (PWD) for further intervention. Although the 22-item Zarit Burden Interview (ZBI) is often used, its available screening versions have not performed as well as the full version in distinguishing significant burden. We developed a brief screening scale that is valid and comparable to ZBI in distinguishing caregiver burden.Design and settingBaseline data of an ongoing cohort study.ParticipantsFamily careivers of community-dwelling PWD (n = 394).MeasuresParticipants completed questionnaires containing ZBI and other caregiving scales. Initially, we split the study samples into 2—the derivation sample (n = 215) was used to develop a brief scale that best distinguishes significant burden (using the best-subset approach with 10-fold cross-validation), whereas the validation sample (n = 179) verified its actual performance in distinguishing significant burden. We then evaluated the derived scale in its internal consistency reliability, factorial validity, known group validity, and construct validity, and mapped the scores between the brief scale and ZBI using the equipercentile equating method.ResultsWe derived a 3-item scale which had comparable performance to ZBI in distinguishing significant burden (area under the receiver operating characteristic curve 0.86, 95% confidence interval 0.81-0.92). It had a single dimension in exploratory factor analysis and maintained good psychometric properties similar to those of ZBI. It also explained 77.8% of the variability in ZBI, and had scores that could be mapped to ZBI with reasonable precision.Conclusions and ImplicationsWe have derived a highly accessible tool to screen for caregiver burden, which can have a wider health system effect of expanding the reach of caregiver-focused interventions to services involved in the care of PWD. Notably, this screening tool was developed using rigorous methods and demonstrated comparability to ZBI in its validity, reliability, and total scores.