ArticleJournal of the American Geriatrics Society2025
Pulling Back the Curtain on Hospital Dementia Detection: Validation of the Informant-Based Clinical Dementia Rating.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Evaluating the accuracy and reliability of telephone-derived Clinical Dementia Rating scores: A comparative analysis with in-person assessments.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Validity of the two different scoring methods of the Clinical Dementia Rating scale in staging and detection of cognitive impairment in the Peruvian population.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Two Brief Steps, Better Foresight: Cognitive Screening and Adverse Outcomes in Older Adults Admitted From the Emergency Department.Journal of the American Geriatrics Society · 2026Article
- Frequent in dementia, deadliest without it: delirium and mortality in hospitalised older adults.Age and ageing · 2026Article
- Bedside cognitive screening to detect dementia and predict poor outcomes in hospitals.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundDementia often goes undetected in hospital settings, where cognitive assessments are challenging due to illness severity and delirium. This study aimed to (1) evaluate the accuracy of the Clinical Dementia Rating (CDR), based solely on knowledgeable informant reports, for detecting preexisting dementia and cognitive impairment in hospitalized patients compared to a gold-standard diagnosis, (2) and compare its performance to the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16).
methodsThis cross-sectional study assessed consecutive patients aged ≥ 65 admitted to inpatient units from five hospitals in Brazil. The informant-based CDR was administered to knowledgeable informants within 48 h of admission, capturing patients' cognitive status 3 months before hospitalization to avoid the influence of acute cognitive impairments. Blinded experts provided a gold standard clinical diagnosis of dementia or cognitive impairment no dementia (CIND) based on a 90-min comprehensive assessment, including a standardized neuropsychology battery. Areas under the curve (AUC) examined diagnostic accuracy.
resultsOf 65 participants (mean age = 79.4 years; women = 54%), 34% had dementia and 32% had CIND. Compared to the gold standard, the informant-based CDR showed excellent diagnostic accuracy for detecting dementia (AUC = 0.92; 95% confidence interval [CI] = 0.86-0.98) and cognitive impairment (AUC = 0.93; 95% CI = 0.88-0.98), with a cutoff of ≥ 1 showing 98% specificity for dementia and a cutoff of ≥ 0.5 showing 98% sensitivity for cognitive impairment. Compared to the IQCODE-16, the informant-based CDR had similar performance in detecting dementia and a nonsignificant slight advantage in identifying cognitive impairment (AUC = 0.93 vs. 0.84, p = 0.069), reducing unrecognized cognitive impairment based on medical record documentation from 70% to 2%.
conclusionsInformant-based CDR is a valid and efficient tool for detecting dementia and cognitive impairment in hospitalized older adults, supporting early diagnosis and guiding multidisciplinary interventions in acute care. Its use in routine hospitals may help clinicians reduce undetected cognitive impairment, enhance decision making, and improve patient care.
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