The Revised Hasegawa's Dementia Scale (HDS-R)-Evaluation of Its Usefulness as a Screening Test for Dementia

TLDR: The revised Hasegawa's dementia scale (HDS-R), consisting of 9 simple questions with a maximum score of 30, was examined in its usefulness for screening age-associated dementia in a total of 157 subijects and proved to be valid in terms of compatability with the established dementia screening test.

Abstract: Revised Hasegawa's dementia scale (HDS-R), consisting of 9 simple questions with a maximum score of 30, was examined in its usefulness for screening age-associated dementia in a total of 157 subijects: 95 demented patients and 62 non-demented persons. The two groups were age-matched. Cronbach's coefficient alpha was as high as 0.90 in HDS-R. In addition, the coefficient of correlation of each question's score to the total score of other questions in the IHDS-R was significantly high, ranging between 0.79 and 0.40. These findings proved that the HDS-R could satisfy the fundamental prerequisite for dementia screening tests: reliability in terms of internal consistency. Clinical applicability of the HDS-R was confirmed by the following two findings. (a) significant differences were noted between the demented and non-demented groups in each question's score, total mean score and mean score by DS-based severity. (b) Dementia could be most exactly discriminated from non-dementia with sensitivity of 0.90 and specificity of 0.82 at a cutoff point of 20/21 . The coefficient of correlation of the HDS-R to the MMSE was as high as 0.94, proving the HDS-R to be valid in terms of compatability with the established dementia screening test. In conclusion, the HDS-R can screen dementia at the highest conceivable accuracy and efficiency. It may also serve to assess the severity of dementia changing with time and the effect of pharmacotherapy and rehabilitation. Keywords: dementia, screening test, HDS-R, sensitivity, specificity INTRODUCTION Since the primary symptoms of dementia are cognitive decline, various intelligence tests such as the WAIS (Weschesler Adult Intelligence Scale) have f used for its assesment. However the WAIS is not generally able for screening for dementia since it takes too long to administer, and has not been adequately standardize for elderly subject with cognitive changes associated with normal aging. For the purpose of screening for dementia, questions dimild be eat answered key normal elderly persons, but individuals with dementa should find them difficult. Ideally, these should ba a standardized, simple and quick test of cognitive function for routine use by the physcian Many simple scales for assessment of dementia have been deVeloped and are currently in use. Of these, the Mini-Mental State Examination (MMSE) of Folstein et al. (1975) and the Dementia RAM Scale of Blessed et al. (1968) are perhaps the most widely used brief instruments for assessing severity. Hasegawa et al. (1974) developed and standardized a brief dementia screening scale, called the Hasegawa's Dementia Stale (HDS) which comprises 11 questions (Hasegawa 1983). The HDS have been the most widely accepted not only for clinical we in hospitals and elderly nursing home, but also epiderrdolcgxcal surveys in Japan (Hasegawa and hnad, 1989). However, a recent review of the HDS required us to reconsider some questions and study a feasibility for worldwide use. In consequence, we decided to delete the following five questions because they were judged to be obsolete or lacking universality: 1. The place of the subject's birth (since it is impossible to confirm without the presence of the subject's family). 2. The year of the termination of World War II in Japan (since it is not appropriate for international use and not even applicable to Japanese population). 3. The number of days in opte years (since it is very easily answered even by patients with dementia). 4. The name of the present prime minister in Japan (since it is not appropriate for intercultural use). 5. How long have you been here (since it needs advance information from person around the subject or lacks uniformity in answers among among individuals). Instead immediate recall of 3 words, delay recall of 3 words, and list-ratirg fluency were added. The HDS was recontructed in this manner and named the revised HDS (HDS-R). …