Dual-Stage Cognitive Assessment (DuCA)

Abstract

The Dual-Stage Cognitive Assessment (DuCA; Cui et al., 2023) is a two-stage screening tool designed for evaluating cognitive function in primary care settings. The initial rapid screening stage (Part 1) assesses verbal fluency, visual perception, and delayed recall within approximately 3 minutes. Individuals suspected of cognitive impairments then proceed to Part 2, which includes assessments of auditory sentence memory, category switching, and visual memory. The total score for the DuCA is a combination of scores from both parts. Additionally, the DuCA incorporates items related to prospective memory and metamemory, though these do not contribute to the overall score. The instrument has been administered to community-dwelling older adults, including those with normal cognition, mild cognitive impairment (MCI), and Alzheimer’s disease (AD). The discriminative capabilities, internal consistency, inter-rater reliability, and test-retest reliability of the DuCA have been reported.

Keywords

Cognitive Function; Cognitive Impairment; Cognitive Screening; Cut-Off Values; Geriatric Assessment; Primary Care

Authors

Cui, Liang; Zhang, Zhen; Huang, Lin; Li, Qinjie; Guo, Yin-Han; Guo, Qi-Hao

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Purpose

The DuCA aims to distinguish adults with cognitive impairment. It serves as a comprehensive multidomain assessment tool, encompassing evaluations of verbal, executive, and visuospatial functions, alongside a thorough assessment of memory function.

Validity

Discriminate Ability/Test Sensitivity/Test Specificity: The DuCA-part 1 demonstrated a discrimination ability for Alzheimer’s Disease (AD) similar to other established tools, with an Area Under the Curve (AUC) of 0.87 (95% confidence interval [CI] 0.848–0.883). This was comparable to Addenbrooke’s Cognitive Examination III (ACE III; Pan et al., 2022) (AUC = 0.86, 95%CI 0.838–0.874) and Montreal Cognitive Assessment Basic (MoCA-B; Huang et al., 2018) (AUC = 0.85, 95%CI 0.830–0.868). The DuCA-total showed a higher AUC of 0.93 (95%CI: 0.917–0.942) for AD discrimination.

When the cutoff for the DuCA-total was set at ≤ 15, the sensitivity was 98.5% and specificity was 80.0%. At a cutoff of ≤ 13, the sensitivity was 85.5% and specificity was 90.8%.

For discrimination ability concerning auditory and visual memory impaired MCI, the DuCA-total demonstrated superior discrimination compared to other tools. The AUC for MCI-A was 0.89 (0.871–0.913), for MCI-AV was 0.96 (0.951–0.970), and for other MCI was 0.91 (0.879–0.937).

Reliability

Internal Consistency: The standardized Cronbach’s coefficient for the first part of the DuCA was 0.56, while for the DuCA total, it was 0.78.
Inter-Rater Reliability: The inter-rater reliability for the DuCA total was reported as 0.98.
Test-Retest Reliability: With a 2-week interval, the test-retest consistency for the DuCA total was 0.95.

Factor Analysis

No factor analysis indicated.

Instrument: Dual-Stage Cognitive Assessment (DuCA)

Test Type: Original Screener
Format: Part 1 of the DuCA has a total score of 10 points, derived from verbal fluency (two points), visual perception (three points), and delayed recall (five points). Part 2 has a total score of 28 points, calculated from auditory sentence memory (six points), category switching (10 points), and visual memory (12 points). The overall total score is 38 points, obtained by summing the scores from Part 1 and Part 2. Items assessing prospective memory and metamemory are included but do not contribute to the total score.
Language Available: Chinese
Population Group: Human; Male; Female
Age Group: Adulthood (18 yrs & older); Middle Age (40-64 yrs); Aged (65 yrs & older)
Population Details: The study was conducted in China, with respondents comprising older adults with normal cognition, mild cognitive impairment, or Alzheimer’s disease.
Test Methodology: Test Reliability; Internal Consistency; Interrater Reliability; Test-Retest Reliability; Test Sensitivity; Test Specificity
Keywords: Cognitive function; Cognitive impairment; Cognitive screening; Cut-off values; Geriatric assessment; Primary care; Alzheimer’s Disease; Cutting scores; Primary Health Care; Screening Tests; Mild Cognitive Impairment

Authors

Author ORCID Identifier: No data is Available
Affiliation:

• Cui, Liang: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Zhang, Zhen: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Huang, Lin: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Li, Qinjie: Shanghai Jiao Tong University School of Medicine Department of Gerontology

• Guo, Yin-Han: University of Queensland Faculty of Medicine

• Guo, Qi-Hao: Shanghai Jiao Tong University School of Medicine Department of Gerontology
  Email Addresses: No data is Available
  Correspondence Address:
  Guo, Qi-Hao: Shanghai Jiao Tong University School of Medicine, Department of Gerontology, Shanghai Sixth People’s Hospital, Shanghai, China, 200233, [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching
Commercial Use: No
Fee: No
Test Year: 2023

References

Cui, L., Zhang, Z., Huang, L., Li, Q., Guo, Y.-H., & Guo, Q.-H. (2023). Dual-stage cognitive assessment: A two-stage screening for cognitive impairment in primary care. BMC Psychiatry, 23(1), Article 368. https://doi.org/10.1186/s12888-023-04883-w

Web Site

creativecommons.org/licenses/by/4.0/

Items of the Dual-Stage Cognitive Assessment (DuCA)

Part 1 Items (contributing to a total of 10 points):

• Verbal Fluency (two points)

• Visual Perception (three points)

• Delayed Recall (five points)

Part 2 Items (contributing to a total of 28 points):

• Auditory Sentence Memory (six points)

• Category Switching (10 points)

• Visual Memory (12 points)

Additional Items (not contributing to the total score):

• Prospective Memory

• Metamemory

Part 1

Part 2

Bolded font indicates items that count in the total score.