1. Harjinder Kaur Community psychiatric nurse manager – Asian link
Diagnosing Vascular Dementia in South Asian Communities: The importance of a culturally appropriate assessment tool
Harjinder Kaur
Community psychiatric nurse manager – Asian link

2. Background
In 1999, health and social care agencies in Wolverhampton (West Midlands, UK) became aware of the large numbers of people from Black, Asian and Minority Ethnic (BAME) communities and their under- representation in mental health services.
Consequently, Fordementia (now Dementia UK) commissioned a research project which reviewed the relevant literature, engaged with local community leaders and organisations, and identified and interviewed people with suspected dementia and their carers from South Asian and African Caribbean communities (Twice a Child, 2001).
The findings led to wide ranging recommendations in several areas and a policy decision was made to appoint a CPN – Asian Link Team Leader, to help implement these recommendations.

3. My role
Promote knowledge, understanding and sensitivity of cultures within services
Provide outreach within communities
Improve and increase access to services
Involve communities in the planning process
Initial assessments
Supporting consultants with diagnosis

4. Wolverhampton City (2011 census)
Ethnicity - Based on Census 2011 data, the majority of residents in the city belong to the White ethnic group (64.5%), whilst the percentage of Black, Asian and Minority Ethnic (BAME) residents has risen since 2001 by 11% to 35.5%. The percentage of Asian residents has risen from 14% to 18%. Mixed ethnic group residents has increased from 3% to 5% and the percentage of Black residents has risen from 5% to 7%.
Country of Birth - According to the Census 2011, of the 16% of residents in the city who were born outside of the UK, 6% were born in India, 3% European Union, 2% Africa, 1% Poland, 1% Pakistan, 1% Zimbabwe, 1% Irish Republic, 1% Poland.
Religion - Wolverhampton now has the 2nd highest percentage of Sikh residents in England. Sikh residents account for 9% of the city’s population (England = 0.8%). Christian residents continue to account for the majority of the population at 56%, however, this group has seen an 11% decrease since Those residents who stated that they had no religious affiliation increased by almost 9% to 20%. This trend mirrors the national picture.

5. Dementia in ethnic minorities
Low dementia diagnosis
Need for early intervention
Avoid crisis
Vascular dementia is most common in South Asian and African Caribbean communities
High incidences of hypertension and diabetes
Diet
Misdiagnosis

6. Challenges for diagnosis
Differences in….
Language
Migration
Culture
Value and Beliefs

7. Standardised Mini Mental State Examination (SMMSE)
SMMSE was developed in 1975 in New York and is a brief measure of cognitive functioning and its change taking about 10 minutes by a trained interviewer to complete. It has high test-retest reliability, internal consistency and high inter-observer reliability

8. Addenbrooke’s Cognitive Examination ACE-III
The Addenbrooke’s Cognitive Examination-III (ACE-III) is a screening test used to assess cognitive performance. It is often used in conjunction with the Standardised Mini Mental State Examination (SMMSE) to provide more detailed screening of cognitive abilities on later life and is helpful in the diagnosis of dementia.
The assessment focusses on the five cognitive domains in more detail:
attention
memory
verbal fluency
language
visuospatial abilities

9. Rowland Universal Dementia Scale (RUDAS)
RUDAS is a relatively new tool in comparison to the MMSE. RUDAS was developed in a multicultural setting in Australia. It is a brief six item screening test which is short and easy to administer and so far, is the most effective tool for diagnosing dementia in ethnic minorities.

10. What does the RUDAS involve?
Functional, practical tests
Relies on verbal communication
Memory recall; a story
Movement and co-ordination
Memory recall; the story
Visual
Planning and judgement
1 minute test

11. Why I like this tool… It’s friendly and fun
Takes away the fear of having an assessment done
They do not have to admit that they cannot read or write
You can use information from the initial assessment to assist with the tool
You still have to be able speak their language and dialogues
They have to hear you (and understand) and see you

12. Dementia in South Asian communities now…
Improved dementia diagnosis rates
Started in 2001…
By 2006, 88 clients
By 2011, 135 clients
By 2012 an additional CPN was employed FT, Asian Link PT
Now, a total of 368 clients, with approximately 60 from memory clinic referrals.

13. Thank you & any questions?
Contact details
Harjinder Kaur: