An Ultra-Brief Informant Questionnaire for Case Finding of Cognitive Impairment Across Diverse Literacy: Diagnostic Accuracy Study

Q: Why are ultra-brief screening questionnaires important for cognitive impairment case finding?

They help efficiently identify individuals who may need further evaluation, especially when follow-up resources are limited. Ultra-brief tools are particularly relevant for screening at community level.

Q: How was the ultra-brief questionnaire developed and evaluated in this study?

A diagnostic study recruited 1856 participants aged 65 and older. The training sample was used to derive the ultra-brief questionnaire from 15 cognition-related items, and the test sample assessed diagnostic performance using AUC.

Q: How did the new questionnaire perform compared with the established AD8?

The new 2-item informant questionnaire showed excellent diagnostic performance (AUC 85%) and performed significantly better than a baseline model. The AD8 also performed well (AUC 76%) but was not significantly different from the baseline model.

Sep 29, 2026

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Undiagnosed cognitive impairment challenges health systems worldwide, driving demand for ultra-brief screening questionnaires using fewer than 2–3 items. Evidence remains limited on whether such tools maintain diagnostic validity across diverse literacy levels. This diagnostic accuracy study develops an ultra-brief informant questionnaire for identifying mild cognitive impairment or dementia across literacy groups and compares it with the established AD8.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

| JMIR AGING Liew et al
Original Paper
An Ultra-Brief Informant Questionnaire for Case Finding of Cognitive Impairment Across Diverse Literacy: Diagnostic Accuracy Study | | --- | | | | Tau Ming Liew 1,2,3,4 , FRCPsych, PhD; King Fan Yip5 , MBBS, MRCP; Kaavya Narasimhalu6 , MD, PhD; Simon Kang Seng Ting6 , MBBS, FRCP; Weishan Li6 , MD, MRCP; Sze Yan Tay7 , MPsych; Way Inn Koay7 , MPsych | | 1Department of Psychiatry, Singapore General Hospital, Singapore, Singapore
2SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore 3Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
4Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore 5Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
6Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore 7Department of Psychology, Singapore General Hospital, Singapore, Singapore
Corresponding Author:
Tau Ming Liew, FRCPsych, PhD Department of Psychiatry Singapore General Hospital Outram Road
Singapore 169608
Singapore
Phone: 65 62223322
Email: [liew.tau.ming@singhealth.com.sg](liew.tau.ming@singhealth.com.sg)
Abstract | Background: Undiagnosed cognitive impairment poses a global challenge, prompting recent interest in ultra-brief screening questionnaires (comprising <2 to 3 items) to efficiently identify individuals needing further evaluation. However, evidence on ultra-brief questionnaires remains limited, particularly regarding their validity across diverse literacy levels. Objective: This study aimed to develop an ultra-brief questionnaire that performs well in detecting mild cognitive impairment or dementia (MCI/dementia) across diverse literacy levels and to compare its performance with an established questionnaire (the 8-item Informant Interview to Differentiate Aging and Dementia [AD8]) . Methods: This diagnostic study involved 1856 participants aged ≥65 years (median education 10 y, range 0‐23 y), prospectively recruited from community settings in Singapore. Participants and informants completed 15 cognition-related questions. MCI/dementia was diagnosed via a comprehensive assessment and consensus conference. The sample was randomly split 70/30—the training sample (70%) was used to derive an ultra-brief questionnaire from the 15 cognition-related questions (using an exhaustive search approach), and the test sample (30%) evaluated the area under the receiver operating characteristic curve (AUC) . Results: The new questionnaire comprised 2 informant questions (ie, assistance with medications and worry about cognition), plus age and years of education. It demonstrated excellent performance in detecting MCI/dementia (AUC 85%, 95% CI 80%‐90%), significantly better (P= .003) than a nested baseline model (comprising age and years of education; AUC 78%, 95% CI 73%‐83%) . In contrast, the AD8 had an AUC of 76%(95% CI 70%‐83%), not significantly different (P>.99) from the baseline model. The questionnaire’s performance was consistent across education subgroups and varying prevalence scenarios. Two optimal cutoffs were used—the lower cutoff provided 80% sensitivity and 96% negative predictive value, and the uppercutoff provided 99% specificity and 81% positive predictive value. A web-based calculator is available for public use . Conclusions: This ultra-brief questionnaire enables rapid screening for cognitive impairment (in <1 min) by family members or as part of community geriatric assessments. Its excellent performance across literacy levels supports its utility for case finding in diverse populations, including underserved communities and lower-and middle-income countries. [https://aging.jmir.org/2026/1/e72963](https://aging.jmir.org/2026/1/e72963) JMIR Aging 2026 | vol. 9 | e72963 | p. 1 (page number not for citation purposes) JMIR AGING Liew et

FAQs

Why are ultra-brief screening questionnaires important for cognitive impairment case finding?

They help efficiently identify individuals who may need further evaluation, especially when follow-up resources are limited. Ultra-brief tools are particularly relevant for screening at community level.

How was the ultra-brief questionnaire developed and evaluated in this study?

A diagnostic study recruited 1856 participants aged 65 and older. The training sample was used to derive the ultra-brief questionnaire from 15 cognition-related items, and the test sample assessed diagnostic performance using AUC.

How did the new questionnaire perform compared with the established AD8?

The new 2-item informant questionnaire showed excellent diagnostic performance (AUC 85%) and performed significantly better than a baseline model. The AD8 also performed well (AUC 76%) but was not significantly different from the baseline model.

Sep 29, 2026

Uploaded by Muffet