Discriminant validity and cost‐consequence of a stepwise dementia case‐finding strategy for Chinese older adults with audiovisual impairment

Abstract Objective To investigate discriminant validity and cost‐effectiveness of a stepwise case‐finding strategy for detecting dementia in Chinese community‐based audiovisual impairment population. Methods Data were derived from the Hangzhou Study and the China Health and Retirement Longitudinal Study (CHARLS). Discriminatory indices for brief cognitive, physical, and combined tests were calculated. A cost‐consequence analysis compared labor and time costs of three scenarios: diagnosis using the Clinical Dementia Rating (CDR), 5‐min Montreal Cognitive Assessment (MoCA), and the stepwise strategy (gait speed followed by delayed word recall). Results Among participants with audiovisual impairment, the stepwise strategy improved accuracy for identifying mild cognitive impairment (MCI; 75.8%) and dementia (94.0%) compared to single tests, reducing labor and time costs for identifying MCI (by 16.7% and 24.8%) and dementia (by 83.6% and 84.9%) compared to the 5‐min MoCA screening. Conclusion This stepwise strategy is valid, time‐efficient, and cost‐effective for large‐scale community‐based dementia screening in older adults with audiovisual impairment. Highlights This is the first study to investigate the discriminant validity of a stepwise case‐finding strategy for cognitive impairment and dementia in the Chinese population with audiovisual impairment, alongside exploring cost‐effectiveness of the screening strategy in the targeted population. In two Chinese community‐based datasets (the Hangzhou Study and the China Health and Retirement Longitudinal Study [CHARLS]), this stepwise strategy demonstrated excellent specificity (≥88%) and accuracy (≥75%) in identifying cognitive impairment among audiovisual impairment populations, suggesting that it excludes healthy individuals more accurately and significantly improves the overall efficacy of the screening process. This stepwise case‐finding dementia screening strategy is more cost‐effective in terms of manpower and time. To identify 100 cases of mild cognitive impairment, the stepwise strategy saved 16.7% of re‐evaluations and 24.8% of assessment time, and over 80% for dementia cases (83.6% and 84.9%, respectively), compared to the 5‐min Montreal Cognitive Assessment screening approach.