{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:32:42Z","timestamp":1790350362189,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1K24AG056578"],"award-info":[{"award-number":["1K24AG056578"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000957","name":"Alzheimer's Association","doi-asserted-by":"publisher","award":["23AARFD\u20101028868"],"award-info":[{"award-number":["23AARFD\u20101028868"]}],"id":[{"id":"10.13039\/100000957","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dementia often goes undetected in hospital settings, where cognitive assessments are challenging due to illness severity and delirium. This study aimed to (1) evaluate the accuracy of the Clinical Dementia Rating (CDR), based solely on knowledgeable informant reports, for detecting preexisting dementia and cognitive impairment in hospitalized patients compared to a gold\u2010standard diagnosis, (2) and compare its performance to the 16\u2010item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE\u201016).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study assessed consecutive patients aged \u2265\u200965 admitted to inpatient units from five hospitals in Brazil. The informant\u2010based CDR was administered to knowledgeable informants within 48\u2009h of admission, capturing patients' cognitive status 3 months before hospitalization to avoid the influence of acute cognitive impairments. Blinded experts provided a gold standard clinical diagnosis of dementia or cognitive impairment no dementia (CIND) based on a 90\u2010min comprehensive assessment, including a standardized neuropsychology battery. Areas under the curve (AUC) examined diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 65 participants (mean age\u2009=\u200979.4\u2009years; women\u2009=\u200954%), 34% had dementia and 32% had\n                      <jats:styled-content style=\"fixed-case\">CIND<\/jats:styled-content>\n                      . Compared to the gold standard, the informant\u2010based\n                      <jats:styled-content style=\"fixed-case\">CDR<\/jats:styled-content>\n                      showed excellent diagnostic accuracy for detecting dementia (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      \u2009=\u20090.92; 95% confidence interval [\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      ]\u2009=\u20090.86\u20130.98) and cognitive impairment (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      \u2009=\u20090.93; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      \u2009=\u20090.88\u20130.98), with a cutoff of \u2265\u20091 showing 98% specificity for dementia and a cutoff of \u2265\u20090.5 showing 98% sensitivity for cognitive impairment. Compared to the\n                      <jats:styled-content style=\"fixed-case\">IQCODE<\/jats:styled-content>\n                      \u201016, the informant\u2010based\n                      <jats:styled-content style=\"fixed-case\">CDR<\/jats:styled-content>\n                      had similar performance in detecting dementia and a nonsignificant slight advantage in identifying cognitive impairment (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      \u2009=\u20090.93 vs. 0.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.069), reducing unrecognized cognitive impairment based on medical record documentation from 70% to 2%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Informant\u2010based\n                      <jats:styled-content style=\"fixed-case\">CDR<\/jats:styled-content>\n                      is a valid and efficient tool for detecting dementia and cognitive impairment in hospitalized older adults, supporting early diagnosis and guiding multidisciplinary interventions in acute care. Its use in routine hospitals may help clinicians reduce undetected cognitive impairment, enhance decision making, and improve patient care.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19494","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T08:56:03Z","timestamp":1746176163000},"page":"2524-2530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pulling Back the Curtain on Hospital Dementia Detection: Validation of the Informant\u2010Based Clinical Dementia Rating"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7467-1745","authenticated-orcid":false,"given":"M\u00e1rlon Juliano Romero","family":"Aliberti","sequence":"first","affiliation":[{"name":"Laboratorio de Investigacao Medica Em Envelhecimento (LIM\u201066), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo  Sao Paulo Brazil"},{"name":"Research Institute, Hospital Sirio\u2010Libanes  Sao Paulo Brazil"},{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-0519","authenticated-orcid":false,"given":"Thiago Junqueira","family":"Avelino\u2010Silva","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigacao Medica Em Envelhecimento (LIM\u201066), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo  Sao Paulo Brazil"},{"name":"Division of Geriatrics, Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Covinsky","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine University of California San Francisco  San Francisco California 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