Supplementary Material for: Screening for cognitive impairment in the emergency department: agreement between older adult patient- and informant-completed Ascertain Dementia 8 tool

Introduction
Emergency department (ED) screening for cognitive impairment (CI) is crucial for early intervention, yet guidance on dementia screening protocols remains limited. Our objective was to assess the concordance between the Ascertain Dementia 8 (AD8), a brief screening tool for CI, administered to ED patients and their informants.

Methods
We conducted a prospective observational study of dyads, including patients ≥65 years without a diagnosis of dementia seeking care in the ED and their informants (e.g. family, friend with close contact). Trained research assistants used the 4AT to exclude patients with concern for delirium. The AD8 was then administered to blinded patients (pAD8) and informants (iAD8), with scores ranging from 0-8 and scores of ≥2 indicating CI. We used the Intraclass Correlation Coefficient (ICC) to calculate the level of agreement between AD8 scores.

Results
Our analytic sample included 538 dyads, of which 63.3% of patients were female with a mean age of 73.5 years. A total of 131 (24.3%) patients without a diagnosis of dementia self-identified as having CI using the pAD8, in comparison to 110 (20.4%) informants using the iAD8. The ICC of 0.519 (95% CI 0.454-0.578) indicated moderate agreement between pAD8 and iAD8 scores.

Conclusions
When seeking emergency care, one in four older adults without a diagnosis of dementia and approximately 20% of informants indicated that patients were cognitively impaired. Our finding of moderate agreement between the pAD8 and iAD8 has important implications for clinicians providing care to patients with suspected CI and investigators conducting dementia-related studies.

{'Introduction': '导言
认知障碍（CI）的急诊部门（ED）筛查对于早期干预至关重要，然而关于痴呆筛查方案的具体指导仍显不足。本研究旨在评估急诊患者及其监护人接受认知障碍简易筛查工具Ascertain Dementia 8（AD8）的筛查结果之间的吻合度。', 'Methods': '方法
本研究采用前瞻性观察性研究方法，纳入了≥65岁且未诊断为痴呆的急诊患者及其监护人（例如亲属、亲密朋友）。经过培训的研究助手使用4AT（Delirium Assessment Tool）排除有谵妄担忧的患者。随后，对盲法下的患者（pAD8）及其监护人（iAD8）进行AD8筛查，评分范围为0-8分，≥2分提示存在认知障碍。我们使用组内相关系数（Intraclass Correlation Coefficient，ICC）来计算AD8评分之间的吻合度。', 'Results': '结果
我们的分析样本包括538对受试者，其中63.3%的患者为女性，平均年龄为73.5岁。在未诊断为痴呆的患者中，有131例（24.3%）通过pAD8自评存在认知障碍，而通过iAD8进行评价的监护人中有110例（20.4%）报告患者存在认知障碍。ICC值为0.519（95%置信区间为0.454-0.578），表明pAD8和iAD8评分之间存在中等程度的吻合度。', 'Conclusions': '结论
在寻求急诊治疗时，四分之一的未诊断为痴呆的老年人和大约20%的监护人指出患者存在认知障碍。pAD8和iAD8评分之间中等程度吻合度的发现，对于为疑似认知障碍患者提供护理的医务人员和进行痴呆相关研究的调查人员具有重要意义。'}