Dementia diagnosis using Addenbrooke’s Cognitive Examination in low literates and illiterates in three Indian languages
Avanthi Paplikar, Feba Varghese, Bidisha Battacharyya, Vasundhara Shukla, Manjari Tripathi, Atanu Biswas, Suvarna Alladi- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
With a rising burden of dementia globally, there is a need to harmonize dementia diagnosis and research across diverse populations. Majority of dementia patients reside in low‐middle income countries (LMICs) such as India. Major challenges in the diagnosis of dementia in LMICs include the lack of a proper diagnostic tool for low literates and illiterates besides the lack of awareness of society about the disease. Addenbrooke’s Cognitive Examination‐III (ACE‐III) is a screening instrument with good validity and reliability to diagnose patients with mild cognitive impairment (MCI) and dementia. Although ACE‐III has been adapted to many languages both in India and worldwide, it has not been adapted for the low literate and illiterate population. The objective of the study is to i) develop a culturally relevant illiterate ACE‐III for the Indian context and standardize the instrument across three commonly used Indian languages: Hindi, Bengali, and Kannada; and ii) to establish the sensitivity and specificity of the illiterate Indian versions of ACE‐III to detect dementia and MCI.
Method
The illiterate version of ACE‐III was adapted from the literate version of ACE‐III based on the suggestions from multidisciplinary expert panel comprising cognitive neurologists, stroke specialists, speech–language pathologists and psychologists from different centres (see Figure 1). In total, 84 controls, 50 dementia, and 46 MCI patients were recruited across three cities in India for the validation study. Psychometric properties of adapted versions were examined, and their sensitivity and specificity were established.
Result
The sensitivity and specificity of illiterate ACE‐III in identifying dementia ranged from 93.3% to 99.9%, sensitivity for MCI ranged from 93.3% to 99%, and specificity from 72.7% to 99.9%. Optimum cut‐off scores were established (see Table 1).
Conclusion
The adapted versions of illiterate ACE‐III have been standardized and validated for use across three Indian languages, with high diagnostic accuracy in identifying dementia and MCI in a linguistically diverse context. The study provides a cognitive screening tool that can be used to uniformly diagnose cognitive impairment in people speaking different languages from both rural and urban populations located across India.