Popular dementia test adapted in seven Indian languages to boost diagnosis

A fast and inexpensive diagnostic test for dementia has been adapted in seven major Indian languages to help boost the detection of the disorder in the country, scientists announced on Thursday. A team of Indian and UK researchers adapted the Addenbrooke's Cognitive Examination (ACE-III), a well-known screening instrument for dementia detection, for use in Hindi, Telugu, Kannada, Malayalam, Urdu, Tamil and Indian English.

"Accounting for cultural differences and linguistic characteristics of different populations is crucial for the development of a common instrument to diagnose dementia," said Eneida Mioshi, a professor of dementia care research at University of East Anglia in the UK. "The development of a common diagnostic tool will facilitate harmonisation of dementia research across diverse populations, and catalyse the development of preventative and treatment strategies for larger cohorts of dementia from diverse demographic and geographic backgrounds," Mioshi said.

The study, published in the journal Archives of Clinical Neuropsychology, aimed to standardise and validate ACE-III across seven Indian languages, and to assess the diagnostic accuracy of the test to detect dementia and mild cognitive impairment. The researchers said a major proportion -- 58 per cent -- of people with dementia reside in low- and middle-income countries, and by 2050 that will increase to 68 per cent.

Standardising diagnostic tools for dementia is important to accurately determine prevalence rates and to establish risk and protective factors for dementia, they noted. "With the rising burden of dementia globally, there is a need to harmonise dementia research across diverse populations," said Suvarna Alladi, professor of neurology at National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru.

"The ACE-III is a well-established cognitive screening tool to diagnose dementia, but there have been few efforts to standardise the use of it across cohorts speaking different languages," said Alladi, who led the study. As many as 1,203 study participants from Hyderabad, Delhi, Thruvananthapuram, Bengaluru and Puducherry were examined by an experienced neurologist.

The team, including researchers from All India Institute of Medical Sciences (AIIMS), Delhi and Jawaharlal Institute of Postgraduate Medical Education and Research in Puducherry, also interviewed a reliable family caregiver for each participant. They reviewed their demographic and cognitive histories and medical records to determine their eligibility for the study.

The study included controls and participants who were diagnosed with dementia or mild cognitive impairment, but those with moderate or severe dementia were excluded. In accordance with the original version of ACE-III, the Indian versions look at five different cognitive functions: attention, memory, fluency, language, and visuospatial functions, according to the researchers.

Culturally appropriate modifications were formulated based on the clinical and research expertise of the researchers. The researchers noted that each of the five domains of the test were evaluated for cultural relevance, translatability, comparable difficulty and adaptability.

For example, in the memory section, participants were asked about Indian politicians and movie actors, they said. A common administration and scoring guide was developed and psychologists were trained to ensure standardised test assessment in seven Indian languages.

The researchers said ACE-III had previously been adapted and validated into one of the Indian languages -- Gujarati. The ACE-III tool has been validated in languages including Arabic, English, French, German, Greek, Hebrew, Italian, Japanese, Korean, Mandarin, Portuguese, Spanish and others.

"The adapted versions of ACE-III show great diagnostic accuracy in identifying dementia and mild cognitive impairment in a linguistically diverse context," Miloshi said. "Not only the ACE-III is a quick and inexpensive method of screening for dementia, it will also allow for harmonisation in future cross-national research studies, propelling Indian dementia research forward," the scientist explained.

"This adapted version of ACE-III is necessary and can be used to uniformly diagnose cognitive impairment in people speaking different languages from both rural and urban populations located across India," said Professor BN Gangadhar, Director and Vice-Chancellor of NIMHANS..

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