Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians

Dementia among Minority Populations: A Scoping Review of Meaning, Language, and Translation

BACKGROUND

Dementia as a neurocognitive disorder is becoming increasingly common worldwide, and minority groups are more vulnerable than the general population. Many factors may contribute to their vulnerability such as misconceptions, language barriers, cultural factors, invalid assessment tools, lack of knowledge, or assigning spiritual beliefs to dementia symptoms. Therefore, this scoping literature review aimed to clarify how empirical studies reflect the meaning of dementia, language, and translation among minority ethnic groups.

SUMMARY

The PRISMA extension for the scoping review protocol was used. Thirty-eight studies published in English were reviewed and analysed. The findings revealed that lack of knowledge about dementia and attributing the disease to the normal ageing process were frequent among minority groups. Furthermore, their cultural-specific perspectives and worldviews of wellness and well-being can impact the way dementia is perceived, consequent help-seeking behaviours, or caregiving. Facilitating educational programs to enhance the knowledge and experiences of ethnic communities might be beneficial. Moreover, language is shown to be an important aspect in dementia assessment and participants' educational level could significantly impact their functional capacity when responding to cognitive measures. Even though there are some useful screening tests, diagnosis barriers might be eased by assessment tool development, modifications, and accurate translations for ethnic communities.

KEY MESSAGES

A promising pathway to support ethnically diverse communities regarding dementia can be raising awareness, providing ethnic-specific services, developing cultural-specific tools to assess dementia or any cognitive impairment by considering perceptions, language, and culture among ethnic groups. Cultural and spiritual considerations could also encourage engagement during assessment.

Culturally adapted cognitive assessment tool for Indigenous communities in Brazil: Content, construct, and criterion validity

INTRODUCTION

Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community.

METHODS

Using a three-stage process and a stakeholder-engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter-rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years.

RESULTS

Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S-CVI] 0.93) and relevance ratings (S-CVI 0.85) between expert panels. The identified cut-off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis.

DISCUSSION

Using a stakeholder-engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups.

Highlights

Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals.

Culture-Fair Cognitive Screening Tools for Assessment of Cognitive Impairment: A Systematic Review

Background

Cognitive screening tools are important in the detection of dementia, including Alzheimer's disease; however, they may contain cultural biases.

Objective

This review examines culture-fair cognitive screening tools and evaluates their screening accuracy, strengths, and limitations.

Methods

Medline, Embase, PsychINFO and CINAHL were searched. The protocol was registered on PROSPERO (CRD42021288776). Included studies used a culture-fair tool to assess cognition in older adults from varying ethnicities. Narrative synthesis was conducted.

Results

28 studies were included assessing eleven different tools. The Rowland Universal Dementia Assessment Scale (RUDAS) was as accurate as the Mini-Mental State Examination (MMSE) (AUC 0.62-0.93), with a similar sensitivity (52-94%) and better specificity (70-98%), and the Multicultural Cognitive Examination (MCE) had improved screening accuracy (AUC 0.99) compared to RUDAS (AUC 0.92). The Visual Cognitive Assessment Test (VCAT) was equivalent to MMSE (AUC 0.84-0.91). The Kimberley Indigenous Cognitive Assessment tool (KICA) had AUC of 0.93-0.95; sensitivity of 90.6%, specificity 92.6%.

Conclusions

The RUDAS, KICA and VCAT were superior to MMSE for screening dementia in ethnic minorities. Other tools also showed good screening accuracy. Further research should be done to validate tools in different populations.

Clinicians' views on cognitive assessment with Aboriginal Australians

BACKGROUND

A shortage of standardised cognitive assessment tools for use with Aboriginal Australians is evident. Clinicians also miss the range of guidelines necessary to inform test selection and interpretation for all Aboriginal clients. This mixed methods study examines clinicians' confidence, views and current practices when conducting cognitive assessments with Aboriginal Australian clients.

METHODS

Clinicians were asked about factors that influence their likelihood of using standardised testing in Aboriginal vs non-Indigenous Australian people. Twenty-one health professionals with experience conducting cognitive assessments with Aboriginal and non-Aboriginal Australians participated. Clinicians were presented with a series of different scenarios per the client's level of education and language of origin via an online survey. Clinicians rated their likelihood and confidence using standardised cognitive assessment for each scenario. Open-ended questions captured clinicians' views and information about their current clinical practices.

RESULTS

Clients' age, education and language of origin influence the likelihood of clinicians' use of standardised cognitive assessment measures with Aboriginal people. Overall, clinicians reported feeling only slightly more confident working with non-Indigenous clients than Aboriginal clients. Qualitative data indicate a lack of consistency regarding test selection.

CONCLUSION

Clinicians expressed concerns about the validity of available cognitive assessment tools for use with Aboriginal Australians and the absence of evidence to assist decision-making. Cited barriers included language, educational attainment and cultural factors.

Validation of the Good Spirit, Good Life quality-of-life tool for older Aboriginal Australians

OBJECTIVE

Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians.

METHODS

One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity.

RESULTS

GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external.

CONCLUSIONS

The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.

Validation of the Rowland Universal Dementia Assessment Scale in Indonesia: Preliminary Evidence

The South-East Asia region has one of the fastest-growing aging populations, for which standardized dementia screening measures will be essential for geriatric care. The Rowland Universal Dementia Assessment Scale (RUDAS) is adopted for use in the Indonesian setting but lacks evidence of its cross-cultural transportability. This study aimed to examine the reliability and validity of scores from the Rowland Universal Dementia Assessment Scale (RUDAS) in the Indonesian setting. Indonesian older adults from a geriatric nursing center (N = 135; 52 males, 83 females; age range 60-82) completed the Indonesian translation of the RUDAS (RUDAS-Ina), following content adaptation study with community living older adults (N = 35), nine neurologists and two geriatric nurses. For face and content validity, we utilized a consensus-building procedure. Results following confirmatory factor analysis yielded a single-factor model. The reliability of scores from the RUDAS-Ina was marginally satisfactory for research purposes (Cronbach α = 0.61). Multi-level linear regression for examining the association of the RUDAS-Ina scores with gender and age indicated older age to be associated with lower RUDAS-Ina scores. In contrast, the association with gender was not significant. Findings suggest a need to develop and validate locally generated items with cultural sensitivity to the Indonesian setting, which may also be studied in other Southeast Asian countries.

Volume, scope, and consideration of ethical issues in Indigenous cognitive impairment and dementia research: A systematic scoping review of studies published between 2000-2021

INTRODUCTION

High quality research involving Indigenous people with cognitive impairment and dementia is critical for informing evidence-based policy and practice. We examined the volume, scope and ethical considerations of research related to dementia with Indigenous populations globally from January 2000-December 2021.

METHODS

Studies were included if they were published in English from 2000 to 2021 and provided original data that focused on cognitive impairment or dementia in any Indigenous population.

RESULTS

The search yielded 13,009 papers of which, 76 met inclusion criteria. The overall number of papers increased over time. Studies were mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 30; 39%). Twenty-six papers directly involved Indigenous participants with cognitive impairment or dementia. Of these studies, ethics approval was commonly required from two or more committees (n = 23, 88.5%). Ethical and legal governance frameworks were rarely discussed.

DISCUSSION

There is a clear need for further robust studies examining cognitive impairment and dementia with Indigenous populations. Future research should consider the ethical aspects of involving Indigenous participants with cognitive impairment in research.

Dementia Incidence, APOE Genotype, and Risk Factors for Cognitive Decline in Aboriginal Australians: A Longitudinal Cohort Study

BACKGROUND AND OBJECTIVES

Aboriginal Australians are disproportionately affected by dementia, with incidence in remote populations approximately double non-Indigenous populations. This study aimed to identify dementia incidence and risk factors in Aboriginal Australians residing in urban areas, which are currently unknown.

METHODS

A population-based cohort of Aboriginal Australians aged 60+ was assessed at baseline and 6-year follow-up. Life-course risk factors (baseline) were examined for incident dementia or mild cognitive impairment (MCI) using logistic regression analyses; adjustments were made for age. APOE genotyping was available for 86 people.

RESULTS

Data were included from 155 participants aged 60-86 years (mean=65.70, SD=5.65; 59 male). There were 16 incident dementia cases (age-standardised rate 35.97/1,000 person-years, 95% CI 18.34-53.60); and 36 combined incident MCI and dementia cases. Older age (OR 2.29, 1.42-3.70), male sex (OR 4.14, 1.60-10.77), unskilled work history (OR 5.09, 1.95-13.26), polypharmacy (OR 3.11, 1.17-8.28), and past smoking (OR 0.24, 0.08-0.75) were associated with incident MCI/dementia in the final model. APOE ε4 allele frequency was 24%; heterozygous or homozygous ε4 was associated with incident MCI/dementia (bivariate OR 3.96, 1.25-12.50).

DISCUSSION

These findings provide the first evidence for higher dementia incidence in Aboriginal Australians from urban areas, where the majority of Aboriginal people reside. This study also sheds light on sociodemographic, health and genetic factors associated with incident MCI/dementia at older ages in this population, which is critical for targeted prevention strategies.

Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes

BACKGROUND

Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.

METHOD

This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.

RESULTS

Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48-5.51).

CONCLUSIONS

Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.

An integrative review of Indigenous informal caregiving in the context of dementia care

AIMS

To appraise the empirical literature on the needs of Indigenous informal caregivers caring for people living with dementia in Indigenous communities.

DESIGN

Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines, and CASP checklists for narrative analysis were followed.

DATA SOURCES

A systematic search of published empirical literature from January 2010 to August 2020 was undertaken in six databases.

REVIEW METHODS

Fifty-one studies met the research question and the inclusion criteria.

RESULTS

Five themes describe the findings: Decolonizing Western perspectives on dementia, the centrality of cultural safety, caregivers' experiences, pre-dementia community education and family and community-centred care emerged from the thematic analysis. Most of the studies used quantitative methodologies, and few studies were conducted using community-based approaches.

CONCLUSION

This review shows that Indigenous caregiving represents an emerging field in nursing and health sciences in a context of a global crisis. Researchers need to focus on Indigenous values and voices to adapt care and support informal caregivers. Our review emphasizes that working with Indigenous communities will likely translate into new care delivery models, policies and practices to support Indigenous informal caregivers and address the specific social determinants impacting caregivers' roles and tasks.

IMPACT

This review highlights the necessity of having community and family-based discussions on enhancing the delivery of dementia care for Indigenous peoples in Canada and worldwide. Decolonizing Western perspectives of dementia translate into culturally safe approaches that aim to integrate Indigenous cultural perspectives of holism, reciprocity, wisdom, respect of older people and relationality into nursing practice. The support of Indigenous informal caregivers requires future studies to address the stigmatizing Western views of dementia.

Comparative analysis of rowland universal dementia assessment scale and mini-mental state examination in cognitive assessment of traumatic brain injury patients

BACKGROUND

Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China.

OBJECTIVE

To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use.

METHODS

86 inpatients with TBI in a hospital were selected from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS.

RESULTS

(1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r = 0.611, P < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r = -0.344, P = 0.001) and RUDAS (r = -0.407, P < 0.001), while education years were positively correlated with MMSE (r = 0.367, P = 0.001) and RUDAS (r = 0.375, P < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively.

CONCLUSIONS

MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China.

Reporting of test comparisons in diagnostic accuracy studies: A literature review

Comparative accuracy studies evaluate the relative performance of two or more diagnostic tests. As any other form of research, such studies should be reported in an informative manner, to allow replication and to be useful for decision‐making. In this study we aimed to assess whether and how components of test comparisons were reported in comparative accuracy studies. We evaluated 100 comparative accuracy studies, published in 2015, 2016 or 2017, randomly sampled from 238 comparative accuracy systematic reviews. We extracted information on 20 reporting items, pertaining to the identification of the test comparison, its validity, and the actual results of the comparison. About a third of the studies (n = 36) did not report the comparison as a study objective or hypothesis. Although most studies (n = 86) reported how participants had been allocated to index tests, we could often not evaluate whether test interpreters had been blinded to the results of other index tests (n = 40; among 59 applicable studies), nor could we identify the sequence of index tests (n = 52; among 90 applicable studies) or the methods for comparing measures of accuracy (n = 59). Two‐by‐four table data (revealing the agreement between index tests) were only reported by 9 of 90 paired comparative studies. More than half of the studies (n = 64) did not provide measures of statistical imprecision for comparative accuracy. Our findings suggest that components of test comparisons are frequently missing or incompletely described in comparative accuracy studies included in systematic reviews. Explicit guidance for reporting comparative accuracy studies may facilitate the production of full and informative study reports.

An integrative review of empirical literature on indigenous cognitive impairment and dementia

AIMS

To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia.

DESIGN

Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed.

DATA SOURCES

A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches.

REVIEW METHODS

Thirty-four studies met the research question and inclusion criteria.

RESULTS

Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools.

CONCLUSION

The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care.

IMPACT

This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.

Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians

OBJECTIVES

To determine preferences for health and aged care services in Aboriginal and Torres Strait Islander Australians and explore related factors.

METHODS

Mixed-method, cross-sectional study including 336 Aboriginal and Torres Strait Islander people aged 60 years and older from regional and urban areas.

RESULTS

Exclusive preference for Aboriginal Community Controlled services was most common. This preference significantly increased when preferences for, and use of, aged care and disability services were considered. The likelihood of holding an exclusive preference for Aboriginal Community Controlled services was higher in regional settings compared to urban and in those reporting lower engagement in traditional activities during childhood.

CONCLUSIONS

These findings suggest that the majority of older Australian Aboriginal and Torres Strait Islander people prefer aged and disability care provided by Aboriginal services. Given the anticipated increase in service demand in this population, there is a growing need for culturally safe services, particularly in regional settings.

Staying in touch with the community: understanding self-reported health and research priorities in older Aboriginal Australians

OBJECTIVES

Aboriginal Australians experience higher rates of non-communicable chronic disease, injury, dementia, and mortality than non-Aboriginal Australians. Self-reported health is a holistic measure and may fit well with Aboriginal views of health and well-being. This study aimed to identify predictors of self-reported health in older Aboriginal Australians and determine acceptable research methodologies for future aging research.

DESIGN

Longitudinal, population-based study.

SETTING

Five communities across New South Wales, Australia (two urban and three regional sites).

PARTICIPANTS

Aboriginal and Torres Strait Islander people (n = 227; 60-88 years, M = 66.06, SD = 5.85; 145 female).

MEASUREMENTS

Participants completed baseline (demographic, medical, cognitive, mental health, and social factors) and follow-up assessments (self-reported health quantified with 5-point scale; sharing thoughts on areas important for future research). Predictors of self-reported health were examined using logistic regression analyses.

RESULTS

Self-reported health was associated with sex, activities of daily living, social activity participation, resilience, alcohol use, kidney problems, arthritis, falls, and recent hospitalization. Arthritis, kidney problems, and resilience remained significant in multiple logistic regression models.

CONCLUSIONS

Perceived resilience and the absence of certain chronic age-related conditions predict older Aboriginal peoples' self-reported health. Understanding these factors could inform interventions to improve well-being. Findings on acceptable research methodologies suggest that many older Aboriginal people would embrace a range of methodologies within long-standing research partnerships, which is an important consideration for Indigenous population research internationally.

Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

OBJECTIVES

To quantitatively synthesize data on the accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in different sociocultural settings and compare its performance to other brief screening instruments for the detection of dementia.

DESIGN

Systematic review and meta-analysis. Literature searches were performed in PubMed, EMBASE, and CINAHL from January 1, 2004 until September 1, 2019.

SETTING

Community, outpatient clinic, and hospital settings in high-, and low- and middle-income countries.

PARTICIPANTS

Twenty-six studies reporting diagnostic accuracy of the RUDAS were included with almost 4000 participants, including approximately 1700 patients with dementia.

MEASUREMENTS

Procedures for translation and cultural adaption of the RUDAS, and influence of demographic variables on diagnostic accuracy, were compared across studies. Bivariate random-effects models were used to pool sensitivity and specificity results, and diagnostic odds-ratios and the area under the hierarchical summary receiver operator characteristic curve were used to present the overall performance.

RESULTS

The pooled sensitivity and specificity for the detection of dementia were .82 (95% CI, .78-.86) and .83 (95% CI, .78-.87), respectively, with an area under the curve of .89. Subgroup analyses revealed that the RUDAS had comparable diagnostic performances across high-, and low- and middle-income settings (z = .63, P = .53) and in samples with a lower and higher proportion of participants with no formal education (z = -.15, P = .88). In 11 studies making direct comparison, the diagnostic performance of the RUDAS was comparable to that of the Mini-Mental State Examination (z = -.82, P = .41), with areas under the curve of .88 and .84, respectively.

CONCLUSIONS

The RUDAS has good diagnostic performance for detecting dementia in different sociocultural settings. Compared to other brief screening instruments, advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language adaptation.

Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada

Background and Objectives

Dementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this study was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada.

Research Design and Methods

We used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Indigenous Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n = 15) and a focus group consultation with local health professionals (n = 7).

Results

Each question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis, and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes.

Discussion and Implications

The research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.

Mild cognitive impairment in Aboriginal Australians

INTRODUCTION

Aboriginal Australians have among the highest rates of dementia worldwide, yet no study has investigated the subtypes, risk factors, or longer term outcomes of mild cognitive impairment (MCI) in this population.

METHODS

A total of 336 community-dwelling Aboriginal Australians aged ≥60 years participated in a longitudinal study, completing a structured interview at baseline. MCI (amnestic subtype, aMCI; non-amnestic subtype, naMCI) and dementia were diagnosed via cognitive screening, medical assessment, and clinical consensus. Associations between life-course factors and baseline MCI subtypes were examined using logistic regression. Conversion to dementia was assessed at 6-year follow-up.

RESULTS

Prevalent aMCI (n = 24) was associated with older age (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.12 to 2.53), head injury (OR = 3.19, 95% CI: 1.35 to 7.56), symptoms of depression (OR = 1.52, 95% CI: 1.04 to 2.24), and lower blood pressure (OR = 0.53, 95% CI: 0.33 to 0.86). Prevalent naMCI (n = 29) was associated with low education (OR = 4.46, 95% CI: 1.53 to 13.05), unskilled work history (OR = 5.62, 95% CI: 2.07 to 13.90), higher body mass index (OR = 1.99, 95% CI: 1.30 to 3.04), and moderate to severe hearing loss (OR = 2.82, 95% CI: 1.06 to 7.55). A small proportion of MCI cases reverted to intact at follow-up (15%), but most remained stable (44%), developed dementia and/or died (41%).

DISCUSSION

Sociodemographic and clinical factors both contributed to baseline MCI and were distinct for MCI subtypes, with similar patterns of conversion to dementia for amnestic and non-amnestic MCI.

Prevalence, Types and Recognition of Cognitive Impairment in Dialysis Patients in South Eastern Sydney

BACKGROUND

In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic Kidney Disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data of cognitive impairment in this at-risk population. This has implications on service planning because cognitive impairment in CKD is associated with higher mortality, morbidity, and healthcare costs.

AIMS

This study examines the prevalence, types, and clinician recognition of cognitive impairment within an Australian dialysis population.

METHODS

A cross-sectional study of haemodialysis and peritoneal dialysis patients in South-East Sydney screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Participant interviews, medical records, physician and carer questionnaires, were used to determine the types of cognitive impairment and rate of recognition.

RESULTS

106 participants were included (median age 66 years, median dialysis duration 2 years) and 58 (54.7%) were cognitively impaired on the MoCA, of whom old age psychiatrists subclassified 21 (36.2%) as having dementia, and 31 (53.4%) with 'Cognitive Impairment, No Dementia'. 36/58 (62.0%) of the cognitively impaired participants on the MoCA were suspected of having cognitive impairment by nephrologists but only 14/58 (24.1%) had this documented in medical records.

CONCLUSION

Although cognitive impairment is common in dialysis patients, there are low levels of detection by clinical teams. Cognitive screening of dialysis patients should be incorporated as part of wider assessment and determination of management goals such as individuals' capacity to self-care and provide informed consent to treatments. This article is protected by copyright. All rights reserved.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review

INTRODUCTION

Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD).

OBJECTIVE

To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate.

METHODS

Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education.

RESULTS

We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy.

CONCLUSION

For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

Clustering and Additive Effects of Nongenetic Risk Factors in Non-Autosomal-Dominant Degenerative and Vascular Young Onset Dementia

INTRODUCTION

Both genetic and nongenetic factors contribute to the risk profile of young onset dementia (YOD), but risk factors often co-occur. This matched case-control study examined whether nongenetic risk factors cluster together, to inform targeted prevention efforts.

METHODS

Ninety-six participants with non-autosomal-dominant degenerative and/or vascular YOD and 175 controls were recruited to 2 Australian epidemiological studies. Risk exposure was retrospectively self-reported and/or informant-reported.

RESULTS

Each additional exposure increased the risk for YOD, though only where vascular dementia was included in the analysis. Cluster analysis identified 4 risk groups, one of which reported a high probability of exposure to all risks and a significantly higher risk for YOD.

DISCUSSION

Results suggest that combinations of nongenetic risk factors confer more risk for young onset vascular dementia, and possibly primary degenerative YOD, than a single factor on its own. Compared with their same-age peers, some people with YOD experience a lifetime of risk exposure starting from early in life.

Non-Genetic Risk Factors for Degenerative and Vascular Young Onset Dementia: Results from the INSPIRED and KGOW Studies

BACKGROUND

Several brain reserve, vascular risk, and other modifiable factors have been associated with late-onset dementia, but their association with young onset dementia (YOD) has not been adequately explored.

OBJECTIVE

To examine the association of cognitive reserve enhancing factors, cardiovascular risk factors (including smoking), depression, alcohol use, and traumatic brain injury (TBI) with non-autosomal dominant degenerative and/or vascular YOD.

METHODS

Data for this matched case-control study were taken from two larger studies conducted in NSW, Australia. One comprised all people with YOD within a geographical region, while the other exclusively included Aboriginal and Torres Strait Islander participants. Dementia diagnosis was confirmed by clinical consensus, and risk exposure was retrospectively self- and/or informant-reported.

RESULTS

Participants were 96 people with YOD (58.4% with probable Alzheimer's disease) and 175 age-group, sex, and sample matched control participants. Poor educational attainment, low participation in cognitive leisure activity, stroke, transient ischemic attack, and self-reported very heavy alcohol use were related to the risk of primary degenerative and/or vascular YOD. The effect of hypertension and depression varied depending on when they occurred relative to dementia onset. Current smoking was significantly associated with risk in univariate analyses but did not retain significance in multivariate modelling. There was no association with hypercholesterolemia, diabetes, or TBI of any kind. Some compensation for low educational attainment was possible via a complex occupation later in life.

CONCLUSION

Non-genetic factors have a role in YOD, though the relative importance of each factor may be different to late onset dementia. The timing and severity of exposure, as well as the potential for compensation with later protective exposures, are important considerations for potential prevention strategies.

Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians

Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.

The Mini-Mental State Examination: Czech Norms and Cutoffs for Mild Dementia and Mild Cognitive Impairment due to Alzheimer's Disease

BACKGROUND

There is a lack of normative studies of the Mini-Mental State Examination (MMSE) for comparison with early Alzheimer's disease (AD) according to new diagnostic criteria.

PARTICIPANTS AND METHODS

We administered the MMSE to normal elderly Czechs and to patients with mild cognitive impairment (MCI) and mild dementia due to AD according to NIA-AA criteria.

RESULTS

We established percentile- and standard deviation-based norms for the MMSE from 650 normal seniors (age 69 ± 8 years, education 14 ± 3 years, MMSE score 28 ± 2 points) stratified by education and age. Dementia patients scored significantly lower than the MCI patients and both groups (110 early AD patients) had significantly lower MMSE scores than the normal seniors (22 ± 5 or 25 ± 3 vs. 28 ± 2 points) (p < 0.01). The optimal cutoff was ≤27 points with sensitivity of 86% and specificity of 79% for early detection of AD patients.

CONCLUSION

We provided MMSE norms, several cutoffs, and higher cutoff scores for early AD using recent guidelines.

The diagnostic accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool: a systematic review

OBJECTIVES

The objective of this study was to conduct a systematic review of evidence for the accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool in supporting the diagnosis of dementia in Indigenous Australian populations.

METHODS

Cross-sectional diagnostic accuracy studies of the KICA with an appropriate reference standard published to November 2015 were included. Comparison to an alternative cognitive assessment tool was required in non-remote populations. Case control analyses were excluded.

RESULTS

Four studies were included: one of the KICA-Cog and KICA-Carer, one of the KICA Screen, and two of the modified-KICA. All tools developed for remote populations had a sensitivity of ≥76% and a specificity of ≥71% for the diagnosis of dementia. The KICA-Cog and KICA-Carer conducted in series had the highest sensitivity and specificity (91% and 94% respectively). In an urban and regional population, the mKICA had similar accuracy to the Mini-Mental State Examination (MMSE) (AUC 0.93, 95% CI 0.88-0.99 vs 0.94, 95% CI 0.89-0.99). Key risk of bias limitations related to lack of pre-determined cut-points and population selection methods.

CONCLUSION

The use of the KICA in remote Indigenous Australians may assist in timely diagnosis of dementia in this population. Using the KICA-Cog and KICA-Carer in series may maximise specificity, decreasing false positive results without compromising sensitivity.