Illiterate Addenbrooke's Cognitive Examination-III in Three Indian Languages: An Adaptation and Validation Study

Area of Science:

• Neuroscience
• Gerontology
• Psychometrics

Background:

• Cognitive performance is significantly influenced by literacy levels.
• Existing cognitive screening tools are often unsuitable for illiterate or low-literate older adults, leading to potential misdiagnosis.
• There is a critical need for validated cognitive screening tools for low-literate elderly populations.

Purpose of the Study:

• To adapt and validate the Addenbrooke's Cognitive Examination-III (ACE-III) for screening general cognitive functions.
• To assess the tool's suitability for illiterate and low-literate older populations within the Indian context.
• To validate the adapted ACE-III in three major Indian languages: Bengali, Hindi, and Kannada.

Main Methods:

• Systematic adaptation of the original ACE-III items by an expert panel to suit illiterate and low-literate individuals.
• Recruitment of 180 participants: 84 healthy controls, 50 with dementia, and 46 with mild cognitive impairment (MCI).
• Validation of the adapted Indian illiterate ACE-III across three linguistic groups at different research centers.

Main Results:

• An optimal cut-off score of 75 on the illiterate ACE-III was identified to differentiate controls from dementia across all three languages.
• Optimal cut-off scores for distinguishing controls from MCI ranged from 79 to 82.
• The adapted tool demonstrated high sensitivity (93%–99%) and specificity (72%–99%) in identifying cognitive impairment.

Conclusions:

• The adapted illiterate ACE-III exhibits favorable psychometric properties for cognitive screening.
• It serves as a reliable tool for detecting dementia and MCI in older adults with limited educational backgrounds in India.
• This validated tool addresses a significant gap in cognitive assessment for low-literate elderly populations.