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

Area of Science:

• Neuroscience and Public Health
• Cross-cultural Psychology
• Gerontology

Background:

• Dementia poses a significant health burden in Indigenous communities in Amazonas, Brazil.
• Culturally appropriate cognitive assessment tools are lacking for these populations.
• This study addresses the need for culturally adapted cognitive tools in Indigenous communities.

Purpose of the Study:

• To culturally adapt the Brazilian Indigenous Cognitive Assessment (BRICA) tool for an urban multiethnic Indigenous community in Manaus, Brazil.
• To provide validity indicators for the adapted BRICA tool.
• To enhance cognitive assessment accuracy and reduce bias in Indigenous populations.

Main Methods:

• A three-stage, stakeholder-engaged approach was used for cultural adaptation of the BRICA tool.
• Content validity was assessed using the content validity index (CVI) and expert inter-rater concordance.
• Criterion and concurrent validity were evaluated in 141 Indigenous participants (aged ≥ 50 years) using diagnostic consensus criteria.

Main Results:

• The adapted BRICA tool demonstrated strong content validity, with scale CVI (S-CVI) scores of 0.93 for equivalence and 0.85 for relevance.
• A cut-off score of ≤ 33/39 on the BRICA showed high diagnostic accuracy: 94.4% sensitivity and 99.2% specificity for dementia.
• Positive and negative predictive values were also high, at 94.4% and 99.2%, respectively.

Conclusions:

• The culturally adapted BRICA tool shows favorable indicators of content, construct, and criterion validity for urban Brazilian Indigenous communities.
• The BRICA tool represents a significant advancement in addressing cognitive assessment bias in Indigenous populations.
• Implementation of the BRICA tool has the potential to improve early dementia detection and management among Indigenous groups.