Dementia Care Research and Psychosocial Factors

Area of Science:

• Neuroscience
• Psychology
• Public Health

Background:

• Global population is aging, increasing Alzheimer's disease and related dementias (ADRD) prevalence, particularly in low- and middle-income countries (LMICs).
• Significant underdiagnosis of ADRD exists globally (75%), with rates up to 90% in LMICs due to a lack of appropriate neuropsychological assessment instruments and local expertise.
• This study addresses these disparities by developing a harmonized cognitive assessment protocol for Botswana.

Purpose of the Study:

• To culturally adapt and validate neuropsychological assessment instruments for ADRD research in Botswana.
• To ensure cognitive measures are suitable for the local context, addressing linguistic, social, and cultural factors.
• To lay the groundwork for improved ADRD diagnosis and research in African settings.

Main Methods:

• Utilized International Test Commission guidelines for translation and cultural adaptation of NACC UDS and ReDLat cognitive measures.
• Employed qualitative methods (focus groups, expert interviews) to assess cultural applicability of test stimuli, constructs, and instructions.
• Conducted pilot testing for face and content validity in a diverse sample.

Main Results:

• Standardizing test instructions posed challenges, especially for speeded tasks.
• Certain tasks (clock drawing, set-shifting) and verbal stimuli were found inappropriate or had poor validity in Batswana adults with lower education, requiring revision.
• Consensus was reached on revising verbal content for better local relevance.

Conclusions:

• This research represents the first cultural adaptation and validation of cognitive assessments in Botswana for ADRD studies.
• Qualitative insights offer crucial guidance for test selection and adaptation in African and Global South settings.
• Future reporting will include quantitative findings on psychometric properties and demographic associations of the adapted battery.