Māori Assessment of Neuropsychological Abilities (MANA): A cognitive, functional and wellbeing screening tool for dementia in older Māori

Abstract

AbstractBackgroundIn New Zealand (NZ) in 2013, 5.4% of Māori (the Indigenous people of NZ) were over the age of 65 years and in the last decade the number of Māori kaumātua (elderly) living beyond the age of 80 years has more than doubled. This increase is likely to be accompanied by increases in the prevalence of dementia for Māori. In 2011, 1,928 Māori were estimated to have dementia and is expected to increase to 4,493 by 2026, although numbers are likely to be much higher because many with dementia remain undiagnosed. Cognitive screening and assessment tools commonly used in the diagnosis of dementia in NZ have not been validated on Māori despite these tools having poor specificity and sensitivity when applied to people from culturally and linguistically diverse backgrounds. Cultural bias in cognitive testing has been well established in the international literature and reiterated in studies conducted with Māori. The authors therefore developed the Māori Assessment of Neuropsychological Abilities (MANA) to address this disparity.MethodTwo hundred and fifty kaumātua representing all the major Māori tribes were interviewed in focus‐group settings about their understandings and experiences of dementia. A team, comprised of Māori and non‐Māori specialists in dementia, neuropsychology, and biostatistics in collaboration with Māori health researchers, Māori elders, and Māori dementia health workers, identified information from the data that paired with those domains commonly assessed for dementia in NZ. This data was then applied to develop a dementia screening tool for Māori consisting of a cognitive, functional and wellbeing interview schedule. We are conducting a Pilot study, N=40 in 2020 to test item content and relevance, scoring criteria, adequacy of floor and ceiling effects, clarity of instructions, and administration procedures. Receiver‐operating characteristic (ROC) curve analysis will also be used to determine the predictive accuracy of the assessment tools and to identify the best cut‐ off points for detecting cognitive and functional impairments.ResultWe will present preliminary results of the pilot study.ConclusionWe hypothesise that a culturally validated and appropriate screening tool will provide improved accuracy in the diagnosis of dementia in Māori.