Cross-cultural Assessment Research Articles

Evaluation of the 10-item Mental Toughness Questionnaire (MTQ10): cross-cultural assessment and scrutiny of method effects

The 10-item Mental Toughness Questionnaire (MTQ10) is an easy to administer, global measure of mental toughness. Previous analysis established that the MTQ10 was psychometrically superior to the preceding, widely used, 18-item version. Nevertheless, the MTQ10 is potentially undermined by a method effect arising from the inclusion of negatively phrased items. Noting this, the present paper further assessed the measurement properties of the MTQ10 via cross-cultural comparisons. This involved assessing the factor composition in samples from the UK (N = 596), Greece (N = 1230), and Italy (N = 425). Rather than a strict method effect, analyses found effects specific to pairs of negative items. The emergent model demonstrated partial invariance across countries. National variations in mental toughness scores were ascribable to societal differences. Convergent validity was demonstrated using theoretically related variables (Dark Triad and Life Satisfaction). Overall, results supported the use of the MTQ10 as a global mental toughness measure. Additionally, outcomes suggested that further cross-cultural comparison would provide useful insights into the nature of mental toughness.

Creativity in the West and the East: A Meta-Analysis of Cross-Cultural Differences

ABSTRACT Cross-cultural differences in individual creativity have been examined extensively, particularly between Western and Eastern cultures, but empirical evidence has been mixed. In an attempt to clarify the inconclusive picture, we meta-analytically synthesized evidence on cross-cultural differences in individual creativity between “Westerners” and “Easterners.” We analyzed 221 effect sizes from 41 studies in a three-level meta-analytic model. We found a statistically significant small-to-medium overall effect (g = 0.329, p < .001), indicating higher creativity among Western individuals. The potential effect of study-, sample-, and assessment-related moderators on West – East differences in creativity was also examined. We found that Western superiority in creativity increased with sample age, showing that cross-cultural differences in creativity were more pronounced in samples with older subjects. Furthermore, our analyses revealed that task framing moderated the effect of culture on creativity: test-like creativity tasks were associated with Western advantages, whereas game-like tasks did not show any West – East differences. The further (statistically less robust) results of this study indicated the importance of creativity-assessment-related factors for cross-cultural differences in creativity. The findings and implications of this study are discussed, particularly in relation to potential (cross-cultural assessment) bias, an issue that is very likely in the context of cross-cultural creativity.

Validation of the Kimberley Cognitive Assessment (KICA-Cog) for Torres Strait Islander Peoples.

The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.

Cross-cultural assessment of the community of inquiry instrument: a comparison between UK and US students

ABSTRACT The purpose of this paper is to conduct a cross-cultural assessment of the Community of Inquiry (CoI) instrument [Arbaugh, J. B., Cleveland-Innes, M., Diaz, S. R., Garrison, D. R., Ice, P., Richardson, J. C., & Swan, K. P. (2008). Developing a community of inquiry instrument: Testing a measure of the community of inquiry framework using a multi-institutional sample. The Internet and Higher Education, 11(3-4), 133–136], comparing its application between students in the UK and the US. Using data collected from 245 UK accounting students, exploratory factor analysis was performed to assess the factorial structure of the CoI instrument. The analysis identifies three factors, consistent with the three presences outlined in the CoI framework [Garrison, D. R., & Archer, W. (2000). A transactional perspective on teaching and learning: A framework for adult and higher education. Elsevier Science]. However, five items display inadequate factor loadings below 0.5. In a cross-cultural comparison with [Arbaugh, J. B., Cleveland-Innes, M., Diaz, S. R., Garrison, D. R., Ice, P., Richardson, J. C., & Swan, K. P. (2008). Developing a community of inquiry instrument: Testing a measure of the community of inquiry framework using a multi-institutional sample. The Internet and Higher Education, 11(3-4), 133–136] US study, distinct differences emerge. Notably, UK students exhibit higher mean scores for teaching, social, and cognitive presences compared to their US counterparts. In conclusion, it appears that cultures with high long-term orientation and low uncertainty avoidance could be more conducive to active engagement in the learning process and critical thinking, thus leading to high student perceptions of CoI.

Cross-cultural assessment of the influence of the COVID-19 pandemic on the perceived mental health and medical experiences of persons with inherited bleeding disorders and their parents/guardians

ABSTRACT Background Objectives were to 1) assess COVID-19-associated medical and psychological challenges facing persons with inherited bleeding disorders (PIBD) and their parents/guardians (PG) in Germany, the US, and the UK; 2) describe similarities and differences among these countries; 3) identify needs and opportunities for intervention by patient advocacy organizations (PAGs). Research Design & Methods A cross-sectional, international survey was conducted in three countries using validated psychometric instruments and investigator-developed items. Results Five hundred and four surveys were included. Significant differences between countries were found including experiences with medical care, specific thoughts, and concerns about COVID-19, anxiety, and other mental health measures, as well as resources used to cope with stress. Age, education, income, race, IBD diagnosis, PIBD vs. BD group, and gender had moderating effects on resources used. Communication with friends/relatives and use of PAG and HTCs as resources for information/coping decreased in all countries during the pandemic. Conclusions There were similarities and differences between respondents across the country in the perceived impact of the pandemic, mental health scores, and strategies used to cope with stress. Recommendations: strategies to increase PAG access for PIBD and their PG during pandemics and natural disasters, ongoing assessment and adaptation to provide supportive resources to specific patient subgroups.

Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory

BackgroundSelf‐care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases.MethodsA cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales.ResultsMost (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test–retest reliability showed an intraclass correlation coefficient of 0.92.ConclusionsThe SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.

Assessing sickness behavior in the French: Validation of the French translation of the sickness questionnaire (SicknessQ) in a non-clinical French population

The Sickness Questionnaire (SicknessQ) is a questionnaire developed to assess symptoms of sickness behavior, including somatic, behavioral, and affective dimensions. To promote cross-cultural assessments of sickness behavior, we aim to expand the use of this questionnaire to other populations and languages. The aim of the present study was to evaluate the French translation of SicknessQ in a French-speaking general population during the COVID-19 pandemic. One hundred and thirty-nine individuals completed the SicknessQ online, along with the construct criteria measures of self-rated health, state anxiety (STAI-S), and depressive symptoms (PHQ-9). The principal component analyses revealed two components: the first component included seven items concerning mood, motivation and experiences of fatigue and pain; the second component included three items concerning somatic sickness symptoms. Higher scores on the total scale and the two component subscales were associated with poorer self-rated health and higher STAI-S and PHQ-9 scores. Since the associations with construct criteria variables were relatively similar between the single- and the two-dimensional solutions, both the total scale and the subscales of the two components of the French SicknessQ can be used in future studies to measure sickness behavior in French-speaking populations.

ASSESSING CROSS-CULTURAL UNDERSTANDING AND INTERCULTURAL COMMUNICATION SKILLS IN EFL CLASSROOMS: CHALLENGES, BEST PRACTICES, AND PERCEPTIONS

This research study explores the challenges and best practices in assessing cross-cultural understanding and intercultural communication skills in English as a Foreign Language (EFL) learners, considering both formative and summative assessment methods. Employing a mixed-methods research design, quantitative and qualitative data were gathered from EFL teachers and learners in diverse cultural settings. The findings reveal a variety of assessment tasks commonly used, such as written assignments, oral presentations, group discussions, and cultural projects, to evaluate cross-cultural competence. Formative assessment methods, including self-reflection, peer feedback, and teacher-student conferences, were prevalent in assessing cross-cultural understanding. Challenges in cross-cultural assessment include developing culturally sensitive tasks and rubrics, addressing biases in assessment instruments, balancing language proficiency and cultural understanding, and ensuring fairness and inclusivity. Best practices identified include providing clear assessment criteria, incorporating authentic tasks, promoting self-reflection and peer feedback, integrating multiple assessment methods, and offering professional development for teachers. The study emphasizes the positive perceptions of both teachers and learners regarding the effectiveness of cross-cultural assessment in promoting intercultural competence. By addressing these challenges and implementing recommended practices, educators can enhance the quality of EFL education and better prepare learners for effective communication in diverse cultural settings.

Postpartum psychosis: a public involvement perspective across three continents

Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders’ engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda.

Psychometric properties of the self-care of chronic illness inventory in Chinese older adults with multiple chronic conditions.

Existing self-care measures for the Chinese population are specific to single chronic conditions. No generic self-care measures exist for the Chinese population with multiple chronic conditions. To test the structural validity, concurrent validity and reliability of the Self-care of Chronic Illness Inventory (SC-CII) in Chinese older adults with multiple chronic conditions. This cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. A diverse sample of Chinese older adults with multiple chronic conditions (n=240) was recruited. Structural validity was assessed with confirmatory factor analysis. Concurrent validity was investigated with hypotheses testing of the relationships between perceived stress, resilience and self-care. Reliability was assessed with Cronbach's alpha and McDonald's omega. Finally, a simultaneous confirmatory factor analysis was conducted to test the general model with all items and all three subscales. Confirmatory factor analysis supported the two-factor structure of the self-care maintenance and self-care management subscales and the one-factor structure of the self-care monitoring subscale. Concurrent validity was supported by the significant negative correlation (r ranged from -0.18 to -0.38, p < .01) with perceived stress and the significant positive correlation (r ranged from 0.31 to 0.47, p < .01) with resilience. Reliability estimates ranged from 0.77 to 0.82 across the three subscales. The simultaneous confirmatory factor analysis did not support the more general model with the combined set of items. The SC-CII is valid and reliable for Chinese older adults with multiple chronic conditions. Future cross-cultural assessment should be conducted to investigate the measurement equivalence of the SC-CII in individuals from Western and Eastern cultural groups. With the increasing number of older adults in China who are living with multiple chronic conditions and the call for culturally tailored self-care interventions, this self-care measure can be used in geriatric primary care settings, long-term facilities and homes to improve the understanding and practice of self-care in older Chinese adults.

Filling the 8-Year-Old Gap in the Study of Well-Being: Cross-Cultural Assessment and Validation of a Subjective Well-Being Measure Across 19 Countries

Research on child well-being under 10 years old is limited. A first step towards stimulating research targeting this population is the validation of psychometric scales across cultures. The current study examines the cross-cultural validity of the Children’s Worlds - Subjective Well-being Scale (CS-SWBS-8-year-old version), a six-item subjective well-being scale in an international sample of 8-year-olds (N = 20,822) across 19 countries. A confirmatory factor analysis of the CW-SWBS-8yo showed adequate fit after structural equation modelling. Multi-group analysis supported scalar invariance when one of the countries (Chile) was not included in the model. When testing convergent validity, results suggested that the CW-SWBS-8yo is predicted by life satisfaction, positive affect, and negative affect. Overall, the findings support the use of the CW-SWBS-8yo in 8 year-olds in both eastern and western countries.

Measuring Fluid Reasoning and Its Cultural Issues: A Review in the Indonesian Context

Fluid reasoning (Gf) is a central component of human abilities and has been shown to be statistically indistinguishable from general cognitive ability. However, measuring fluid reasoning is not that easy since the operationalization of the construct itself is not conclusive. This situation is exacerbated if the measurements and comparisons are carried out in groups with different cultural and language abilities. The purpose of this paper is to provide a brief overview of the fluid reasoning construct as well as measurement practices that have been carried out in Indonesia. My review would mention the positioning of fluid reasoning in several intelligence theories, how researchers conceptualize fluid reasoning, how researchers measure fluid reasoning in a multicultural context, and outline critical future directions for test development. In conclusion, I emphasize the importance of using a multi-processes figural fluid reasoning test as a proxy for a culture fair intelligence test that can be used in cross-cultural assessments.

Cross-cultural assessment of the effect of spatial information on firefighters’ wayfinding performance: A virtual reality-based study

When firefighters conduct search and rescue operations during building fire emergencies, effective wayfinding plays a critical role in protecting them from disorientation and improving the efficiency of their operations. However, whether and how different cultural backgrounds affect firefighters' acquisition and utilization of spatial knowledge during wayfinding tasks has not been comprehensively explored. To narrow this knowledge gap, we conducted a virtual reality-based search and rescue experiment with a 4 (spatial information type: control, landmark, route, and survey condition) × 2 (culture: the US and China) mixed factorial design. For each trial, firefighters were required to find three trapped victims in a virtual office maze within 3 min after a 3-min review of a certain type of spatial information. The wayfinding performance metrics (number of victims found, rescue score, distance to the goal path), direction decision-making strategy, and cognitive load of 62 firefighter participants were measured and analyzed. The results indicated that spatial information type, culture, and the interaction influence between them all significantly affected the firefighters' wayfinding performance. We found that the route and survey information contributed to firefighters' wayfinding performance with different degrees of influence on the US and Chinese firefighters; whereas the landmark information increased firefighters’ cognitive load and impaired their wayfinding performance. We also found that the acquisition and utilization process of spatial information for navigation varied among different cultures. The findings of this study are expected to help develop better training strategies for firefighters, as well as improve their safety and efficiency during search and rescue operations.

Cross-cultural assessment of the impact of eczema in six countries with different lifestyles

Atopic dermatitis or eczema is a common skin disease in children but also in adults; in Europe alone, it affects more than 23 million adults. At the time of internationalization of studies, it seems important to know that the impact of eczema is different according to lifestyle. It seems that the use of two patient-reported outcomes, one specific, the other not, to measure the impact of eczema is relevant and should be recommended.

Отношения с социальным окружением как мотив правопослушного поведения молодежи: опыт кросс-культурного исследования

Introduction. Understanding the grounds of the law-abiding behavior of young people is a socially significant, but poorly studied research domain. Knowledge of the psychological causes of law-abiding behavior is important for the implementation of preventive work with deviant youth and the socialization of the younger generation. Contemporary scientific ideas do not have sufficient information about the role of the entire system of relations of the subject with the social environment for the motivation of law-abiding behavior, focusing on the study of the role of its specific participants - family members, relatives, friends and colleagues. &#x0D; The study is focused on the relations with the social environment as a motive for law-abiding behavior. For this purpose, the study performs a cross-cultural assessment of these relationships in Chinese and Russian youth samples.&#x0D; Methodology, methods and techniques. The methodological basis of the study is the social network approach to the social environment studies. This approach makes it possible to describe the social environment as a quasi-social group, the basis (center) of which is the subject, while the rest of the participants are connected to the subject through social and psychological relations. Application of this approach reveals the significance of the social environment as a motive for law-abiding behavior, showing the effect of relations with the social environment on delinquent behavior readiness.&#x0D; Cross-cultural studies represent the research strategy. Information collecting method is a questionnaire analyzing the social relations and the motives of law-abiding behavior, as well as a standardized self-report measuring the subjective interaction features. &#x0D; Results processing method: descriptive statistics, non-parametric alternative to one-way analysis of variance - Kruskal-Wallis H-test.&#x0D; Survey sample: 100 people, consisted of Russian (50 people) and Chinese (50 people) students, of the similar age and gender. &#x0D; Results: the social environment features have been determined affecting law-abiding behavior and making up motivation: (1) Social environment parameters (volume, homogeneity, interaction difficulties) within the average (standard) values do not affect the law-abiding behavior of young people; (2) Self-assessment of interaction with the social environment enhances the motivation for law-abiding behavior for Russian youth; (3) Social support from individuals in the social environment enhances the motivation for law-abiding behavior in the Russian and Chinese sampling; (4) The system of motives for law-abiding behavior can be represented as emotional, social, personal and rational motives developed under the social environment influence. &#x0D; Scientific Novelty. The data obtained expand the understanding of the motivating role of relationships with the social environment, showing that the help and support of others, as well as self-assessment of interaction with the social environment, enhances the law-abiding behavior motivation. &#x0D; Practical Significance. The represented classification of the motives of law-abiding behavior can be applied to develop procedures for measuring and evaluating the readiness of young people to comply with legal standards.

Cross-national measurement invariance of the Purpose in Life Test in seven Latin American countries.

The Purpose in Life Test (PIL) is a measure of purpose in life widely used in many cultures and countries; however, cross-cultural assessments are scarce. The present study aimed to evaluate the cross-cultural measurement invariance of the PIL in the general population of seven Latin American countries (Colombia, Ecuador, El Salvador, Mexico, Paraguay, Argentina, and Uruguay). A total of 4306 people participated, selected by non-probabilistic convenience sampling, where Uruguay has the highest mean age (M = 41.8; SD = 16.6 years); while Ecuador has the lowest mean age (M = 24.6; SD = 7.8 years). Furthermore, in each country, there is a higher proportion of women (>60%) than men (<40%). Using Multi-Group Confirmatory Factor Analysis, the factorial structure does not show evidence of invariance among the included countries. However, based on the Multi-Group Factor Analysis Alignment, there is evidence that a three-dimensional structure of the PIL (Meaning of existence, Freedom to make meaning in daily life and Will to find meaning in the face of future challenges) is the same in the participating countries. Results based on item response theory indicate that most PIL items can significantly differentiate responses according to the level of life purpose. In addition, people with low life purpose will tend to choose the lower response alternatives on the PIL; while people with higher life purpose will choose higher response alternatives. The findings indicate that the PIL has the potential to increase knowledge about how people conceive and experience their purpose in life in different countries.

Falls efficacy scale international or elderly in Maharashtra: cross cultural adaptation and validation assessment

Background: Aim of the study was to translate falls efficacy scale international (FES-I) in Marathi and to evaluate the translation on the basis of test-retest reliability, internal consistency, concurrent validity for elderly in Maharashtra.Methods: The study was divided in 2 phases. Phase 1: Translation of FES-I following translation back translation method following ProFane guidelines. Phase 2: Psychometric testing of the new version. In phase 1 translation in to Marathi and back. The 507 participants were included for the study. Activity specific balance scale was used to as a gold standard for criterion validity and Berg balance scale was used for construct validity.Results: Study had 53.3% of male and 43.7% of female participant. The validity (Cronbach alpha and ICC) and reliability (Spearman coefficient value) of the scale is excellent.Conclusions: FES-I (M) has excellent reliability and good validity. Hence this scale can be used to assess fear of falls in Maharashtrian elderly.

Geocultural variation in correlates of psychological distress among refugees resettled in the United States.

Attention to cultural variability in mental health symptoms could inform intervention targets; however, this is currently a neglected area of study. This study examined whether the associations between common mental health disorder (CMD) symptoms and predictors of CMDs varied cross-culturally. Participants were 290 refugees from three geocultural regions (Afghanistan, Great Lakes region of Africa, and Iraq and Syria) who recently resettled in the United States and completed assessments of CMD symptoms and predictors. Multilevel generalized linear modeling was used to examine the interactions between correlates of depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms and each of the three cultural reference groups. Relative to refugees from other regions, Iraqi and Syrian participants demonstrated stronger associations between the number of reported traumatic experiences and both depressive, B = 0.01, SE = .003, p = .003, and anxiety symptoms, B = 0.01, SE = .003, p < .001; Afghan participants showed a stronger association between physical quality of life and PTSD symptoms, B = 0.02, SE = .011, p = .037; and African participants demonstrated stronger associations between gender and symptoms of all three CMDs, Bs = 0.11-.020, SEs = .04-.06, ps = .005-.008, and weaker associations between traumatic event exposure and CMD symptoms, Bs = -0.01--0.02, SEs = .003-.006, ps = .000-.002. CMD symptoms likely present differently across cultures, with various predictors more salient depending on cultural backgrounds and differential experiences that vary based on context. These findings have implications for cross-cultural assessment research and mental health.

Cross-Cultural Measurement of Positive and Negative Emotions in Adolescence: Evidence from Three Countries.

Cross-cultural assessment of affective well-being among adolescents has received scarce attention in positive psychological research. The present study investigated cross-cultural measurement invariance of the Scale of Positive and Negative Experience (SPANE) among adolescents from three countries (India, Poland, and Serbia). The sample included a total of 1080 adolescents (53.6% female; Mage = 16.75, range = 15–19 years). Surveys were administered online in each country. Measurement invariance testing provided evidence for partial scalar invariance of the SPANE across cultures, with item “afraid” showing nonivariance across the three countries. Latent factor correlations between positive and negative emotions were stronger in Serbia compared to Poland and India. Positive emotions and life satisfaction had strong positive associations in all three countries (ranging from 0.68 to 0.75). The inverse correlations between negative emotions and life satisfaction were − 0.27, − 0.54, − 0.69 in India, Poland, and Serbia, respectively. Polish adolescents demonstrated the lowest levels of affective well-being, whereas Indian and Serbian adolescents did not differ substantially in levels of positive and negative emotions. The present study demonstrated that the SPANE is a reliable and useful tool for the assessment of positive and negative emotions among adolescents from different cultural settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10902-022-00521-6.

What is the optimum thiamine dose to treat or prevent Wernicke's encephalopathy or Wernicke-Korsakoff syndrome? Results of a randomized controlled trial.

BackgroundThe primary cause of Wernicke–Korsakoff syndrome (WKS) is thiamine deficiency, and more than 90% of cases are reported in alcohol‐dependent patients. While observational studies show parenteral thiamine administration drastically reduced WKS‐related mortality, relevant treatment trials have never been conducted to determine the optimum thiamine dose.MethodsTwo double‐blind, parallel groups, randomized controlled trials (RCTs) were conducted to determine the optimal thiamine dose required for (1) the prevention of Wernicke's encephalopathy (WE), the acute phase of WKS, in asymptomatic but “at‐risk” alcohol misuse patients (Study 1) and (2) the treatment of WE in symptomatic alcohol misuse patients (Study 2). Each study had a dosage regimen comprising three parenteral thiamine doses that were allocated at a ratio of 1:1:1. Study 1: Asymptomatic At‐Risk patients (N = 393) received either 100 mg daily, 100 mg thrice daily, or 300 mg thrice daily, for 3 days. Study 2: Symptomatic patients (N = 127) received either 100 mg thrice daily, 300 mg thrice daily, or 500 mg thrice daily, for 5 days. Cognitive function was the primary outcome, assessed using the Rowland Universal Dementia Assessment Scale, two Cogstate subtests, and an adapted Story Memory Recall test. Secondary analyses examined differences in neurological function (ataxia, oculomotor abnormalities, and confusion) at follow‐up.ResultsNo significant differences were observed between any of the dosage conditions for either Study 1 or Study 2 on cognition or neurological functioning. This real‐world study found that having a clinically unwell target population with high comorbidity and multiple presentations, coupled with challenges in cross‐cultural assessment is likely to complicate RCT findings.ConclusionsThe results of this study showed no clear benefit of high dose thiamine over intermediate or lower doses of thiamine, over the time intervals examined, for the treatment and prevention of cognitive and neurological abnormalities related to WKS. Several study limitations temper the interpretation of these findings. Nevertheless, the absence of conclusive evidence for the superiority of high‐dose thiamine supports a recommendation for patient‐specific treatment, while ensuring that the potential impact of other biochemical factors (e.g., magnesium and other B vitamin deficiencies) are considered and corrected if necessary.