Indigenous Cognitive Assessment Research Articles

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

Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. Using a three-stage process and a stakeholder-engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter-rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S-CVI] 0.93) and relevance ratings (S-CVI 0.85) between expert panels. The identified cut-off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. Using a stakeholder-engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals.

Telephone cognitive screening with older Aboriginal Australians: A preliminary study.

Cognitive screening via telehealth is increasingly employed, particularly during the COVID-19 pandemic. Telephone adaptations of existing cognitive screening tests must be validated across diverse populations. The present study sought to evaluate an existing 26-point telephone adaptation of the Mini-Mental State Examination (tMMSE) in a sample of older Aboriginal Australians. Additionally, we aimed to evaluate a telephone adaptation of the urban version of the Kimberley Indigenous Cognitive Assessment short-form (tKICA screen). A sub-sample (n=20) of participants (aged 55-69 years; 11 women) who had completed an in-person cognitive assessment (MMSE and KICA screen) within the past 6months as part of the Koori Growing Old Well Study completed telephone-based cognitive testing without an assistant. There was moderate correlation and reasonable agreement between MMSE versions (rs =0.33; p=0.2), although the limits of agreement were unacceptably wide (-4.1 and 4.8 points difference). Poorer performance was seen on the tMMSE for Season (p=0.02) and Phrase (p=0.02) items, and better performance for three-word Recall (p=0.03). KICA-screen versions were poorly correlated (rs =0.20; p=0.4) with telephone scoring a mean of 2.17 points below the face-to-face score, greater bias observed at the lower end of the performance and worse scores for Season (p=0.02) and Recall (p=0.001) items. Age and education were not associated with telephone screening performance. Hearing impairment was associated with poorer performance on the tKICA screen (p=0.04) but not the tMMSE (p=0.6). Results indicate that telephone administration of the MMSE and/or KICA screen is not equivalent to in-person testing for older Aboriginal people, and further revision and evaluation are required.

Canadian Indigenous Cognitive Assessment (CICA): Inter-rater reliability and criterion validity in Anishinaabe communities on Manitoulin Island, Canada.

IntroductionDespite increasing dementia rates, few culturally informed cognitive assessment tools exist for Indigenous populations. The Canadian Indigenous Cognitive Assessment (CICA) was adapted with First Nations on Manitoulin Island, Canada, and provides a brief, multi‐domain cognitive assessment in English and Anishinaabemowin.MethodsUsing community‐based participatory research (CBPR) methods, we assessed the CICA for inter‐rater and test–retest reliability in 15 individuals. We subsequently evaluated validity and established meaningful CICA cut‐off scores in 55 individuals assessed by a geriatrician.ResultsThe CICA demonstrated strong reliability (intra‐class coefficient = 0.95 [0.85,0.98]). The area under the curve (AUC) was 0.98 (0.94, 1.00), and the ideal cut‐point to identify likely cases of dementia was a score of less than or equal to 34 with sensitivity of 100% and specificity of 85%.DiscussionWhen used with older First Nations men and women living in First Nations communities, the CICA offers a culturally safe, reliable, and valid assessment to support dementia case‐finding.

Adaptation of the Canadian indigenous cognitive assessment in three provinces and evidence for validity

AbstractBackgroundThe Canadian Indigenous Cognitive Assessment (CICA) tool is an innovative culturally‐grounded dementia case finding tool. Currently, dementia is underdiagnosed and when diagnosis occurs it is at later stages in Indigenous populations in Canada when compared to the general population; a trend documented in Indigenous populations beyond Canada, including Australia and New Zealand. As communities and health systems prepare for rapidly aging Indigenous populations with high rates of multiple chronic conditions, the need for an accurate, reliable dementia case‐finding tool in Canada is critically needed to inform necessary supports and services.MethodAn interdisciplinary, international team composed of researchers and Indigenous community partners led the development of the CICA. The CICA is a community‐based adaptation of the Kimberley Indigenous Cognitive Assessment (KICA) tool, which is a validated dementia screening assessment that was originally developed with Indigenous populations in Western Australia. To adapt the KICA for Canadian contexts, we undertook iterative and community‐specific processes of translation, adaptation, and piloting before we conducted reliability and validity testing in three different sites: Manitoulin Island, Ontario, which is home to seven First Nations communities; an urban Indigenous population in Calgary, Alberta; and File Hills Qu’Appelle Tribal Council, Saskatchewan, which serves 11 First Nations communities. The adaptation process was community‐driven in each site and integrated both Indigenous community knowledge and trauma‐informed approaches to cognitive assessment. The intersections of culture, geography and colonial trauma were explored across these diverse Indigenous communities.ResultThe resulting CICA adaptations were scored out of a possible 39 points and took approximately 15 minutes to administer. The CICA assessed 11 domains of cognition including orientation, recognition and naming, registration, verbal comprehension, verbal fluency, recall, visual naming frontal/executive functioning, free recall, cued recall, and praxis using culturally safe methods in English, Anishinaabemowin, and Nakota. For successful adaptation from the KICA, the orientation, verbal comprehension, verbal fluency, praxis, and naming domains required the most adaptation. Preliminary results indicate that the CICA demonstrated strong inter‐rater reliability, test‐retest reliability, and criterion validity.ConclusionThe CICA is the first tool of its kind in Canada and offers promising applications in the detection of dementia among Indigenous populations.

Classification accuracy of the English version of the Canadian Indigenous Cognitive Assessment (CICA) in a majority culture memory clinic sample

AbstractBackgroundMost cognitive screening tools are culturally inappropriate for Indigenous peoples. The Kimberly Indigenous Cognitive Assessment (KICA) screening tool was collaboratively developed in Australia with, and for, Indigenous peoples. Using a similar community‐based method, the KICA was adapted to Canadian Indigenous peoples’ culture and translated into other languages, beginning in Ontario on Manitoulin Island, and was re‐named the Canadian Indigenous Cognitive Assessment (CICA). The classification accuracy of the CICA‐Ontario version, English translation, was explored in the current project in a memory clinic setting where the majority of patients were of Eurocentric origin.MethodOf 79 consecutive cases presenting to an interdisciplinary diagnostic memory clinic, 58 completed the CICA. Inclusion criteria included consent for participation in research and planned administration of the typical 2 hour long neuropsychological battery. CICA data were not used for any clinical process; consequently, diagnosis was independent. Diagnosis was made by consensus of the neurologist and neuropsychologist after patient and collateral informant interviews and nursing, neurological, medical (comprehensive blood work, neuroimaging), neuropsychological, and physical therapy evaluations.ResultPatients’ ages ranged between 38 and 90 (M= 65.3, SD= 12.3) and 52 percent were male. Diagnoses included no objective cognitive impairment despite cognitive concerns termed subjective cognitive impairment (SCI; n= 23; CICA M = 37.09; CICA SD = 1.08), mild cognitive impairment (MCI; n= 14; CICA M = 34.93; CICA SD = 2.46), dementia due to Alzheimer disease (AD; n= 9; CICA M = 31.44; CICA SD = 3.00), and non‐AD dementias (n= 12; CICA M = 32.75; CICA SD = 5.07). Classification accuracy as measured by the area under the receiver operating characteristic (ROC) curve (AUC) for groups with diagnoses of dementia (n= 21) vs no dementia (SCI or MCI; n= 37) was .78 (AUC confidence interval (CI) .66‐.92). Accuracy was high for cognitive impairment (dementia and MCI; n= 35) versus SCI (n= 23) (AUC=.84 CI .74‐.94) and lower for MCI (n= 14) vs dementia (n= 14)(AUC=.67; CI .49‐.85).ConclusionAlthough additional validity data from Indigenous peoples is needed, these data support the measurement properties of the CICA‐Ontario English‐version in a majority culture sample.

Identifying mild cognitive impairment with older aboriginal Australians in community settings: Performance of the Clock Drawing Test relative to other cognitive screening tools

AbstractBackgroundThe Clock Drawing Test (CDT) is commonly used in the detection of cognitive disorder. Easily administered in both clinical and non‐clinical settings and well accepted by patients, this test is a good candidate for use in early detection of dementia with older Aboriginal Australians. This study aimed to: (i) compare three CDT scoring methods and their reliability/validity in detecting mild cognitive impairment (MCI) and dementia in Aboriginal communities; (ii) determine the optimal CDT sensitivity, specificity and cut‐off scores; (iii) investigate the relative and combined performance of the CDT with other cognitive screening tools [Kimberly Indigenous Cognitive Assessment (KICA); Mini Mental State Examination (MMSE); Rowland Universal Dementia Assessment Scale (RUDAS)].MethodA subset of participants (n=153; aged 60‐93) recruited for the Koori Growing Old Well Study completed neurocognitive evaluation as part of a comprehensive medical assessment and were diagnosed by expert consensus as intact, MCI or dementia. CDT responses originally scored as part of the Addenbrooke’s Cognitive Examination Revised (ACE‐R) were rescored using the Mendez and Sunderland methods by an assessor blind to diagnosis.ResultThere were strong positive correlations between all three CDT scoring methods (r s range=.895‐.924). All methods differentiated dementia from MCI and intact participants (p<.001), but not intact from MCI (Mendez p=.712; Sunderland p=.545; ACE‐R p=.094). There was no significant difference between scoring methods in diagnostic validity for dementia (AUC=.739‐.756); however, the simple ACE‐R method had the highest positive and negative predictive values (PPV=0.643; NPV=0.862), with optimal cut‐off score <3.The MMSE outperformed all other screening tests in detecting cognitive impairment (MCI or dementia; AUC=.851) and was superior to both the KICA and CDT in distinguishing MCI from intact participants, but comparable to the RUDAS. Combining the CDT with other screening tools did not significantly improve their diagnostic performance for either cognitive impairment or MCI.ConclusionCDT alone is not an adequate screening tool for MCI; however, has potential for detecting moderate to severe cognitive impairment in older Aboriginal Australians. Relative to other screening tools, the MMSE performed well for detecting both cognitive impairment and MCI; the addition of the CDT did not significantly improve other tests’ performance.

The validation of the adapted Kimberley Indigenous Cognitive Assessment in a Brazilian indigenous community of older adults from Amazonas

AbstractBackgroundDementia detection in indigenous populations, represents a challenge worldwide, due to the absence of culturally adapted cognitive tests. The Kimberley Indigenous Cognitive Assessment (KICA) was developed and validated to evaluate global cognitive performance in Aboriginal Australians. We aimed to determine reliability and validity of the KICA, and specificity and sensitivity in detecting cognitive impairment in a Brazilian indigenous community.MethodThe KICA was translated and back translated into Portuguese by independent translators. The translated version was revised by an experts committee and pre‐tested. Healthy indigenous older adults (n=123, Age mean=63.7, SD=±9.1; Education mean=1.5, SD±2.3) and indigenous patients with cognitive impairment (n=94; Age mean=65.0, SD±11.5; Education mean=1.1, SD±11.5) from Amazonas, Brazil, were administered the KICA and Mini‐Mental State Examination (MMSE). Cognitive impairment classification was based on the DSM‐IV and ICD‐10 criteria. The KICA reliability and validity was analyzed using Cronbach's alpha and Pearson correlation coefficient between KICA and MMSE scores. Sensitivity and specificity were calculated at several cutoff values and the area under the Receiver Operator Characteristic (ROC) curve was calculated.ResultThe KICA demonstrated moderate internal consistency (Cronbach's alpha coefficient=0.787) and was significantly correlated with MMSE scores (r=0.660; p<0.001; Pearson coefficient). The best equilibrium was at the cutoff value of 26/27 out of 39 showing 72% sensitivity and 73% specificity; the area under the ROC curve was 0.78 (95% CI: 0.72‐0.84).ConclusionOur results indicate that the KICA is a reliable tool and can be used for screening cognitive impairment in Brazilian indigenous with low education background.

Developing the Canadian Indigenous Cognitive Assessment for Use With Indigenous Older Anishinaabe Adults in Ontario, Canada.

Background and ObjectivesDementia is a growing public health issue for aging Indigenous populations. Current cognitive assessments present varying degrees of cultural, educational, and language bias, impairing their application in Indigenous communities. Our goal is to provide Anishinaabe communities in Canada with a brief cognitive test that can be administered within the community setting by community health workers or professionals. The purpose of this study was to adapt the Kimberly Indigenous Cognitive Assessment (KICA) for use as a brief cognitive test with Anishinaabe populations in Canada.Research Design and MethodsWe used a community-based participatory research approach coupled with two-eyed seeing to provide an equitable space for Indigenous knowledge. Adaptation of the KICA was accomplished over 22 months using an iterative cycle of monthly consultations between an 11-member expert Anishinaabe language group (EALG) and the investigators, with ad hoc consultations with an Indigenous Elder, a community advisory council, and the KICA authors. Face validity was established with two pilot studies using cognitive interviewing with Indigenous older adults (n = 15) and a focus group consultation with local health professionals (n = 7).ResultsEach question of the KICA was scrutinized by the EALG for cultural appropriateness, language and translation, and cultural safety. Every domain required adaptation to reflect cultural values, specificity of language, tone, and a culturally safe approach. Orientation, verbal comprehension and fluency, praxis, and naming domains required the most adaptations. The first pilot for face validity resulted in additional changes; the second confirmed satisfactory adaptation of all changes.Discussion and ImplicationsThe research resulted in the new Canadian Indigenous Cognitive Assessment. The findings reveal important cultural and linguistic considerations for cross-cultural cognitive assessment in Indigenous contexts. This new culturally appropriate and safe brief cognitive test may improve case finding accuracy and lead to earlier diagnosis and improved dementia care for Indigenous peoples.

Identifying culturally acceptable cognitive tests for use in remote northern Australia

BackgroundA lack of culturally appropriate tests hampers accurate assessment of cognition in remote Australian Aboriginal communities. In Arnhem Land, this study employed a community consultation process to evaluate commonly used Western tests of executive function, memory, attention, and visuospatial function.MethodsAn initial consultation process and a follow-up pilot study resulted in the rejection of some common tests, the development of new tests, and culturally adapted versions of others. In the subsequent 30-person main trial, adult Aboriginal volunteers were examined on nine tests, plus the Kimberly Indigenous Cognitive Assessment screen, and a brief literacy test.ResultsExecutive function, memory, and attention tests were found to group separately after an exploratory principal components analysis. Correlations between new tests and similar Kimberly screen items were not significant, but ceiling effects may be relevant. Six of 13 test scores were found to correlate with the literacy measure.ConclusionsA selection of cognitive tests were identified that Aboriginal people found culturally acceptable and engaging. In particular, Self-Ordered Pointing, Trail-Making, a verbal-switching task, and a new test “Which car?” show promise for further development. This work may contribute to the need for culturally appropriate cognitive testing in Aboriginal communities.

Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study

AbstractBackground:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Validation of the Kimberley Indigenous Cognitive Assessment short form (KICA-screen) for telehealth

Introduction Studies show Aboriginal and Torres Strait Islander people are at increased risk of dementia. Whilst there have been several studies evaluating the use of telehealth for improving Aboriginal and Torres Strait Islander health outcomes, and studies validating telehealth dementia screening tools for the wider community, none have addressed the pressing need for culturally appropriate telehealth dementia screening for this at-risk population. The aim of the study was to examine the utility of using a culturally appropriate dementia screening tool (KICA-screen) in a telehealth setting. Methods A prospective field trial was used to compare administration of the short version of the Kimberley Indigenous Cognitive Assessment (KICA-screen) face-to-face and via telehealth. A total of 33 medically stable Aboriginal and Torres Strait Islander inpatients/outpatients participated. The stability of the KICA-screen scores, administered face-to-face and via telehealth, for each participant was measured. Results The two test delivery methods showed not only good correlation (Pearson’s r = 0.851; p < 0.01) but good agreement (intraclass correlation coefficient = 0.85; p < 0.01). Discussion Results of the assessment showed that KICA-screen can be reliably administered via videoconference and resulted in comparable scores to face-to-face testing in the majority of cases. The telehealth process was acceptable to participants, who were able to understand the process and complete the full screen remotely.

The Prevalence of Cognitive Impairment among People Attending a Homeless Service in Far North Queensland with a Majority Aboriginal and/or Torres Strait Islander People

ObjectiveTo establish the point prevalence of cognitive impairment among a representative group of homeless people in Cairns. The sample included a large number of Aboriginal and/or Torres Strait Islander people.MethodThis research was conducted among an opportunistic sample of participants residing in a homeless shelter. An interview administered cross‐sectional survey was conducted with 60 participants over 12-weeks. The Kimberly Indigenous Cognitive Assessment (KICA‐Cog) and a clinical diagnosis by a psychiatrist (using DSM‐V criteria) were used to establish cognitive impairment. The 36‐item version of the World Health Organisation Disability Assessment Survey 2.0 (WHODAS 2.0) was employed to ascertain limitations in daily living activities.ResultsSeventy‐five percent of participants were Aboriginal and/or Torres Strait Islander people. Thirty‐five percent of the sample had a cognitive impairment based on the KICA‐cog while over 70% of the sample had a cognitive impairment based on clinical criteria. Being screened for dementia or global cognitive impairment according to the KICA‐Cog was significantly correlated with having greater difficulty across the following WHODAS domains: understanding or communicating, self‐care, and life activities.ConclusionsMany people who are homeless have a cognitive impairment and this impairment impacts their ability to participate in society. A shift in practice is necessary to support homeless populations with a high proportion of Aboriginal and/or Torres Strait Islander people. It is important that culturally appropriate methods—focusing on cognitive health—are employed to support Aboriginal and/or Torres Strait Islander people who are homeless.

Barriers to early detection of cognitive impairment in the elderly despite the availability of simple cognitive screening tools and the pharmacist's role in early detection and referral

AbstractAimThe aim of this review is to identify a suitable cognitive screening tool that can be used by the pharmacist during home medication review in addition to calculating the medications’ total anticholinergic burden (ACB).Data sourcesA search of the literature was conducted using PubMed, Embase, Medline and Google Scholar databases to identify relevant studies using the following keywords: ‘cognitive impairment’, ‘cognitive impairment AND diagnosis’, ‘cognitive scales’, ‘dementia’, ‘delirium’, ‘pharmacist role’, ‘mini‐mental state examination (MMSE)’, ‘the Rowland dementia assessment scale (RUDAS)’, ‘the Alzheimer's Disease Assessment Scale ‐ Cognition (ADAS‐Cog)’ and ‘barriers and problems’. Only informational websites, clinical trials and review articles were included.ResultsThe MMSE, RUDAS, ADAS‐Cog, Psychogeriatric Assessment Scale (PAS) and Kimberley Indigenous Cognitive Assessment (KICA‐Cog) require specialist training. The anxiety and depression checklist (K10) and ‘worried about your memory’ (WAYM) can be self‐administered without prior training. The ACB scoring system can also be used to determine the total medications ACB.ConclusionThe K10 and WAYM can be used by the pharmacist during medication reviews to detect cognitive impairment early and refer the elderly for further medical care supported by the calculated score for the patient‘s total medications‘ ACB.

The diagnostic accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool: a systematic review

The objective of this study was to conduct a systematic review of evidence for the accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool in supporting the diagnosis of dementia in Indigenous Australian populations. Cross-sectional diagnostic accuracy studies of the KICA with an appropriate reference standard published to November 2015 were included. Comparison to an alternative cognitive assessment tool was required in non-remote populations. Case control analyses were excluded. Four studies were included: one of the KICA-Cog and KICA-Carer, one of the KICA Screen, and two of the modified-KICA. All tools developed for remote populations had a sensitivity of ≥76% and a specificity of ≥71% for the diagnosis of dementia. The KICA-Cog and KICA-Carer conducted in series had the highest sensitivity and specificity (91% and 94% respectively). In an urban and regional population, the mKICA had similar accuracy to the Mini-Mental State Examination (MMSE) (AUC 0.93, 95% CI 0.88-0.99 vs 0.94, 95% CI 0.89-0.99). Key risk of bias limitations related to lack of pre-determined cut-points and population selection methods. The use of the KICA in remote Indigenous Australians may assist in timely diagnosis of dementia in this population. Using the KICA-Cog and KICA-Carer in series may maximise specificity, decreasing false positive results without compromising sensitivity.

ADAPTING THE KIMBERLY INDIGENOUS COGNITIVE ASSESSMENT FOR USE WITH INDIGENOUS OLDER ADULTS IN CANADA

ADAPTING THE KIMBERLY INDIGENOUS COGNITIVE ASSESSMENT FOR USE WITH INDIGENOUS OLDER ADULTS IN CANADA

The impacts of a GO-game (Chinese chess) intervention on Alzheimer disease in a Northeast Chinese population.

A GO game can enhance mental health, but its effects on Alzheimer Disease (AD) remains unknown. To address the issue, 147 AD patients were randomly assigned into control (without GO-game intervention), Short-time GO-Game Intervention (SGGI, 1 h daily) and Long-time GO-game Intervention (LGGI, 2 h daily) groups. After 6-month follow-up, the game reduced the mean score of Montgomery-Asberg Depression Rating Scales (MADRS) of 4.72 (95% CI, 0.69 to 9.12) and Hospital Anxiety and Depression Scale (HADS) of 1.75 (95% CI, 0.17–3.68), and increased the mean score of Global Assessment of Functioning (GAF) of 4.95 (95% CI, −1.37–9.18) and RAND-36 of 4.61 (95% CI, −2.75–11.32) (P < 0.05 via controls). A GO-game intervention improved 9 of 11 items of KICA-dep (Kimberley Indigenous Cognitive Assessment of Depression). Meanwhile, serum levels of brain derived neurotrophic factor (BDNF) were higher in SGGI and LGGI groups (24.02 ± 7.16 and 28.88 ± 4.12 ng/ml respectively, P = 0.051) than those in controls (17.28 ± 7.75 ng/ml) (P < 0.001). The serum levels of BDNF showed a negative relation with MADRS and a positive relation with RAND-36 (P < 0.01). A GO-game intervention ameliorates AD manifestations by up-regulating BDNF levels.

The KICA Carer: informant information to enhance the Kimberley Indigenous Cognitive Assessment.

A quality dementia-screening tool is required for older remote Aboriginal Australians who have high rates of dementia and limited access to appropriate medical equipment and clinicians. The Kimberley Indigenous Cognitive Assessment (KICA Cog) is a valid cognitive test for dementia in Aboriginal and Torres Strait Islander peoples. The KICA cognitive informant questionnaire (KICA Carer) had yet to be analyzed to determine validity alone or in combination with the KICA Cog. The KICA Carer was completed by nominated informants of 349 remote-living Aboriginal Australians in the Kimberley region, Western Australia. Validity was assessed by comparing KICA Carer with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-10) consensus diagnoses based on a blinded specialist review. KICA Carer and KICA Cog were then compared to determine joint validity. A KICA Carer score of ≥3/16 gave optimum sensitivity (76.2%) and specificity (81.4%), area under curve (AUC) 0.89 (95% CI = 0.85, 0.94) with positive predictive value (PPV) of 35.8%, and negative predictive value (NPV) of 96.2%. A KICA Cog score of ≤33/39 gave a sensitivity of 92.9% and specificity of 89.9%, AUC 0.96 (95% CI = 0.94, 0.98), with PPV of 55.6% and NPV of 98.9%. Cut-off scores of KICA Cog ≤ 33/39 and KICA Carer ≥ 2/16 in series indicate possible dementia, with sensitivity of 90.5% and specificity of 93.5%. In this setting, PPV was 66.5% and NPV was 98.6%. The KICA Carer is an important tool to accurately screen dementia in remote Aboriginal Australians when the KICA Cog is unable to be used for a patient. It is readily accepted by caregivers. • For the best practice in the cognitive assessment of an Aboriginal Australian aged over 45 years, KICA Cog should be utilized. • In cases where Aboriginal patients are not assessed directly, KICA Carer should be conducted with an informant. A cut-off score of ≥3/16 should be used (these tools can be downloaded from www.wacha.org.au/kica.html).

Comparison of Three Cognitive Screening Tools in Older Urban and Regional Aboriginal Australians

Background: Validated cognitive screening tools for use in urban and regional Aboriginal populations in Australia are lacking. Methods: In a cross-sectional community-based study, 235 participants were assessed on the Mini-Mental State Examination (MMSE), the Rowland Universal Dementia Assessment Scale (RUDAS) and an urban modification of the Kimberley Indigenous Cognitive Assessment (mKICA). Performance on these cognitive screening tools was compared to dementia diagnosis by clinical consensus. Results: All tests were culturally acceptable with good psychometric properties. Receiver operating characteristic curve analyses revealed that the MMSE and mKICA were the most accurate. Conclusion: The MMSE is an effective cognitive screening tool in urban Aboriginal populations. The mKICA is a good alternative when illiteracy, language or cultural considerations deem it appropriate. The RUDAS also has adequate validity in this population.

Preparing a persian version of kimberley indigenous cognitive assessment for assessing the cognitive problems of illiterate geriatric patients.

Background:The rate of dementia is increasing rapidly. With the recognized high rate of illiteracy among geriatric patients, preparing an appropriate device for special screening among the low-educated elderly seems to be necessary. The aim of this study is to prepare and assess the psychometric properties of the Persian version of the Kimberley Indigenous Cognitive Assessment (KICA) in Iranian adults, in 2012.Materials and Methods:One hundred and eighty elders participated in this psychometric study. Ninety patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, Text Revision (DSM-IV-TR) criteria, who had been admitted to Geriatrics and Neurology in some of the private clinics in Esfahan, Iran, in 2012, were selected. The rest of the participants were normal persons with the same demographic characteristics as the dementia group, who were selected from the patients’ acquaintances and from the Retired Personnel Organization. The statistical tools were the KICA scale, Mini-Mental State Examination (MMSE), and Modified Mini-Mental State Examination (3MSE).Results:The best clinical cutoff point of the test was 31, with a sensitivity of 92% and specificity of 88%. The Cronbach's alpha coefficient of KICA was 0.93. Among the KICA's subscales, the maximum Cronbach's alpha coefficient belonged to Praxis (α = 0.933) and the minimum one belonged to Delayed Recall (α = 0.927). The correlation coefficients of the KICA score with MMSE and 3MSE were 0.58 and 0.57, respectively.Conclusion:The KICA test has been seen to be a reliable and valid tool to assess cognitive impairment in the aged people of Iran. The KICA test can be used as a cognitive assessment test for distinguishing patients with dementia, especially illiterate ones from other healthy people in Iran.

The Kimberley assessment of depression of older Indigenous Australians: prevalence of depressive disorders, risk factors and validation of the KICA-dep scale.

ObjectiveThis study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population.MethodsCross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from ‘never’ to ‘all the time’ (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history.ResultsThe study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8).ConclusionsThe KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities.