Kimberley Indigenous Cognitive Assessment Research Articles

Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention...

Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies

BackgroundRates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.Methods/designThree cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).DiscussionGreater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

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.

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.

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.

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.

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.

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.

The KICA Screen: The psychometric properties of a shortened version of the KICA (Kimberley Indigenous Cognitive Assessment)

To describe the development and psychometric properties of the KICA (Kimberley Indigenous Cognitive Assessment) Screen. A short 10-item version of the KICA, the KICA screen was developed from original data of 363 Aboriginal people. The KICA Screen was subsequently independently validated in a non-random sample of 55 people living in Northern Queensland. In the original sample the KICA Screen showed an optimal cut-point score of 21/22 (out of a score of 25), and resulted in a sensitivity of 95.6% and specificity of 88.6% with AUC of 0.95 (95% CI 0.91-0.98). This cut point was subsequently tested on 55 people living in Northern Queensland, with a sensitivity of 82.4% and specificity of 88.5% for the diagnosis of dementia, and the area under the ROC (receiver operating characteristic) curve was 0.87 (95% CI 0.77-0.97). The KICA Screen is a valid and acceptable screening tool among Indigenous Australians living in remote and rural areas of Australia.

Factors Associated with Dementia in Aboriginal Australians

Although the prevalence of dementia in remote living Aboriginal Australians is one of the highest in the world, the factors associated with dementia in this population are yet to be examined. This study was designed to determine the demographic, lifestyle and clinical factors associated with dementia in Aboriginal Australians living in the Kimberley region of Western Australia. A total of 363 Aboriginal Australians aged over 45 years from the Kimberley region were selected by semi-purposeful sampling. The factors analysed for association with dementia were age, sex, education, smoking, chewing tobacco, alcohol, head injury, heart disease, hypertension, diabetes, previous stroke, epilepsy, falls, mobility, incontinence, urinary problems, vision and hearing. This exposure data was collected from participants' and informants' reports using the Kimberley Indigenous Cognitive Assessment and specialist review, and medical records. Factors associated with dementia included older age, male gender (OR 3.1, 95%CI 1.4, 6.8) and no formal education (OR 2.7, 95%CI 1.1, 6.7) and after adjusting for age, sex and education, dementia was associated with current smoking (OR 4.5, 95%CI 1.1, 18.6), previous stroke (OR 17.9, 95%CI 5.9, 49.7), epilepsy (OR 33.5, 95%CI 4.8, 232.3), head injury (OR 4.0, 95%CI 1.7, 9.4), and poor mobility, incontinence and falls. Interventions aimed at better management or prevention of the modifiable factors identified could reduce dementia risk in Aboriginal populations.

Assessing cognitive impairment in Indigenous Australians: Re-evaluation of the Kimberley Indigenous Cognitive Assessment in Western Australia and the Northern Territory

The Kimberley Indigenous Cognitive Assessment (KICA) was initially developed and validated as a culturally appropriate dementia screening tool for older Indigenous people living in the Kimberley. This paper describes the re-evaluation of the psychometric properties of the cognitive section (KICA-Cog) of this tool in two different populations, including a Northern Territory sample, and a larger population-based cohort from the Kimberley. In both populations, participants were evaluated on the KICA-Cog tool, and independently assessed by expert clinical raters blinded to the KICA scores, to determine validity and reliability of dementia diagnosis for both groups. Community consultation, feedback and education were integral parts of the research. For the Northern Territory sample, 52 participants were selected primarily through health services. Sensitivity was 82.4% and specificity was 87.5% for diagnosis of dementia, with area under the curve (AUC) of .95, based on a cut-off score of 31/32 of a possible 39. For the Kimberley sample, 363 participants from multiple communities formed part of a prevalence study of dementia. Sensitivity was 93.3% and specificity was 98.4% for a cut-off score of 33/34, with AUC = .98 (95% confidence interval: 0.97–0.99). There was no education bias found. The KICA-Cog appears to be most reliable at a cut-off of 33/39.

High prevalence of dementia and cognitive impairment in Indigenous Australians

To determine the prevalence of dementia and cognitive impairment among older Indigenous Australians. A total of 363 Indigenous Australians aged over 45 years from the Kimberley region in the far north of Western Australia were assessed with the Kimberley Indigenous Cognitive Assessment (KICA). All those scoring less than 37 on the KICA and a percentage of those scoring 37 or more were reviewed by specialist clinicians and DSM-IV consensus diagnoses were obtained from two other specialists blinded to KICA results. The prevalence of dementia was 12.4%, substantially higher than in the Australian general population. The prevalence of cognitive impairment not dementia was 8.0%. The prevalence of dementia among Indigenous Australians is substantially higher than that found in non-Indigenous Australians and all other studied populations.

‘Ngana minyarti? What is this?’ Development of cognitive questions for the Kimberley Indigenous Cognitive Assessment

Objectives: To describe the processes used to develop an instrument to assess cognition in the older Indigenous community of the Kimberley region of Western Australia, given the diverse history and culture of the region. Methods: Cognition questions were discussed with Indigenous organisations, councils, linguists, interpreters and health professionals. Existing assessment tools were reviewed. The cognition questions and the way in which they were approached were trialled with older Indigenous participants. Results: Questions to assess cognition were developed and incorporated into the Kimberley Indigenous Cognitive Assessment (KICA) instrument, which has since been demonstrated to be a valid and reliable assessment of cognition in older Indigenous Australians in the Kimberley. Conclusion: The KICA‐Cog questions in the KICA survey tool provide the first specific instrument for assessing cognitive decline in older Indigenous Australians. This instrument, or a modification of this instrument, is likely to have broader applicability across Indigenous communities in Northern Australia.

Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous Australians

Indigenous Australians have a unique cultural heritage dating back many thousands of years. Unfortunately, there is no validated tool to assess cognition in older indigenous Australians. This study was designed to address this deficiency. The Kimberley Indigenous Cognitive Assessment (KICA) was developed with Indigenous health and aged care organizations, and comprises cognitive, informant and functional sections. The psychometric properties of the cognitive assessment section (KICA-Cog) are described in this paper. The KICA-Cog was tested in 70 indigenous subjects, of varying cognitive abilities and diagnoses, over 45 years of age. Subjects were interviewed using the KICA-Cog and then independently assessed by expert clinical raters using DSM-IV and ICD-10 criteria. Interrater and internal reliability were determined. The KICA-Cog score showed no systematic interrater difference; the mean was -0.07 (SD = 1.83). Interrater reliability for 16 individual questions from the cognitive section revealed a kappa-value > or = 0.6 and intraclass correlations for 12 questions. Internal consistency, as assessed by Cronbach's alpha, was 0.88. Three items on the cognitive score (pension week, recall and free recall) effectively discriminated 85-7% of dementia cases. Sensitivity and specificity were 90.6% and 92.6%, respectively, using a cut-off score of 31/32. The KICA-Cog appears to be a reliable assessment tool for cognitive impairment in an Australian older traditionally living indigenous population.