The prevalence of dementia among Indigenous Australians is substantially higher than that found in non-Indigenous Australians and all other studied populations.

Interventions aimed at better management or prevention of the modifiable factors identified could reduce dementia risk in Aboriginal populations.

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.

BackgroundDementia is a major cause of disability worldwide [1], but despite its high prevalence inadequate screening at the level of primary care remains a problem [2]. To encourage case finding, a tool needs to be quick, easy to administer, and culturally and educationally appropriate [3].Aboriginal and Torres Strait Islander people have the worst health status of any population in Australia, with life expectancy approximately 17 years shorter than non-Indigenous people and burden of disease more than twice that of other Australians [4,5]. We have recently documented that dementia affects 12.4% of Indigenous Australians aged 45 years or older living in the Kimberley region [6], a prevalence estimate that is 5.2 times greater than for non-Indigenous Australians.Indigenous Australians, including those from the Torres Strait, express a rich diversity of traditions, law and culture, with a large number of spoken languages [7], and often have limited Western style education. For these reasons, conventional screening for cognitive impairment may not be appropriate even when translated into traditional language [7,8].The Kimberley Indigenous Cognitive Assessment (KICA) tool was developed by the authors to address a gap in the availability of a culturally appropriate assessment tool specifically Despite its widespread use, a possible limitation of the KICACog is the time required to complete the assessment, which hinders its acceptability in busy primary care settings. The aim of this study is to describe the psychometric properties of the KICA Screen and its subsequent validation in an independent population of older Aboriginal and Torres Strait Islanders living in Far North Queensland. Methods Development of KICA ScreenThe KICA Screen (Appendix I) was derived from the original KICA-Cog items used to test a population sample of 363 people living in the Kimberley. Recruitment was based on semi-purposeful sampling. All residents over the age of 45 years living in six remote Aboriginal communities and a random sample of one third of eligible Indigenous people in one town were approached [6]. Their characteristics have been described in detail elsewhere [6]. Items that were best able to differentiate between the participants with and without cognitive impairment and dementia were determined by discriminant function analysis (DFA) from the full KICACog. Sensitivity, specificity and cut points for the shortened version of the instrument were determined from the original validation sample. Validation of KICA Screen in QueenslandThe KICA Screen was then evaluated in a group of people from Northern Queensland over the age of 45 years. The Queensland study used convenience sampling methods, where a deliberate attempt was made to assess participants with varying degrees of cognitive impairment ranging from normal to dementia, using an approach similar to that of the original validation study in the Kimberley [9]. Participants were initially assessed with the KICA Screen and subsequently reviewed by a geriatrician who was unawar...

Falls, urinary incontinence and pain are common and reported for the first time in older indigenous people living in remote regions. The presence of these syndromes in ages over 45 may be due to accumulation of health insults during the life course.