A hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in india

Abstract

SUMMARYThe Indo-US Cross-National Dementia Epidemiology Study seeks to compare two rural populations, in the US and India: the Monongahela Valley, a rural community of relatively low socioeconomic status in southwestern Pennsylvania (USA), and Ballabgarh, a rural community near New Delhi in North India. Of particular interest is the fact that the Ballabgarh elderly population is exclusively Hindi-speaking, has little or no education and is largely illiterate, rendering its cognitive screening a particular challenge. In this article we report methods and preliminary data on the development of a Hindi cognitive screening instrument suitable for the Ballabgarh elderly population. We use as an example our Hindi adaptation of the Mini-Mental State Examination (MMSE), a widely used global cognitive screening scale. Systematic, item-by-item, empirically based test development has shown that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant while still tapping the appropriate cognitive domains. Certain cognitive functions, particularly orientation to time, remain difficult to test adequately in this type of population. In Ballabgarh, as in the Monongahela Valley, educated individuals obtain higher test scores. Implications for dementia screening are discussed, including those relevant to the hypothesis that low education predisposes to dementia.KEY WORDS-dementia epidemiology; ageing; neuropsychology; cross-cultural research Cognitive impairment, characteristic of dementia, is measured objectively by standard neuropsychological (cognitive) tests. Screening for dementia is usually accomplished by means of a global cognitive

Proportion and Factors Associated with Depressive Symptoms among Elderly in an Urban Slum in Bangalore

“…This time was arrived from pilot study experiences. The questionnaire included information relating to sociodemographic particulars (Modified Kuppuswamy scale), 23 assessment scales Hindi Mental Status Examination (HMSE scale), 24 Center for Epidemiologic Studies Depression (CESD) scale, 25 life events in the previous 1 year, 26 and information on other important issues of substance use, chronic illness. Questions pertaining to alcohol and tobacco were asked to the females also.…”

Neuropsychological dysfunction in idiopathic hypoparathyroidism and its relationship with intracranial calcification and serum total calcium

“…All the subjects were assessed separately in a session lasting 2-3 h between 1100 and 1400 h. Various tests used included: i) Hindi Mental State Examination (HMSE) to assess orientation, arithmetic, memory and language (11); ii) Brief Psychiatric Rating Scale (BPRS) for psychopathology (12); iii) Trail Making Test (TMT-A/B) assessing visual attention, psychomotor speed and task switching (13); iv) Abnormal Involuntary Movement Scale (AIMS) to measure abnormal movements (14); v) The PGI-Memory scale (PGIMS) for memory (15); vi) Bender Gestalt Test (BGT) for visuo-spatial gestalt functioning and micrographia (16); vii) Finger Tapping test (FTT) for psychomotor deficits (17); viii) Verbal Adult Intelligence Scale (VAIS) to assess verbal quotient (VQ) (15); ix) Benton Visual Retention Test (BVRT) for visual perception, visual memory and visual constructive abilities (18); and x) Stroop test for executive function and response inhibition (19). Quality of physical and mental health was assessed by Short Form (SF-36) questionnaire (20).…”

“…Corrections for age and education were applied to the raw scores of PGIMS and VAIS tests. HMSE used in the current study is an adaptive version of MMSE validated for the Indian population (11,26). The cognitive tests were standardised for inter-and intra-personal variations.…”

“…The frequency of impaired cognitive dysfunction was analysed using standard cutoffs for HMSE, AIMS and VAIS (11,14,15). BPRS, TMT, BGT and BVRT tests were categorised as impaired when the raw scores of the respective tests were more than upper quartile of the values observed in the healthy controls.…”

Characteristic differences in the mini-mental state examination used in Asian countries

“…For example, in the Hindi Mental State Exam (HMSE) [13], 16 of the original items were changed to adapt for rural older adults in India, who have little or no education. Another 3 Korean versions of the MMSE (not included in this analysis) measured judgment instead of reading and writing with 2 questions [34][35][36], "Why do you clean your clothes?"…”