A model of cognitive evaluation battery for diagnosis of mild cognitive impairment and dementia in educated and illiterate Egyptian elderly people

Abstract

Background The high illiteracy rates in the North African and Middle Eastern region make direct cognitive testing challenging. Validated instruments for dementia in Arabic language are lacking specially those targeting low-educated subjects. Objectives The aim of this study was to develop a cognitive evaluation battery suitable for both educated and illiterate Egyptian elderly people. Design A cross-sectional study was conducted. Setting: Ain-Shams University geriatric and ophthalmology wards, geriatrics outpatient clinic, and geriatric clubs. Participants: 159 male and female participants aged ≥ 60 years were recruited. Measurements Cut-off points were determined according to DSM-IV criteria for dementia and MMSE scores which divided the participants into 3 quadrants as normal, having mild cognitive impairment and having dementia then application of the new battery test was done. Results Test re-test reliability ranged from adequate to high in most of its tests with r ≥ 0.7. There was a statistical significance between all battery tests when divided into normal and dementia according to DSM IV criteria except in digit span forward length, digit span backward length, stimulus cue of confrontation naming and judgment. Means and standard deviations were calculated for each battery subset, for the whole sample, for low-educated group and group with > 9 years education according to three quadrants of MMSE. Conclusion A new valid and reliable neurocognitive evaluation battery that can differentiate between normal, mild cognitive impairment, and dementia in both educated and illiterate subjects under the name of Ain Shams Cognitive Assessment (ASCA) scale is now available.

Diagnostic Performance of Ain-Shams Cognitive Assessment tool among older adults with Mild Cognitive Impairment

“…The current study showed that ASCA total and subdomains scores including Semantic Fluency, Verbal learning (VL), Distractor interval, Bender Gestalt (BG) copy and recall, Digit Span forwards and backwards, set shifting lines and time, Confrontation naming (CN) total, CN phonemic cue, CN stimulus cue, spherical fluency, and lexical fluency were statistically significant in MCI diagnosis. This result was partially concordant with El-Kholy et al [17] except for digit span forward and backward, and phonemic cuing of confrontation naming that weren`t significant in diagnosing MCI among illiterate and low-educated people in El-Kholy et al [17] but were significant in the current study. This difference could be attributed to the higher level of education in El-Kholy et al [17] sample in comparison to this study.…”

“…This result was partially concordant with El-Kholy et al [17] except for digit span forward and backward, and phonemic cuing of confrontation naming that weren`t significant in diagnosing MCI among illiterate and low-educated people in El-Kholy et al [17] but were significant in the current study. This difference could be attributed to the higher level of education in El-Kholy et al [17] sample in comparison to this study.…”

“…The objective of this study was to evaluate the diagnostic performance of a newly developed neuropsychiatric battery named Ain Shams Cognitive Assessment tool "ASCA". ASCA was designed to overcome the defects in existing dementia screening instruments and their inability to detect early cognitive impairment by assessments of verbal learning, shortand long-term memory, cued memory, visuospatial functions, executive functions, verbal fluency, and confrontation naming and to apply tests that are less affected by education, in diagnosing MCI among literate and illiterate elderly Egyptian population [17] A-RUDAS was used as the gold standard test for MCI diagnosis [16].…”

“…Step 3: cognitive assessment by using ASCA [17]. ASCA includes the following tests: Step 4: Cut-off scores for some battery tests with the highest diagnostic accuracy of MCI were calculated.…”

“…RUDAS is easy to apply, takes around 10 min to administer, demands minimal training [15] and has been translated into the Arabic version of Rowland Universal Dementia Assessment Scale (A-RUDAS) [16]. Recently, a new neuropsychiatric battery has been developed in Egypt at Geriatrics and Gerontology department, Ain-shams university named as Ain-shams cognitive assessment tool (ASCA) targeting the diagnosis of MCI and dementia, the battery should be appropriate for illiterates, low educated and highly educated Egyptian elderly people [17].…”