AD8-Brazil: Cross-Cultural Validation of the Ascertaining Dementia Interview in Portuguese

Abstract

Dementia is a global public health problem and detection in the primary care setting, particularly in developing countries, is challenging. The aim of this research was to produce the cross-cultural validation of the AD8 interview to the Brazilian Portuguese Language. The original version of the AD8 was submitted to translation, back-translation, and application of the questionnaire to 20 elderly informants for face validation. The AD8-Brazil was then evaluated in 109 community-dwelling elderly with a sociodemographic questionnaire, clinical examination, Mini Mental State Examination (MMSE), Katz Inventory of Activities of Daily Living (ADL), and Clinical Dementia Rating scale (CDR). The AD8-Brazil was compared with the other instruments and with the clinical diagnosis (DSM-IV) for criterion validation. There was significant agreement of AD8-Brazil with diagnosis of dementia (p < 0.001), MMSE (p = 0.047), and ADL (PFisher = 0.004). Also, the AD8-Brazil was able to differentiate the stages of dementia by CDR scale. The reliability was high (alpha = 0.818) and reproducibility analysis showed excellent inter-rater (kappa = 0.889) and test-retest consistency (kappa = 0.814). The AD8-Brazil showed excellent discrimination between CDR 0 and CDR > 0 (area under the curve 86.1%) and between CDR 0 and CDR 0.5 (area under the curve 76.9%). The administration of the questionnaire took 2.3 ± 0.1 minutes. The Brazilian version of the AD8 is a valid, reliable, quick, and easy screening instrument for dementia.

The reliability and validity of the informant AD8 by comparison with a series of cognitive assessment tools in primary healthcare

“…Therefore, the reliable and valid psychometric properties of informant AD8 established in the present study further support a recent study on the clinical utility of the informant AD8 for dementia case finding in the primary healthcare setting (Chan et al, 2015). The short administration time (< 3 minutes) of the informant AD8 is consistent with previous studies (Galvin et al, 2006;Ryu et al, 2009;Correia et al, 2011;Dong et al, 2013). This is more desirable than the MoCA which was reported to have an average administration time of 12 minutes (Wong et al, 2009) and the MMSE which requires an average administration time of 6-10 minutes (Lin et al, 2013).…”

“…In addition to good reliability, the informant AD8 also demonstrated good concurrent validity evidenced by strong correlations with performancebased cognitive screening assessments such as the MMSE and MoCA; clinical assessments such as the CDR; and formal neuropsychological assessments (Galvin et al, 2006;Ryu et al, 2009;Koski et al, 2010;Correia et al, 2011;Yang et al, 2011). In regards to construct validity, individual items of the informant AD8 were reported to correlate well with cognitive domains of memory (daily problems with memory, repeating statements, trouble remembering appointments), orientation (trouble remembering month or year), executive abilities (problems with judgment, trouble handling finances), and complex function (loss of interest, trouble learning new appliances) (Correia et al, 2011).…”

“…In regards to construct validity, individual items of the informant AD8 were reported to correlate well with cognitive domains of memory (daily problems with memory, repeating statements, trouble remembering appointments), orientation (trouble remembering month or year), executive abilities (problems with judgment, trouble handling finances), and complex function (loss of interest, trouble learning new appliances) (Correia et al, 2011). Construct validity was considered acceptable with a convergent validity of moderate to strong correlations (R ࣙ 0.4) between individual AD8 items and the corresponding CDR domains and neuropsychological tests (Galvin et al, 2006).…”

Detection of Dementia

“…The AD8 has a sensitivity of 84 %, and specifi city of 80 % with excellent ability to discriminate between non-demented older adults and those with mild dementia (92 %) regardless of the cause of impairment [ 20 ]. The AD8 has been translated into Spanish [ 63 ], Portuguese [ 64 ], Korean [ 65 ] and Chinese [ 66 ] with similar psychometric properties.…”

Cross-cultural adaptation and validation of the episodic autobiographic memory interview for Brazilian Portuguese

“…The Geriatric Depression Scale 17 was employed to assess the presence of depressive symptoms. The Functional Activities Questionnaire (FAQ) 21 and AD-8 22 were completed by a caregiver, and the results were used to quantify functional impairment and assess their perception of patients' cognitive status. Finally, we applied an adapted version of the Remember-Know paradigm 5 .…”