Dementia Diagnosis in Seven Languages: The Addenbrooke’s Cognitive Examination-III in India

Dement Geriatr Cogn Disord Extra

Mekala

et al. 2020

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Objectives: Frontotemporal dementia (FTD) syndromes are a complex group of disorders characterised by profound changes in behaviour and cognition. Many of the observed behavioural abnormalities are now recognised to be due to impaired social cognition. While deficits in emotion recognition and empathy are well-recognised in behavioural-variant (Bv)FTD, limited information exists about the nature of social cognitive impairment in the language variant primary progressive aphasia (PPA) that includes progressive non-fluent aphasia (PNFA) and semantic dementia (SD), and in the motor variants FTD amyotrophic lateral sclerosis (FTD-ALS) and FTD progressive supranuclear palsy (FTD-PSP). This prospective study sought to explore the nature and profile of social cognition deficits across the spectrum of FTD. Methods: Sixty patients on the FTD spectrum, i.e., classical (16 with BvFTD and 20 with PPA) and overlap FTD syndromes (13 with FTD-ALS and 11 with FTD-PSP) were evaluated by means of the social cognition tasks, the Interpersonal Reactivity Index (IRI) for empathy, and pictures of facial affect (POFA) for emotion recognition. General cognition and behaviour were also assessed. Results: A significant impairment in emotion recognition and empathy was detected in both the classical and overlap FTD syndromes. The recognition of positive emotions was relatively preserved compared to that of negative emotions. Among the FTD subtypes, maximal impairment of empathy was demonstrated in FTD-PSP. Conclusion: Social cognition impairment is pervasive across the spectrum of FTD disorders, and tests of emotion recognition and empathy are clinically useful to identify the nature of behavioural problems in both classical and overlap FTD. Our findings also have implications for understanding the neural basis of social cognition in FTD.

Section: Methodsmentioning

confidence: 99%

Social Cognition Deficits Are Pervasive across Both Classical and Overlap Frontotemporal Dementia Syndromes

Arshad

Dement Geriatr Cogn Disord Extra

Mekala

et al. 2020

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“…This was also reiterated by the GLM results on the control data set in our study. This nonsignificant impact of language has also been similarly demonstrated in our recent 7-language validation study of ACE-III, which was used as one of the gold standard tests for this study [18]. We used composite Z scores based on the understanding that raw test scores, but not the standardized Z scores, would vary across languages/locations [24].…”

Section: Discussionmentioning

confidence: 62%

“…Literate participants from each institution were selected and placed into 3 groups, that is, controls, MCI, and VaMCI following stroke as per current criteria based on their performance on gold standard cognitive tools (Addenbrooke’s Cognitive Examination-III [ACE-III], Rey Auditory Verbal Learning Test [RAVLT], and Color Trails Test [CTT]) and a clinical interview conducted by a practicing clinician. Language-wise cutoffs as well as common cutoffs in age and education bands in ACE-III adaptations have been published recently [18]. Impairment on at least 2 out of the aforementioned 3 tests was mandatory for inclusion as MCI/VaMCI.…”

Section: Methodsmentioning

confidence: 99%

Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society

Menon

Varghese

Dement Geriatr Cogn Disord

et al. 2020

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Background/Aims: In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. Methods: Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. Results: Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of −0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI. Conclusions: The ICMR-NCTB is a “first of its kind” approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.

“…In older adults, cognitive changes occur due to neurodegeneration from diseases such as Alzheimer’s disease and frontotemporal dementia, that results in cerebral atrophy (Jacoby et al, 1980; Raz et al, 2007) and decrease in cerebral metabolism (Sophie, 2007). These changes result in cognitive decline that is typically measured by cognitive tests such as the ACE, a widely-used test that has been standardised for use in India across seven languages across educational and socioeconomic levels (ACE-III: Mekala et al, 2020; ACE-R: Alladi et al, 2015). The results of our study showed that there was a significant association between ACE scores and LEQ scores (total, young adulthood, mid-life, and late-life stage scores) in the overall cohort, healthy elderly, and patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive evaluation : Cognitive assessment was done using Addenbrooke’s Cognitive Examination (ACE-III: Mekala et al, 2020; ACE-R: Alladi et al, 2015) adapted for Indian languages and educational levels. The ACE III is a global cognitive testing tool and also measures individual subdomains of attention, memory, fluency, language and visuospatial functions through its subscores.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Lifestyle Experiences across Lifespan and Cognitive Ageing in the Indian Context

Psychology and Developing Societies

Ballal

Varghese

et al. 2020

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With rising numbers of elderly and dementia in developing societies, there is a need to understand factors protective against dementia. Evidence suggests that lifetime cognitive activities including education, occupation, and complex leisure activities contribute to cognitive reserve. However, these factors are understudied in India. This paper describes the validation of the Lifetime of Experiences Questionnaire (LEQ), a comprehensive measure of complex lifetime activities, to the Indian cultural context. It also examines the relationship between lifetime experiences and cognition among 52 healthy elderly and 30 dementia patients. High inter-rater (κ=0.923, p < 0.001), test-retest (ρ: 0.905 to 0.986) reliability, and internal consistency were found for LEQ-total (0.992) and sub-scores. Literate dementia patients (25) scored significantly lower mid-life (27.5 vs. 23.3), late-life (28.5 vs. 22.5) and total LEQ (83.5 vs. 20.9) scores than literate healthy group (37). LEQ scores positively correlated with global cognition, and domains of attention and memory on the Addenbrooke’s Cognitive Examination, in healthy and dementia groups. Moreover, LEQ scores correlated positively with age at onset of dementia and negatively with clinical dementia rating (CDR) scores. Our study demonstrates that lifetime activities, especially mid-life experiences, play a protective role in development of late-life dementia, and need to be advocated to preserve late-life cognition.