Developing and implementing guidelines on culturally adapting the Addenbrooke’s cognitive examination version III (ACE-III): a qualitative illustration

Abstract

Background Cognitive tests currently used in healthcare and research settings do not account for bias in performance that arises due to cultural context. At present there are no universally accepted steps or minimum criteria for culturally adapting cognitive tests. We propose a methodology for developing specific guidelines to culturally adapt a specific cognitive test and used this to develop guidelines for the ACE-III. We then demonstrated their implementation by using them to produce an ACE-III Urdu for a British South Asian population. Methods This was a several stage qualitative study. We combined information from our systematic review on the translation and cultural adaptation of the ACE-III with feedback from previous ACE-III adaptors. This identified steps for cultural adaptation. We formatted these into question-by-question guidelines. These guidelines, along with feedback from focus groups with potential users were used to develop ACE-III Urdu questions. Clinical experts reviewed these questions to finalise an ACE-III Urdu. Results Our systematic review found 32 adaptations and we received feedback from seven adaptors to develop the guidelines. With these guidelines and two focus groups with 12 participants a sample ACE-III Urdu was developed. A consensus meeting of two psychiatrists with a South Asian background and familiarity with cognitive tests and cultural adaptation finalised the ACE-III Urdu. Conclusions We developed a set of guidelines for culturally adapting the ACE-III that can be used by future adaptors for their own language or cultural context. We demonstrated how guidelines on cultural adaptation can be developed for any cognitive test and how they can be used to adapt it.

Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis

“…Waheed et al 38 proposed that every cognitive test should have its own set of specific guidelines on culturally adapting each of its questions. These would be developed through an incorporation of previous literature and feedback from those who have previously adapted it.…”

“…These would be developed through an incorporation of previous literature and feedback from those who have previously adapted it. 38 …”

“…At present, there are only one set of guidelines that have been developed for the cultural adaptation of a specific cognitive test. 38 These are for the Addenbrooke's Cognitive Examination Version III (ACE-III), a gold standard for the diagnostic accuracy of cognitive impairment and dementia. 39 , 40 These guidelines were developed through a multi-stage qualitative study combining findings from a systematic review on the translation and cultural adaptations of the ACE-III with feedback received via questionnaires from previous adaptors of the ACE-III.…”

“… 39 , 40 These guidelines were developed through a multi-stage qualitative study combining findings from a systematic review on the translation and cultural adaptations of the ACE-III with feedback received via questionnaires from previous adaptors of the ACE-III. 36 , 38 , 41 …”

Bilingualism: A Global Public Health Strategy for Healthy Cognitive Aging

“…Specific challenges may arise when utilizing neuropsychological tests in many LMIC settings for bilingualism and dementia research. Traditionally these tests have been derived for educated and English-speaking western populations and may have limited applicability to other cultures (76,77). Although, Alladi and colleagues (68) successfully used culturally and linguistically amended versions of the Addenbrookes Cognitive Examination and Dementia Rating Scale there are other specific challenges to consider.…”