The validation of the adapted Kimberley Indigenous Cognitive Assessment in a Brazilian indigenous community of older adults from Amazonas

Abstract

Background Dementia detection in indigenous populations, represents a challenge worldwide, due to the absence of culturally adapted cognitive tests. The Kimberley Indigenous Cognitive Assessment (KICA) was developed and validated to evaluate global cognitive performance in Aboriginal Australians. We aimed to determine reliability and validity of the KICA, and specificity and sensitivity in detecting cognitive impairment in a Brazilian indigenous community. Method The KICA was translated and back translated into Portuguese by independent translators. The translated version was revised by an experts committee and pre‐tested. Healthy indigenous older adults (n=123, Age mean=63.7, SD=±9.1; Education mean=1.5, SD±2.3) and indigenous patients with cognitive impairment (n=94; Age mean=65.0, SD±11.5; Education mean=1.1, SD±11.5) from Amazonas, Brazil, were administered the KICA and Mini‐Mental State Examination (MMSE). Cognitive impairment classification was based on the DSM‐IV and ICD‐10 criteria. The KICA reliability and validity was analyzed using Cronbach's alpha and Pearson correlation coefficient between KICA and MMSE scores. Sensitivity and specificity were calculated at several cutoff values and the area under the Receiver Operator Characteristic (ROC) curve was calculated. Result The KICA demonstrated moderate internal consistency (Cronbach's alpha coefficient=0.787) and was significantly correlated with MMSE scores (r=0.660; p<0.001; Pearson coefficient). The best equilibrium was at the cutoff value of 26/27 out of 39 showing 72% sensitivity and 73% specificity; the area under the ROC curve was 0.78 (95% CI: 0.72‐0.84). Conclusion Our results indicate that the KICA is a reliable tool and can be used for screening cognitive impairment in Brazilian indigenous with low education background.