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Adaptation and validation of the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) in a low-literacy setting in sub-Saharan Africa

Lookup NU author(s): Dr Stella Paddick, Dr Catherine DotchinORCiD, Professor Richard Walker


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© Scandinavian College of Neuropsychopharmacology 2017 Objective: This study aimed to assess the feasibility of a low-literacy adaptation of the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) for use in rural sub-Saharan Africa (SSA) for interventional studies in dementia. No such adaptations currently exist. Methods: Tanzanian and Nigerian health professionals adapted the ADAS-Cog by consensus. Validation took place in a cross-sectional sample of 34 rural-dwelling older adults with mild/moderate dementia alongside 32 non-demented controls in Tanzania. Participants were oversampled for lower educational level. Inter-rater reliability was conducted by two trained raters in 22 older adults (13 with dementia) from the same population. Assessors were blind to diagnostic group. Results: Median ADAS-Cog scores were 28.75 (interquartile range (IQR), 22.96–35.54) in mild/moderate dementia and 12.75 (IQR 9.08–16.16) in controls. The area under the receiver operating characteristic curve (AUC) was 0.973 (95% confidence interval (CI) 0.936–1.00) for dementia. Internal consistency was high (Cronbach’s α 0.884) and inter-rater reliability was excellent (intra-class correlation coefficient 0.905, 95% CI 0.804–0.964). Conclusion: The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.

Publication metadata

Author(s): Paddick S-M, Kisoli A, Mkenda S, Mbowe G, Gray WK, Dotchin C, Ogunniyi A, Kisima J, Olakehinde O, Mushi D, Walker RW

Publication type: Article

Publication status: Published

Journal: Acta Neuropsychiatrica

Year: 2017

Volume: 29

Issue: 4

Pages: 244-251

Print publication date: 01/08/2017

Online publication date: 27/03/2017

Acceptance date: 23/10/2016

ISSN (print): 0924-2708

ISSN (electronic): 1601-5215

Publisher: Cambridge University Press


DOI: 10.1017/neu.2016.65


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