10/66 Dementia tools

Revision and validation of the short 10/66 dementia diagnostic assessment for older populations in Kintampo, Ghana

The lack of standardization of dementia diagnostic assessments and algorithms has been recognized as a major issue in the estimation of the burden of disease across cultures. Standardization is difficult to achieve because of the diversity of language, culture, and levels of literacy in the different regions of the world. Besides, most of the population-based studies in Sub-Saharan Africa (SSA) have been using two-stage diagnostic approaches. However, this approach might not be feasible across the continent for large scale surveys given the lack of specialist resource. The development of a culturally adapted one-stage dementia assessment, harmonized with those used in other settings, with robust training methods to ensure high standards of fidelity of administration and rating, is therefore critical.

Standardization of dementia assessment can be challenged by the diversity of language, culture, and levels of literacy in the different regions of the world. A culture- and education-fair dementia computerized diagnostic algorithm to ascertain dementia status was developed and validated by the 10/66 Dementia Research Group (10/66 DRG), in Asia, Latin America and only one African site. The instruments contributing to this assessment are the Community Screening Instrument for Dementia (CSI-D), the Geriatric Mental State (GMS) examination, and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) 10-word list recall task. This one-phase fully structured assessment can be administered by appropriately trained lay interviewers while two-phase assessments, requiring specialist clinical diagnosis, are often not feasible in resource poor settings. Less attention has been given to the validity of survey diagnostic approaches in SSA compared with other regions of the world. Data from recent studies carried out in Nigeria, Ghana and South Africa, Central African Republic, Congo and Tanzania raised concerns about the robustness of assessments that are core to the 10/66 dementia diagnostic assessment.

Challenges of cross-cultural adaptation exist, and usual training, supervision and quality control procedures might not guarantee the expected level of quality and validity. There is therefore a growing need to establish and validate a culture- and education-fair one stage approach adapted for sub-Saharan population surveys. This work builds on the last 10 years of dementia research carried out in SSA and existing collaborations developed with the10/66 DRG (Centre for Global Mental Health) and the University of Newcastle as well as the Kintampo Health Research Centre in Ghana. The foundation of the adaptation and validation of the short 10/66 dementia diagnostic assessment and algorithm in Ghana will rely on several triangulated approaches.

Aims : To adapt and validate the 10/66 short-form dementia diagnostic assessment for older populations in Kintampo, Ghana.

Specific aims :
– To analyse existing data from SSA and other 10/66 population surveys in order to identify potential centre or interviewer effects, and other sources of measurement bias.
– To adapt the diagnostic assessment and recalibrate its algorithm, by exploring assessment quality and deviations from protocol.
– To validate the revised version of the 10/66 short-form dementia diagnostic assessment in Kintampo.

Key words : Diagnosis, Dementia, Older people, Adaptation, Validation, sub-Saharan Africa