Adaptation of the ACE for a Malayalam speaking population in southern India.
OBJECTIVE
To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original.


METHODS
The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 +/- 7.4; education >/= 9, mean = 10.9 +/- 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: 'India >/= 9' (n = 50; mean age = 67.8 +/- 5.2; education >/= 9, mean = 13.9 +/- 2.7) and 'India </= 8' (n = 50; mean age = 67.1 +/- 5.3; education </= 8, mean = 3.1 +/- 2.0).


RESULTS
Most ACE items were retained. The score distribution (mean +/- 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India >/= 9 groups. Language, Naming, Attention and Orientation are relatively easy (>/= 80% at ceiling) and Recall and Verbal fluency are relatively difficult (</= 22% at ceiling). Although the percentage at ceiling were lower for the India </= 8 group, the order of relative difficulty was similar and the percentage scoring at floor was </= 10% on all except visuospatial item.


CONCLUSIONS
The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.
Mathuranath
P S
PS
Cognition and Behavioural Neurology Center (CBNC), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India. mathu@sctimist.ac.in
Hodges
John R
JR
Mathew
Robert
R
Cherian
P Joseph
PJ
George
Annamma
A
Bak
Thomas H
TH
D000368:Aged; D001288:Attention; D003071:Cognition; D003469:Culture; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007802:Language; D008297:Male; D008568:Memory; D008875:Middle Aged; D009949:Orientation; D011581:Psychological Tests; D013060:Speech