title: The symptomatology of Alzheimer's disease: a cross-cultural study.
abstract: OBJECTIVE
  This paper presents the results of a trans-cultural study looking at the possible differences in the symptomatology of Alzheimer's disease (AD) in people from Manchester, UK and Rawalpindi, Pakistan.
  
  
  METHODS
  Two groups of people with AD (45 in each group) were recruited at the two sites. The participants and their carers were interviewed to investigate possible differences in demographics and symptomatology including cognition, depression, personality change and every day activities. The instrument used included the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD), The Brooks and McKinlay Personality Inventory and Informant Questionnaire on Cognitive Decline in the Elderly (IQ CODE).
  
  
  RESULTS
  The data analysis showed that compared to people from Manchester the Pakistanis had lower literacy levels but similar cognitive deficits when MMSE scores were adjusted for education. They were however more depressed; they had a different profile of personality change since the onset of illness and their reported changes in activities of daily living were more severe.
  
  
  CONCLUSIONS
  The study has shown a number of possible cultural differences in affective symptoms, personality changes and every day activities. It highlights the need for developing mental health services for older people in Pakistan and making UK services more accessible for this growing community. Further research on service and care needs along with developing culturally sensitive instruments for assessing cognition, psychiatric symptoms, personality changes and daily activities is needed.
authors.affiliation: Psychiatry Research Group, University of Manchester, Manchester, UK. salman.karim@manchester.ac.uk
authors.forename: Salman
authors.initials: S
authors.lastname: Karim
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Minhas
authors.forename: Sharmi
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Kyaw
authors.initials: K
authors.lastname: Sein
authors.forename: Babu
authors.initials: B
authors.lastname: Nayar
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: Asad
authors.initials: A
authors.lastname: Nizami
authors.forename: Fareed
authors.initials: F
authors.lastname: Minhas
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis; D003431:Cross-Cultural Comparison; D003863:Depression / Q000175:diagnosis; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales