title: Adaptation and validation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) in a low-literacy setting in sub-Saharan Africa.
abstract: 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).
  
  
  CONCLUSIONS
  The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.
authors.affiliation: 1Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Stella-Maria
authors.initials: SM
authors.lastname: Paddick
authors.affiliation: 3Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Kisoli
authors.affiliation: 3Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mkenda
authors.affiliation: 3Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbowe
authors.affiliation: 1Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: William Keith
authors.initials: WK
authors.lastname: Gray
authors.affiliation: 1Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Dotchin
authors.affiliation: 5University College Hospital,University of Ibadan,Ibadan,Nigeria.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: 6Hai District Hospital,Boman'gombe,Kilimanjaro,Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Kisima
authors.affiliation: 5University College Hospital,University of Ibadan,Ibadan,Nigeria.
authors.forename: Olaide
authors.initials: O
authors.lastname: Olakehinde
authors.affiliation: 3Kilimanjaro Christian Medical University College,Moshi,Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: 1Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
authors.forename: Richard William
authors.initials: RW
authors.lastname: Walker
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000067010:Literacy; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D009549:Nigeria; D011594:Psychometrics / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012424:Rural Population; D013636:Tanzania
keywords: Alzheimer’s disease; clinical trials; cognition; dementia