A HINDI VERSION OF THE MMSE - THE DEVELOPMENT OF A COGNITIVE SCREENING INSTRUMENT FOR A LARGELY ILLITERATE RURAL ELDERLY POPULATION IN INDIA

The Indo-US Cross-National Dementia Epidemiology Study seeks to compar e two rural populations, in the US and India: the Monongahela Valley, a rural community of relatively low socioeconomic status in southweste rn Pennsylvania (USA), and Ballabgarh, a rural community near New Delh i in North India. Of particular interest is the fact that the Ballabga rh elderly population is exclusively Hindi-speaking, has little or no education and is largely illiterate, rendering its cognitive screening a particular challenge. In this article we report methods and prelimi nary data on the development of a Hindi cognitive screening instrument suitable for the Ballabgarh elderly population. We use as an example our Hindi adaptation of the Mini-Mental State Examination (MMSE), a wi dely used global cognitive screening scale. Systematic, item-by-item, empirically based test development has shown that effective modificati ons can be made to existing tests that require reading and writing; an d that culturally sensitive modifications can be made to render the te st meaningful and relevant while still tapping the appropriate cogniti ve domains. Certain cognitive functions, particularly orientation to t ime, remain difficult to test adequately in this type of population. I n Ballabgarh, as in the Monongahela Valley, educated individuals obtai n higher test scores. Implications for dementia screening are discusse d, including those relevant to the hypothesis that low education predi sposes to dementia.