Practical issues in cognitive screening of elderly illiterate populations in developing countries. The Indo-US Cross-National Dementia Epidemiology Study

The study of the epidemiology of dementia, specifically Alzheimer's disease , in developing countries requires specialized instruments and personnel. C ultural and sub-cultural differences among populations are highly relevant to the design of such instruments. Over and above the cultural issues, it i s widely recognized that low education and illiteracy pose considerable cha llenges to reliable and valid cognitive screening. The overall objectives o f the Indo-US Cross-National Dementia Epidemiology Study were: a) to determ ine the prevalence and incidence of, and risk factors for, Alzheimer's and other dementias in a defined Indian community; and b) to compare these resu lts with those found in a defined American community. To achieve these epid emiological objectives, our first task was to develop, systematically and e mpirically, suitable cognitive and activities assessment screening instrume nts for use in India, which would II be culturally fair, psychometrically s ound, and valid for a population with little or no education; 2) be optimal ly, sensitive and specific for dementia; and 3) allow not only the identifi cation but also the more detailed characterization of dementia, and of norm al and abnormal cognitive aging. In this paper we address the practical iss ues involved in the development and administration of the modified cognitiv e screening battery in our rural Indian context. (C) 1998, Editrice Kurtis.