1Northumbria Healthcare NHS Foundation Trust,North Tyneside General Hospital,North Shields,UK.
3Kilimanjaro Christian Medical University College,Moshi,Tanzania.
Acta Neuropsychiatr. 2017 Aug;29(4):244-251. doi: 10.1017/neu.2016.65. Epub 2017 Mar 27.
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.
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.
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).
The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.
本研究旨在评估对阿尔茨海默病评估量表认知部分（ADAS-Cog）进行低识字水平改编的可行性，以便在撒哈拉以南非洲农村地区（SSA）开展痴呆症干预研究。目前尚无此类改编。
坦桑尼亚和尼日利亚的卫生专业人员通过共识对 ADAS-Cog 进行改编。在坦桑尼亚，对 34 名居住在农村地区、有轻度/中度痴呆症的老年人和 32 名非痴呆症对照者进行了横断面样本验证。对教育程度较低的人群进行了超采样。在同一人群中，两名经过培训的评估者对 22 名老年人（13 名痴呆症患者）进行了两次评估，以评估评估者间的可靠性。评估者对诊断组不了解。
在轻度/中度痴呆症患者中，ADAS-Cog 的中位数得分为 28.75（四分位距（IQR），22.96-35.54），在对照组中为 12.75（IQR 9.08-16.16）。痴呆症的受试者工作特征曲线下面积（AUC）为 0.973（95%置信区间（CI）0.936-1.00）。内部一致性较高（Cronbach's α 0.884），评估者间可靠性良好（组内相关系数 0.905，95%CI 0.804-0.964）。
ADAS-Cog 的低识字水平改编在该环境下具有良好的心理测量学特性。需要在类似环境中进一步评估。
