Academic journal article East Asian Archives of Psychiatry

Adaptation of the Montreal Cognitive Assessment for Elderly Filipino Patients

Academic journal article East Asian Archives of Psychiatry

Adaptation of the Montreal Cognitive Assessment for Elderly Filipino Patients

Article excerpt

Introduction

Dementia is a progressive brain dysfunction involving memory, language, gnosis, praxis, and executive function. The cognitive impairment is sufficient to interfere with a patient's ability to function independently. (1) Dementia also causes disturbing behaviours that impair relationships with others and lead to distress to the family and the affected individual. The most common form of dementia is Alzheimer's disease (AD), (2) and age is clearly associated with an increased risk for AD. (3)

Since AD develops insidiously and progresses gradually, it is not uncommon that it goes unnoticed for many years before disturbing symptoms that merit medical attention occur. At the onset, when symptoms are mildest and commonly related to memory decline, such change is typically dismissed as part of normal ageing. However, early diagnosis is important as it provides an opportunity for early drug intervention, which has been shown to improve cognition (4) and function, and may delay deterioration or institutionalisation in countries where elderly people are eventually cared for in nursing homes. (5) Aside from early treatment, early diagnosis promotes acceptance and better understanding of the disease, its symptoms, and its course. Early diagnosis enables families to better care for their relative and plan ahead for social, financial, and legal issues that may arise from a patient's disabilities.

The cognitive domains that are affected in AD are orientation, memory, attention, executive function, language, visuospatial function, visuomotor speed, and visuoconstruction. Involvement of these domains is defined and documented through the use of neuropsychological tests that could help to identify both the impaired and preserved skills. Given that the core feature of AD is cognitive impairment, neuropsychological tests are ancillary to the diagnosis of AD. Most tests are developed in western English-speaking populations, where they have been developed from clinical experience and validated in the local population. Test performance is known to be influenced by age, education, and language as observed for the Mini-Mental State Examination (MMSE). (6) Values and beliefs can also affect neuropsychological testing. (7) The issue of how culture and language affect test performance has been a topic of concern in past decades. (8,9) Floor effects have been apparent when English tests were administered to non-native populations in the US, particularly because of the high cultural bias of some of the items found in the tests. (10) Thus, particularly for screening instruments used in the medical field, cross-cultural adaptation is imperative. Important aspects in cross-cultural adaptation are reliability, content, and construct validity. Careful forward translation, synthesis, back-translation, expert judging, and pre-final testing components are needed. (11,12) Most importantly, contextual adaptation by using experiential and conceptual equivalence to the culture where the instrument is being adapted to must be meticulously accorded. (13)

In an Asian country such as the Philippines, early dementia or mild cognitive impairment may not be detected as some people still regard cognitive decline as part of normal ageing and elderly people are commonly spared strenuous or mentally challenging activities. Mild impairment is also not detected by the validated Filipino version of the MMSE (MMSE-P). (14) There is therefore a need to adapt a good screening tool in the Philippines to help clinicians detect dementia early and accurately. This study aimed to adapt the Montreal Cognitive Assessment (MoCA) (15) and determine the adapted version's psychometric reliability among the Filipino elderly. The MoCA was chosen because it has been shown to be sensitive to mild cognitive impairment (15) and validated in different languages. (16-19) The MoCA has also gained worldwide acceptability, being recommended as the screening instrument not only for AD, but also for other types of dementia such as vascular cognitive impairment by some professional groups and researchers. …

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