Clinical Validity of NIMHANS Neuropsychological Battery for Elderly: A Preliminary Report

By Tripathi, Ravikesh; Kumar, Janakiprasad et al. | Indian Journal of Psychiatry, July-September 2013 | Go to article overview

Clinical Validity of NIMHANS Neuropsychological Battery for Elderly: A Preliminary Report


Tripathi, Ravikesh, Kumar, Janakiprasad, Bharath, Srikala, Marimuthu, Palaniappan, Varghese, Mathew, Indian Journal of Psychiatry


Byline: Ravikesh. Tripathi, Janakiprasad. Kumar, Srikala. Bharath, Palaniappan. Marimuthu, Mathew. Varghese

Background: Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there is a dearth of culturally appropriate standardized measure to assess cognitive functions in early dementia. The aim of the study was to examine clinical validity of NIMHANS Neuropsychological Battery for Elderly (NNB-E) in identifying early dementia. Objectives: To examine validity (discriminant and concurrent) of NIMHANS Neuropsychological Battery for Elderly (NNB-E). Materials and Methods: The study sample consisted of 99 participants [39 patients with Alzheimer's disease (AD) and 60 normal controls] within an age range of 55-87 years. All the participants were assessed on NNB-E, which comprised of tests for verbal and visuo-spatial memory, working memory, executive function, language, and construction. Receiver operating characteristic (ROC) curve was used to examine the discriminating power of different neuropsychological tests. Pearson correlation coefficient was used to examine the concurrent validity. Results: Participants with AD showed significantly poorer performance on every test including memory and non-memory domains. However, tests of episodic and semantic memory were particularly sensitive in discriminating between normal and AD groups. Further scores on various subtests in the NNB-E were positively associated with scores on HMSE and negatively associated with Clinical Dementia Rating and Everyday Abilities Scale for India (EASI) scores. Conclusions: NNB-E was able to differentiate normal controls from AD patients, and it can therefore be an ecologically valid tool for Indian older adults.

Introduction

Cognitive decline is a major concern in aging and dementia research. Neuropsychological assessment is considered as crucial in identifying cognitive decline associated with dementia and related disorders. [sup][1],[2] Cognitive decline is often identified by culturally appropriate neuropsychological assessment. This is particularly true for country such as India, which has majority of the population from rural regions with low literacy levels and 122 local languages (234 mother tongues). [sup][3] There is a dearth of indigenously developed neuropsychological test battery that is suitable for Indian older adults to assess cognitive function as well as decline, [sup][4] and the need for developing and validating cognitive measures has been highlighted by several researchers. [sup][5],[6] To the best of our knowledge, there are very few standardized neuropsychological test batteries with culturally appropriate materials to identify early Alzheimer's disease (AD) from age-associated cognitive decline. Recently, NIMHANS Neuropsychological Battery for Elderly (NNB-E) has been developed and standardized on Indian population. [sup][7] The present study is an attempt to examine the effectiveness of NNB-E in discriminating patients with AD from normal. The second aim of the study was to examine the concurrent validity of NNB-E.

Materials and Methods

Sample

The study sample consisted of 99 participants (39 patients with AD and 60 normal controls) within an age range of 55-87 years. Patients with AD were selected from the Geriatric Clinic, Outpatient Department, NIMHANS, Bangalore. Inclusion criteria for AD were as follows: Age >55 years; definite cognitive decline indicated by Hindi Mental Status Examination (HMSE); Clinical Dementia Rating (CDR) of 1 or <2; Diagnosis of Alzheimer's Dementia according to DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Patients with AD were excluded if they had a history of neurological/neurosurgical/psychiatric illness (including substance dependence other than nicotine) other than dementia of Alzheimer's Type. …

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