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Background: Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. Aims: In this cross-sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture-naming performance in patients with MCI and dementia. Methods & Procedures: A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR-PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross-cultural adaptation guidelines and item-wise factor analysis and correlations established separately across five languages, the final version of the ICMR-PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR-PNT were examined, and sensitivity and specificity were examined. Outcomes & Results The ICMR-PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F[subscript 2], [subscript 615] = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR-PNT scores and a positive correlation between Addenbrooke's Cognitive Examination--III (ACE-III) and ICMR-PNT scores in control and patient groups. Conclusions & Implications: The ICMR-PNT was developed by following cross-cultural adaptation guidelines and establishing correlations using item-wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context.

Byline: Subhash. Kaul, Sheetal. Goyal, Avanthi. Paplikar, Feba. Varghese, Suvarna. Alladi, Ramshekhar. Menon, Meenakshi. Sharma, R. Dhaliwal, Amitabha. Ghosh, Jwala. Narayanan, Ashima. Nehra, Manjari. Tripathi Background and Purpose: Vascular cognitive [...]

Byline: Avanthi. Paplikar, Gowri. Iyer, Feba. Varghese, Suvarna. Alladi, Apoorva. Pauranik, Shailaja. Mekala, Subhash. Kaul, Meenakshi. Sharma, R. Dhaliwal, Aralikatte. Saroja, Santosh. Dharamkar, Aparna. Dutt, Gollahalli. Divyaraj, Amitabha. Ghosh, Rajmohan. [...]

Byline: Apoorva. Pauranik, Annamma. George, Aparna. Sahu, Ashima. Nehra, Avanthi. Paplikar, Chitralekha. Bhat, Gopee. Krishnan, Harsimar. Kaur, Jitendra. Saini, P. Suresh, Pawan. Ojha, Pinky. Singh, Pratap. Sancheti, Prathibha. Karanth, P. [...]

Background: Active bilingualism provides cognitive reserve/resilience against age‐related neurodegenerative conditions like MCI and dementia. Evidences suggest that bilingualism delay the onset of MCI and dementia by preserving cognitive functioning for a longer period of time. India has a linguistically diverse population where bilingualism is a norm and its effects on cognitive reserve are devoid of immigration, education and socioeconomic status. We conducted a door‐to‐doorcommunity‐based study to investigate the impact of bilingualism on the prevalence of dementia and MCI in healthy older monolingual and bilingual population. The study also examined the effect of bilingualism on cognitive performance. Method: A total of 1145 older adults (366 monolinguals and 779 bilinguals) were recruited. The cognitive functions of elderly persons of ≥ 60 years old residing in urban Bengaluru, India were assessed using Clinical Dementia Rating Scale (CDR), Addenbrooke's Cognitive Examination (ACE‐III), TNI, Verbal Learning Test (VLT), and Instrumental Activities of Daily Living‐Elderly (IADL‐E). The Language Use Questionnaire (LUQ) scores were used to categorize speakers into monolinguals and bilinguals. Based on the neurologic, neuropsychological, and functional data, participants were classified into 3 categories: normal cognitive functioning, MCI (based on Petersen's criteria), and dementia (based on DSM‐IV criteria). Result: There was a significant difference in the proportion of MCI and dementia patients between monolingual (2.10 % dementia and 7.14 % MCI) and bilingual (0.40 % dementia and 4.64 % MCI) elderly (p < 0.001) (Table 1). Healthy elderly bilinguals performed significantly better on global cognition and delayed verbal recall than monolinguals independent of the effects of age, education and gender (Table 2). Conclusion: The findings of this large door‐to‐door community study reveals the protective role of bilingualism in developing cognitive impairment due to MCI and dementia. Furthermore, the study demonstrates the effect of bilingualism as a measure of cognitive reserve/resilience through better cognitive status and episodic memory in older people from a socio‐culturally and linguistically diverse population. [ABSTRACT FROM AUTHOR]

Objective In the background of a large population of bilinguals globally, the study aimed to develop standards of neuropsychological testing in the context of bilingualism. Because bilingualism is known to affect cognitive processes, bilinguals and monolinguals were compared on their performance on cognitive tests, to investigate the possibility of the need for separate normative data for the two groups. Method A comprehensive neuropsychological test battery, standardized across five Indian languages: the Indian Council of Medical Research-Neuro Cognitive Tool Box (ICMR-NCTB) was administered to 530 participants (267 monolingual and 263 bilinguals matched for age and education). A systematic method of testing cognition in bilinguals was developed; to identify the appropriate language for testing, ensure language proficiency of examiner, and to interpret the bilingual responses. Additionally, the performance of bilinguals on the ICMR-NCTB was compared with monolinguals. Results Cognitive testing in the bilingual context was performed in the most proficient language of the participants, by examiners well versed with the language. Results from the language-based tests suggested that the frequent occurrence of borrowed- and language-mixed words required consideration while scoring. The reported bilingual effect on cognitive processes did not reflect as differences in the performance between bilinguals and monolinguals. Conclusions Observations from the study provide robust recommendations for neuropsychological testing in the context of bilingualism. Results indicate that separate normative data may not be required for bilinguals and monolinguals. The study will be relevant and provide a reference framework to address similar issues in the large population of bilinguals in other societies. [ABSTRACT FROM AUTHOR]

Objectives: While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings. Methods: A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India. Results: Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed. Conclusions: A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India. [ABSTRACT FROM AUTHOR]

Primary progressive aphasia (PPA) describes a group of language-led dementias. Speech and language therapy is the main available intervention for people with PPA. Despite best practice recommendations for speech and language therapy to include access to group therapies (Volkmer et al, 2023a), research evidence to date has predominantly focused on delivery in individual sessions. The aim of this study was to gather the collective intelligence of expert speech and language therapists/pathologists delivering group therapy for people with PPA to synthesize guidance for clinicians. This paper describes a qualitative study using narrative synthesis methods. Data were collected using the Template for Intervention Description and Replication – TIDiER. Eight respondents described a total of 17 different groups. Respondents worked across healthcare, research clinics and third sector organizations in Australia, Canada, Spain, the USA and the UK. For the purposes of analysis, groups were divided into two main types: (1) groups delivering specific therapy interventions; and (2) groups providing broader opportunities for conversational practice and support. This initial synthesis of the current state of the art in PPA therapy groups highlights several important considerations around candidacy, content and ecological validity of delivering group intervention for people with PPA. [ABSTRACT FROM AUTHOR]

Background: Recently there have been ongoing efforts to harmonise research across dementia cohorts from different centres and countries. Establishing comparability of cognitive test performance across languages and educational levels therefore becomes crucial. Differences due to educational disparity or linguistic variability will need to be differentiated from more genuine differences due to disease. This is especially important in countries like India that are characterised by a socioculturally heterogeneous population. To address this, the Indian Council of Medical Research‐Neuro Cognitive Test Battery (ICMR‐NCTB) was developed and validated to diagnose dementia in five Indian languages. In this study, we aimed to investigate the cognitive construct and comparability of the ICMR‐NCTB across five Indian languages using confirmatory factor analysis and measurement invariance. Methods: 991 healthy literate controls with normal cognition (Telugu = 302; Hindi = 191, Malayalam = 195; Bengali = 135 and Kannada = 168) were assessed with the ICMR NCTB which includes tests of attention/executive function, verbal and visual episodic memory, language and visuospatial Functions. The dimensional structure of ICMR‐NCTB was studied with regard to its cognitive constructs, and measurement invariance across five different Indian languages was evaluated. Results: Confirmatory factor analysis of the data demonstrated that a five factor model in which the tests were divided into the cognitive domains: attention/executive function, verbal memory, non‐verbal memory, language and visuospatial functions provided the best model fit both within and across all five languages. Analysis of factorial invariance across groups indicated that configural and metric invariance were achieved, thereby suggesting that the tests of the ICMR‐NCTB measure the same cognitive construct across different languages. On analyzing scalar invariance, non‐invariance of intercept was demonstrated, indicating a possible measurement bias between the different language groups. Conclusions: The study results indicate that cognitive constructs measured by the tests in the ICMR‐NCTB across the five different Indian languages are the same. However, there are differences that influence the performance of subjects across languages groups. The study findings have significant implications for harmonising cognitive test data in dementia research that involves linguistically diverse cohorts. [ABSTRACT FROM AUTHOR]

Background: In the background of linguistic diversity and a large population of bilinguals in India, it is essential to develop standards of neuropsychological testing in the context of bilingualism. Since bilingualism is known to impact specific cognitive processes, there is also the possibility of the need for separate normative data for bilinguals and monolinguals. Towards addressing these gaps, in this large multicentric study from India, bilinguals and monolinguals were evaluated on a comprehensive neuropsychological test battery: the Indian Council of Medical Research‐Neuro Cognitive Tool Box (ICMR‐NCTB). Method: The ICMR‐NCTB that was standardized across five Indian languages was administered to 530 participants: 267 monolingual and 263 bilinguals A systematic method of testing cognition in bilinguals was developed, to identify the appropriate language for testing, ensure language proficiency of examiner, and to interpret the bilingual responses. Additionally, the performance of bilinguals on the ICMR‐NCTB was compared with monolinguals matched for age, education, and gender. Result: Linguistic proficiency of both participants and examiners were determined using validated measures. Cognitive testing in the bilingual context was performed in the most proficient language of the participants, by examiners well versed with the language. Results from the language‐based tests suggested language interference i.e. a frequent occurrence of borrowed‐ and language‐mixed words in responses thereby requiring consideration while scoring. The reported bilingual effect on cognitive processes did not reflect as differences in the performance between bilinguals and monolinguals on any of the standard cognitive tests of attention, executive function, language and visuospatial functions. Conclusion: Observations from the study provide robust recommendations for neuropsychological testing in the context of bilingualism. These recommendations are consistent with the practice of bilingualism in the Indian context and are more ecologically valid. Results also indicate that separate normative data may not be required for bilinguals and monolinguals, in the Indian context. The study will provide a reference framework for comparison to address similar issues in other bilingual societies. [ABSTRACT FROM AUTHOR]

Introduction: Neurological disorders are the leading causes of death and disability globally. In low-middle-income countries such as India, there is a wide treatment gap for neurological disorders. To address this gap, an initiative known as the Karnataka Brain Health Initiative (KaBHI) was developed in collaboration with the public health system of the state of Karnataka in India., Method: A structured hybrid training program was conducted for 120 medical doctors working in the Primary Health Centers (PHCs) in the public health system in three districts of Karnataka. Pre- and post-training evaluation was conducted to assess physicians' knowledge and skills for evaluating patients with common neurological conditions., Results: Of 120 PHC doctors, 111 (92%) scored below the passing score of 50 points out of 100 before the training program. After the training, all trainees scored above this cut-off. The study found a significant improvement in knowledge and skills after the training (before training: 40.48 ± 7.92, after training: 66.28 ± 8.98 ( P < 0.001) mean difference = 25.81), and was comparable among the PHC doctors in all three districts., Conclusions: Our study shows the feasibility of training primary care doctors in the public health system to manage selected common neurological disorders. The training program can potentially help to reduce the treatment gap for neurological disorders in India., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: Literacy is an important factor that predicts cognitive performance. Existing cognitive screening tools are validated only in educated populations and are not appropriate for older adults with little or no education leading to poor performance on these tests and eventually leading to misdiagnosis. This challenge for clinicians necessitates a screening tool suitable for illiterate or low-literate older individuals., Objectives: The objective was to adapt and validate Addenbrooke's Cognitive Examination-III (ACE-III) for screening general cognitive functions in illiterate and low-literate older populations in the Indian context in three languages., Method: The Indian illiterate ACE-III was systematically adapted by modifying the original items of the Indian literate ACE-III to assess the cognitive functions of illiterates and low-literates with the consensus of an expert panel of professionals working in the area of dementia and related disorders. A total of 180 illiterate or low-literate participants (84 healthy-controls, 50 with dementia, and 46 with mild cognitive impairment [MCI]) were recruited from three different centers speaking Bengali, Hindi, and Kannada to validate the adapted version., Results: The optimal cut-off score for illiterate ACE-III to distinguish controls from dementia in all 3 languages was 75. The optimal cut-off scores in distinguishing between controls and MCI ranged from 79 to 82, with a sensitivity ranging from 93% to 99% and a specificity ranging from 72% to 99%., Conclusion: The test is found to have good psychometric properties and is a reliable cognitive screening tool for identifying dementia and MCI in older adults with low educational backgrounds in the Indian context., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)