Examining the measurement equivalence of Alzheimer’s Disease Centre Neuropsychological Test Battery (Version 3) across two distinct cultures

Abstract Background Neuropsychological assessments are important in clinical diagnostic process for dementia as it help early detection of cognitive difficulties. Prior to using neuropsychological test batteries across different populations, it is critical to standardize the battery to ensure consistency in the assessment process, as well as valid and comparable results across different settings. The Alzheimer’s Disease Centre Neuropsychological Test Battery (Version 3) (ADCNTB3) is a widely used battery that had shown sensitivity in detecting cognitive decline in MCI and early dementia, with minimal test repetition effects (Boccardi et. al., 2022). While norms are available in America, harmonization efforts are currently in place to adapt ADCNTB3 for European populations. Method This study examined whether ADCNTB3 could be adapted to Singapore (multi‐ethic Asian population), a culture distinctly different from America, and whether ADCNTB3 demonstrates measurement equivalence when adapted to the Singapore population. Following the qualitative process of cultural adaptation, the ADCNTB3 was administered to 266 community‐dwelling older persons with normal cognition in Singapore. Scores from these participants were then compared with 1064 random samples with normal cognition from National Alzheimer’s Coordinating Centre (NACC) to evaluate whether the ADCNTB3 has equivalent scores across the two distinct populations. Score‐difference between the 2 populations was computed using multiple linear regression (adjusted for age, education, gender, family history of dementia, cardiovascular conditions, psychiatric and neurological history, smoking, untreated hearing loss, obesity, MoCA total score, CDR sum of boxes, NPI‐Q total score) and equivalence scores are considered to be present if the 90% confidence interval of the adjusted score‐difference fall within the equivalence margin. A priori, we defined the equivalence margin as 0.5 Standard Deviation of tests from ADCNTB3, as this often defines the minimally important clinical significance (Sloan et al., 2005). Result Other than working and delayed memory tasks, all other tests from the ADCNTB3 are not directly equivalent. Notably, Asians performed better in visuospatial task, but consistently performed poorer in most other tasks. Conclusion Other than working and delayed memory tasks, all other tests from the ADCNTB3 are not directly equivalent. Notably, Asians performed better in visuospatial task, but consistently performed poorer in most other tasks.

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