Development and implementation of Persian test of Elderly for Assessment of Cognition and Executive function (PEACE)

Authors

  • Pari Sadat Haji Seyed Javadi M.D., Resident of Psychiatry, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran.

Keywords:

Development and implementation of Persian test of Elderly for Assessment of Cognition and Executive function (PEACE)

Abstract

Introduction: A considerable segment of the elderly population in Iran is illiterate, and it seems the existing neuropsychological screening tests are not very useful for detecting dementia in illiterate participants. The purpose of this study was to develop and validate a tool called Persian test of Elderly for Assessment of Cognition and Executive function (PEACE) for detecting dementia in both illiterate and literate participants. 

Methods: First, in order to design some of the cognitive aspects of the PEACE assay, we considered other prevalent neuropsychological instruments, such as the General Practitioner assessment of Cognition (GPCOG), Functional Assessment Staging (FAST), Mini Mental State Examination (MMSE), and Wechsler Memory scale. The other domains of PEACE were designed according to our clinical proficiencies and the culture of the society. In the next step, the participants were classified into three distinct groups, i.e., the control group (n=33), the Mild Cognitive Impairment (MCI) group (n=30), and the Alzheimer’s group (n=38). All of the participants in each group were divided according to their educational level, i.e., illiterate, semi-literate, and literate. 

Results: We developed PEACE consisting of 14 items, each of which represents a specific cognitive function, with a maximum score of 91. The 14 items are Orientation, Praxis, Attention and Concentration, Attention and Calculation, Memory, Similarity, Abstract Thinking, General Information, Language, Judgment, Gnosis, Planning (Sequencing), Problem Solving, and Animal Naming. PEACE scores are highly correlated with those of the MMSE (r=0.78). The optimal cut-off point of PEACE chosen for diagnosis of Alzheimer’s disease was 67.5 (sensitivity: 75.8%, specificity: 97.4%). The PEACE scores showed a significant difference between Participants with Alzheimer’s disease and the control group (p=0.0000) and the MCI group (p=0.003). In addition, there was no significant difference between illiterate and literate participants in the Alzheimer’s group. However, the PEACE scores differed significantly (p=0.0000) between illiterate and literate participants in the control group. 

Conclusion: The PEACE addresses the limitations of existing tests and is appropriate for use in countries that have high rates of illiteracy. It is a valid screening mechanism for the detection of dementia in both illiterate and literate participants.

References

Fratiglioni L, Winblad B, von Strauss E. Prevention of Alzheimer's disease and dementia. Major findings

from the Kungsholmen Project. Physiology & behavior, 2007. 92(1):98-104. doi:

1016/j.physbeh.2007.05.059. PMID: 17588621

Prince M, Acosta D, Chiu H, Scazufca M, Varghese M. Dementia diagnosis in developing countries: a

cross-cultural validation study. Lancet, 2003. 361(9361):909-17. doi: 10.1016/S0140-6736(03)12772-9.

PMID: 12648969

Lucca U, Tettamanti M, Logroscino G, Tiraboschi P, Landi C, Sacco L, et al. Prevalence of dementia in the

oldest old: The Monzino 80-plus population based study. Alzheimer's & Dementia, 2015. 11(3):258-70. e3.

doi: 10.1016/j.jalz.2014.05.1750. PMID: 25150732

Carcaillon L, Brailly-Tabard S, Ancelin ML, Tzourio C, Foubert-Samier A, Dartigues JF, et al. Low

testosterone and the risk of dementia in elderly men: Impact of age and education. Alzheimer's &

Dementia, 2014. 10(5):S306-S314. doi: 10.1016/j.jalz.2013.06.006. PMID: 24035146

Jia J, Wang F, Wei C, Zhou A, Jia X, Li F, et al. The prevalence of dementia in urban and rural areas of

China. Alzheimer's & Dementia, 2014. 10(1):1-9. doi: 10.1016/j.jalz.2013.01.012. PMID: 23871765

Babacan-Yildiz G, Isika AT, Ur E, Aydemir E, Ertas C, Cebi M, Soysal P., et al. COST: Cognitive State

Test, a brief screening battery for Alzheimer disease in illiterate and literate patients. International

Psychogeriatrics, 2013. 25(03):403-12. doi: 10.1017/S1041610212001780. PMID: 23137551

Meng, X, D’Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a

systematic review with meta-analyses and qualitative analyses. PLoS One, 2012. 7(6):e38268. doi:

1371/journal.pone.0038268. PMID: 22675535. PMCID: PMC3366926

Del-Ser T, Munoz DG, Hachinski V. An autopsy-verified study of the effect of education on degenerative

dementia. Brain, 1999. 122(12):2309-19. doi: 10.1093/brain/122.12.2309 2309-2319. PMID: 10581224.

Ashford JW, Borson S, O'Hara R, Dash P, Frank L, Robert P., et al. Should older adults be screened for

dementia? Alzheimer's & Dementia, 2006. 2(2):76-85. doi: 10.1016/j.jalz.2006.02.005. PMID: 19595860

Caffarra P, Gardini S, Dieci F, Copelli S, Maset L, Concari L., et al. The qualitative scoring MMSE

pentagon test (QSPT): a new method for differentiating dementia with Lewy Body from Alzheimer’s

disease. Behavioural neurology, 2013. 27(2):213-20. doi: 10.3233/BEN-120319. PMID: 23396218

Noroozian, M. The Elderly population in Iran: An ever growing concern in the health system. Iranian

journal of psychiatry and behavioral sciences, 2012. 6(2):1. PMID: 24644476. PMCID: PMC3940007

Chandra V, Ganguli M, Ratcliff G, Pandav R, Sharma S, Belle S., et al. Practical issues in cognitive

screening of elderly illiterate populations in developing countries. The Indo-US Cross-National Dementia

Epidemiology Study. Aging Clinical and Experimental Research, 1998. 10(5):349-57. doi:

1007/BF03339881. PMID: 9932138

Park S, Park SE, Kim MJ, Jung HY, Choi JS, Park KH., et al. Development and validation of the Pictorial

cognitive screening inventory for illiterate people with dementia. Neuropsychiatric disease and treatment,

10:1837. doi: 10.2147/NDT.S64151. PMID: 25285007. PMCID: PMC4181741

Cordell CB, Borson S, Boustani M, Chodosh J, Reuben D, Verghese J., et al. Alzheimer's Association

recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual

Wellness Visit in a primary care setting. Alzheimer's & Dementia, 2013. 9(2):141-150. doi:

1016/j.jalz.2012.09.011. PMID: 23265826

Noroozian, M, Shakiba A, Iran-Nejad S. The impact of illiteracy on the assessment of cognition and

dementia: a critical issue in the developing countries. International Psychogeriatrics, 2014. 26(12):2051- 2060. doi: 10.1017/S1041610214001707. PMID: 25166718

Sheehan, B. Assessment scales in dementia. Therapeutic advances in neurological disorders,

:1756285612455733. doi: 10.1177/1756285612455733. PMID: 23139705. PMCID: PMC3487532

Association, A.P. and A.A.o.F. Physicians, Diagnostic and statistical manual of mental disorders: Primary

care version. 1996: American Psychiatric Pub.

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM., et al. Clinical diagnosis of

Alzheimer's disease Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of

Health and Human Services Task Force on Alzheimer's Disease. Neurology, 1984. 34(7):939-44. PMID:

Abdollahpour I, Noroozian M, Nedjat S, Majdzadeh R. Caregiver burden and its determinants among the

family members of patients with dementia in Iran. International journal of preventive medicine, 2012.

(8):544. PMID: 22973484. PMCID: PMC3429801

Jones RN, Fong TG, Metzger E, Tulebaev S, Yang FM, Alsop DC., et al. Aging, brain disease, and reserve:

implications for delirium. The American Journal of Geriatric Psychiatry, 2010. 18(2):117-27. doi:

1097/JGP.0b013e3181b972e8. PMCID: PMC2848522

Qiu C, Bäckman L, Winblad B, Agüero-Torres H, Fratiglioni L. The influence of education on clinically

diagnosed dementia incidence and mortality data from the Kungsholmen Project. Archives of Neurology,

58(12):2034-9. doi:10.1001/archneur.58.12.2034. PMID: 11735777

Manly JJ, Touradji P, Tang MX, Stern Y. Literacy and memory decline among ethnically diverse elders.

Journal of clinical and experimental neuropsychology, 2003. 25(5):680-90. doi:

1076/jcen.25.5.680.14579. PMID: 12815505

Shao Z, Janes E, Visser K, Meyer AS. What do verbal fluency tasks measure? Predictors of verbal fluency

performance in older adults. Frontiers in psychology, 2014. 5:772. doi: 10.3389/fpsyg.2014.00772.

PMCID: PMC4106453

Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a

screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Disease & Associated

Disorders, 2007. 21(1):65-7. doi: 10.1097/WAD.0b013e31802f244f. PMID: 17334275

Giffard B, Desgranges B, Nore-Mary F, Lalevée C, de la Sayette V, Pasquier F. The nature of semantic

memory deficits in Alzheimer's disease. Brain, 2001. 124(8):1522-32. doi: 10.1093/brain/124.8.1522.

PMID: 11459744

Published

2022-03-08