Adaptation of the ACE for a Malayalam speaking population in southern India

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Abstract
Objective To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original. Methods The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 ± 7.4; education ≥ 9, mean = 10.9 ± 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: ‘India ≥ 9’ (n = 50; mean age = 67.8 ± 5.2; education ≥ 9, mean = 13.9 ± 2.7) and ‘India ≤ 8’ (n = 50; mean age = 67.1 ± 5.3; education ≤ 8, mean = 3.1 ± 2.0). Results Most ACE items were retained. The score distribution (mean ± 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India ≥ 9 groups. Language, Naming, Attention and Orientation are relatively easy (≥ 80% at ceiling) and Recall and Verbal fluency are relatively difficult (≤ 22% at ceiling). Although the percentage at ceiling were lower for the India ≤ 8 group, the order of relative difficulty was similar and the percentage scoring at floor was ≤ 10% on all except visuospatial item. Conclusions The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty. Copyright © 2004 John Wiley & Sons, Ltd.