An adapted Arabic version of the Test of Nine Images for the illiterate Lebanese population: Validation and preliminary normative data

Abstract

Objectives: In the absence of a simple validated instrument to screen for cognitive impairment among illiterate Lebanese older adults, the aims of this study were to validate an Arabic version of the Test of Nine Images (A-TNI93) adapted by the Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l’Univesité Saint Joseph (GTD-USJ) for illiterate older Lebanese and to establish normative data. Method: A national population-based sample of 332 community-dwelling illiterate Lebanese aged 55 years and older was administered the A-TNI93 (GTD-USJ) scoring free and overall recall. The sample is part of a larger national sample (1342 participants) used to validate an Arabic version of the Mini-Mental State Examination already reported. Reproducibility, sensitivity, specificity, and area under the curve of the A-TNI93 (GTD-USJ) scoring to detect cognitive impairment according to Clinical Dementia Rating (CDR) as the gold standard were measured. Normative data were established among 188 cognitively normal participants. Results: A threshold score of six on free recall (FR) provided a sensitivity of 66.7% and a specificity of 90.5%. The area under the curve was 0.93. By taking either scores, that is, a FR ≤ 6 or a total recall ≤ 8, the A-TNI93 (GTD-USJ) slightly improved dementia case detection with a sensitivity of 70.8% and a specificity of 88%. Normative data illustrate the distribution of cognitive performance among illiterate older adults. Conclusions: Compared to the CDR requiring physician’s competence, the A-TNI93 (GTD-USJ) is a valid Arabic adaptation to screen for cognitive impairment among illiterate Lebanese older adults.

Effect of Mediterranean Dietary Pattern on Cognitive Status in Community-Dwelling Older Adults

“…Screening and diagnosis of cognitive impairment were conducted using 2 instruments, the Adapted Arabic versions of Mini-Mental State Examination (A-MMSE) and Test des Neufs Images (A-TNI-93) [ 57 , 58 ]; these tools were administered to the literate and illiterate participants, respectively.…”

“…The duration of the test is around 10–15 min. Participants having scored at or below the population-specific cut-offs, below or equal to 6 for the TNI Free Recall or a TNI Total Recall score below or equal to 8, were considered as having low cognitive status [ 58 , 59 ]. Since, to our knowledge, no previous research showed interchangeable use between MMSE and TNI, and with education being an important component of cognitive reserve preservation and determinant of cognitive decline rates in elderly [ 50 , 60 ], participants were split into 2 groups for analysis, and data concerning CD were dichotomized based on literacy and analyzed separately.…”