Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis

Abstract

Background Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures. Aims We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA. Method We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions. Results Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors’ feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it. Conclusions This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.

Regression-Based Normative Data for the Montreal Cognitive Assessment (MoCA) and Its Memory Index Score (MoCA-MIS) for Individuals Aged 18–91

“…Although the official available international versions of the MoCA were created with the goal of being equivalent, slight differences between MoCA performances across regions may be present. These may not only be due to variations between the respective translations but also related to the use of culture-specific items (for instance, different international MoCA versions use different animals for naming, related to the familiarity with these animals in a specific region of the world, also see [ 93 ]). Finally, although we applied exclusion criteria to exclude individuals with psychiatric disorders or brain diseases, we did not perform extensive neuropsychological assessments or obtain magnetic resonance images in our participants.…”

Cultural modification of neuropsychiatric assessment: complexities to consider

“…The article by Khan et al 2 addresses a complex and difficult dilemma. Culture has important and pervasive effects on the testing and assessment of neuropsychiatric disease.…”

“…As Khan et al 2 point out, the ultimate validation of adaptations of scales is their use in conjunction with more definitive diagnostic measures. The more definitive diagnosis of dementia against which the sensitivity and specificity of the MoCA have been tested is based on the performance of other cognitive tests or on comprehensive clinical assessment by experts.…”

“…In their excellent review and their development of guidelines for the adaptation of the Montreal Cognitive Assessment (MoCA © ), Khan et al 2 examined 52 publications reporting on language and cultural adaptations of the MoCA that attempted to maintain its integrity. Problems that were overcome included the picture of a rhinoceros not being readily recognisable in certain countries or the memory-testing words being modified to words with a similar semantic frequency in the language being used.…”

A new tool for assessing the cultural adaptation of cognitive tests: demonstrating the utility of the Manchester Translation Evaluation Checklist (MTEC) through the Mini-Mental State Examination Urdu

“…28 When referring to cognitive tests, the dimensions would be defined as follows. 34 Technical equivalence: the test is administered in a manner that is culturally appropriate for the person being assessed. Semantic equivalence: after translation, the individual test questions retain the same meaning as their original versions. Content equivalence: after accounting for culture, the individual test questions are relevant to the culture of the person being assessed. Conceptual equivalence: after accounting for culture, the individual test questions still assess the same cognitive domains they were meant to at the original level of difficulty. Criterion equivalence: after accounting for culture, the overall test is still assessing for dementia or MCI. …”