Development of the Central Africa Daily Functioning Interference Scale for Dementia Diagnosis in Older Adults: The EPIDEMCA Study

Abstract

Background: There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. Objectives: Our aim was to develop an adapted tool, the Central African – Daily Functioning Interference (DFI) scale. Methods: An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. Results: A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: –1.067 to 1.587) with good item discrimination properties (1.397–4.076) and a high reliability (Cronbach’s al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. Conclusions: These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.

Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

“…For example, most translated tools investigated in South America were applied in clinical urban environments and required skilled professionals to conduct the assessments, which may not be applicable or feasible for rural communities. In contrast, Edjolo, et al [29] highlights that items included in the CA-DFI may not be applicable to urban settings, such as assessing one's ability to work in fields. As such, suitable urban alternatives need to be validated.…”

“…In addition, there were geographical trends in the selection of IADL tools assessed. In African and South Asian LMICs, bespoke culturally-specific tools were predominately investigated [10,[26][27][28][29][30][31], while translated and adapted tools were mainly used in South America and West Asian LMICs [12,13,16,[20][21][22][23][24][25][32][33][34].…”

“…presiding over ceremonies, keeping up with local affairs/festivals) as younger family members have responsibility over more traditional IADLs measured in Western scales (e.g. financial management) [10,29]. It is difficult to compare the efficacy of tools which used directly translations of IADL scales used in high-income countries (i.e.…”

“…Articles included in this review similarly highlight significant rates of illiteracy and low educational levels [22,26,27,29,30]. These illiteracy and education rates can be considered barriers to comprehensive cognitive assessment, and as such, brief cognitive assessments and IADL tools are recommended to reduce bias [38].…”

“…These illiteracy and education rates can be considered barriers to comprehensive cognitive assessment, and as such, brief cognitive assessments and IADL tools are recommended to reduce bias [38]. Both translated and bespoke IADL questionnaires assessed in populations with high illiteracy and low education demonstrated excellent diagnostic accuracy scores [22,27,29], showing that evaluation of the sensitivity and specificity of cut-off IADL scores have been established for illiterate populations in LMICs. Furthermore, Hendrie, et al [30] reported the use of an observational IADL tool (i.e., CHIF) in a…”