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Validation of the Literacy Independent Cognitive Assessment

Published online by Cambridge University Press:  15 September 2010

Seong Hye Choi
Department of Neurology, Inha Univeristy School of Medicine, Incheon, Republic of Korea
Yong S. Shim
Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Bucheon, Republic of Korea
Seung-Ho Ryu
Department of Psychiatry, Konkuk University School of Medicine, Seoul, Republic of Korea
Hui Jin Ryu
Department of Neurology, Konkuk University Hospital, Seoul, Republic of Korea
Dong Woo Lee
Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
Jun-Young Lee
Department of Psychiatry, Seoul National University Boramae Hospital, Seoul, Republic of Korea
Jee H. Jeong
Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
Seol-Heui Han*
Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
Correspondence should be addressed to: Seol-Heui Han, MD, PhD, Department of Neurology, Konkuk University Hospital, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea. Phone: +82 2 2030 7561; Fax: +82 2 2030 5169. Email:


Background: Low education and illiteracy are associated with an increased risk of dementia. This study aimed to develop a neuropsychological test battery applicable to both illiterate and literate elderly and to assess its reliability and validity for a diagnosis of dementia.

Methods: We developed the Literacy Independent Cognitive Assessment (LICA), which consists of 13 subtests assessing memory, language, visuoconstruction, executive function, attention and calculation. We investigated its reliability and validity on 152 patients with dementia, 66 with mild cognitive impairment and 639 normal controls.

Results: The subtests were found to be applicable to most of the illiterate normal controls (97.3%) and were found to have high inter-rater reliabilities (r = 0.85–1.00, p < 0.001) and moderate to high test-retest reliabilities (r = 0.50–0.86, p < 0.001). The LICA performed well in discriminating participants across Clinical Dementia Rating stages and showed excellent internal consistency and good concurrent validity with the Korean Mini-mental State Examination in both literate and illiterate participants. The area under the curve of the receiver operating characteristic was 0.985 in each of the two literacy groups. Sensitivity and specificity of the LICA to make a diagnosis of dementia was 91.9% and 91.8% at the cutoff point of 186.0 in the literate subjects and 96.2% and 91.1% at the cutoff point of 154.5 in the illiterate subjects. The battery was factored into two separate factors consisting of verbal memory tests and tests for other cognitive domains.

Conclusion: The LICA is a valid and reliable instrument for a diagnosis of dementia in both illiterate and literate elderly.

Research Article
Copyright © International Psychogeriatric Association 2010

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Almor, A. et al. (2009). A common mechanism in verb and noun naming deficits in Alzheimer's patients. Brain and Language, 111, 819.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Baiyewu, O. et al. (2005). The Stick Design test: a new measure of visuoconstructional ability. Journal of the International Neuropsychological Societies, 11, 598605.Google Scholar
Benson, D. F. and Barton, M. I. (1970). Disturbances in constructional ability. Cortex, 6, 1946.Google Scholar
Choi, S. H. et al. (2008). Effect of ApoE genotype on response to donepezil in patients with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 25, 445450.Google Scholar
Christensen, K. J., Multhaup, K. S., Nordstrom, S. and Voss, K. (1991). A cognitive battery for dementia: development and measurement characteristics. Psychological Assessment, 3, 168174.Google Scholar
Chui, H. C., Victoroff, J. I., Margolin, D., Jagust, W., Shankle, R. and Katzman, R. (1992). Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology, 42, 473480.Google Scholar
Fuh, J. L. et al. (1995). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening tool for dementia for a predominantly illiterate Chinese population. Neurology, 45, 9296.Google Scholar
Horner, M. D., Teichner, G., Kortte, K. B. and Harvey, R. T. (2002). Construct validity of the Babcock Story Recall Test. Applied Neuropsychology, 9, 114116.Google Scholar
Jacob, K. S., Kumar, P. S., Gayathri, K., Abraham, S. and Prince, M. J. (2007). The diagnosis of dementia in the community. International Psychogeriatrics, 19, 669678.Google Scholar
Kang, S. J., Choi, S. H., Lee, B. H., Kwon, J. C., Na, D. L. and Han, S. H. (2002). The reliability and validity of the Korean Instrumental Activities of Daily Living (K-IADL). Journal of the Korean Neurological Association, 20, 814.Google Scholar
Kang, Y. (2006). Normative data on the Korean Mini-Mental State Examination (K-MMSE) in Korean elderly. Korean Journal of Psychology, 25, 112.Google Scholar
Kang, Y. and Na, D. L. (2003). Seoul Neuropsychological Screening Battery, Incheon: Human Brain Research and Consulting Co.Google Scholar
Lee, J. Y. et al. (2008). Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. International Psychogeriatrics, 20, 976985.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). 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, 34, 939944.Google Scholar
Milner, B. (1971). Interhemispheric differences in the localization of psychological processes in man. British Medical Bulletin, 27, 272277.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.Google Scholar
National Institute of the Korean Language (2009). The Survey of National Literacy. Available at: Last accessed 22 October 2009.Google Scholar
Ngandu, T. et al. (2007). Education and dementia: what lies behind the association? Neurology, 69, 14421450.Google Scholar
Ostroski-Solis, F., Ardila, A. and Rosselli, M. (1998). Neuropsychological test performance in illiterate subjects. Archives of Clinical Neuropsychology, 13, 645660.Google Scholar
Patterson, K., Nestor, P. J. and Rogers, T. T. (2007). Where do you know what you know? The representation of semantic knowledge in the human brain. Nature Reviews Neuroscience, 8, 976987.Google Scholar
Petersson, K. M., Reis, A. and Ingvar, M. (2001). Cognitive processing in literate and illiterate subjects: a review of some recent behavioral and functional neuroimaging data. Scandinavian Journal of Psychology, 42, 251267.Google Scholar
Prencipe, M., Casini, A. R., Ferretti, C., Lattanzio, M. T., Fiorelli, M. and Culasso, F. (1996). Prevalence of dementia in an elderly rural population: effects of age, sex, and education. Journal of Neurology, Neurosurgery and Psychiatry, 60, 628633.Google Scholar
Reis, A., Faísca, L., Ingvar, M. and Petersson, K. M. (2006). Color makes a difference: two-dimensional object naming in literate and illiterate subjects. Brain and Cognition, 60, 4954.Google Scholar
Rogers, T. T., Patterson, K. and Graham, K. (2007). Colour knowledge in semantic dementia: it is not all black and white. Neuropsychologia, 45, 32853298.Google Scholar
Seo, S. K. (1998). The Frequency of Present-day Korean Words, Seoul: Yonsei University Press.Google Scholar
Storey, J. E., Rowland, J. T. J., Conforti, D. A., Dickson, H. G. (2004). The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16, 1331.Google Scholar
Tremont, G., Halpert, S., Javorsky, D. J. and Stern, R. A. (2000). Differential impact of executive dysfunction on verbal list learning and story recall. Clinical Neuropsychologist, 14, 295302.Google Scholar
UNESCO (2009). Global Monitoring Report on Education for All. Available at: Last accessed 22 October 2009.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240246.Google Scholar