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

Published online by Cambridge University Press:  04 May 2022

Rita El-Hayeck Open the ORCID record for Rita El-Hayeck [Opens in a new window] ,
Rafic Baddoura ,
Amine Wehbé ,
Nazem Bassil ,
Salam Koussa ,
Karine Abou Khaled ,
Sami Richa ,
Rita Khoury ,
Abbas Alameddine Open the ORCID record for Abbas Alameddine [Opens in a new window]  and
François Sellal
Rita El-Hayeck*
Affiliation:
Department of Geriatrics, Saint Joseph University, School of Medicine, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Rafic Baddoura
Affiliation:
Department of Epidemiology and Public Health, Saint Joseph University, School of Medicine, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Amine Wehbé
Affiliation:
Department of Geriatrics, Saint Joseph University, School of Medicine, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Nazem Bassil
Affiliation:
Department of Geriatrics, University of Balamand, Saint George Hospital Medical Centre
Salam Koussa
Affiliation:
Department of Neurology, Lebanese University, Lebanese Hospital Geitaoui – UMC, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Karine Abou Khaled
Affiliation:
Department of Neurology, Saint Joseph University, School of Medicine, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Sami Richa
Affiliation:
Department of Psychiatry, Saint Joseph University, School of Medicine, Beirut, Lebanon Working Group on Dementia at Saint Joseph University, Groupe de Travail sur les Démences de l’USJ (GTD-USJ)
Rita Khoury
Affiliation:
Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, University of Balamand, School of Medicine, Beirut, Lebanon Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, School of Medicine, Missouri, USA
Abbas Alameddine
Affiliation:
Department of Psychiatry, Hôtel-Dieu de France Hospital, Beirut and Department of Psychology, University of Balamand, Koura, Lebanon
François Sellal
Affiliation:
Department of Neurology, Hôpitaux Civils de Colmar and INSERM U-1118, School of Medicine, Strasbourg University, France
*
Corresponding author: Rita El-Hayeck, emails: rita.elhayeck@usj.edu.lb, rihayeck@gmail.com
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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.

Keywords

agedcognitive dysfunctionLebanonliteracymental status and dementia testssensitivity and specificity
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 3 , March 2023 , pp. 316 - 323
Copyright
Copyright © INS. Published by Cambridge University Press, 2022

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