Adaptation of the ACE for a Malayalam speaking population in southern India

OBJECTIVE: To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original. METHODS: The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 +/- 7.4; education >/= 9, mean = 10.9 +/- 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: 'India >/= 9' (n = 50; mean age = 67.8 +/- 5.2; education >/= 9, mean = 13.9 +/- 2.7) and 'India </= 8' (n = 50; mean age = 67.1 +/- 5.3; education </= 8, mean = 3.1 +/- 2.0). RESULTS: Most ACE items were retained. The score distribution (mean +/- 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India >/= 9 groups. Language, Naming, Attention and Orientation are relatively easy (>/= 80% at ceiling) and Recall and Verbal fluency are relatively difficult (</= 22% at ceiling). Although the percentage at ceiling were lower for the India </= 8 group, the order of relative difficulty was similar and the percentage scoring at floor was </= 10% on all except visuospatial item. CONCLUSIONS: The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.