Restricted accessResearch articleFirst published online 2025-4
Validation of the Brief Assessment of Impaired Cognition and Brief Assessment of Impaired Cognition Questionnaire in a multicultural memory clinic sample across six European countries
With the changing demographic landscape in most countries worldwide, accurate and brief culture-sensitive case-finding instruments are needed to identify patients with possible cognitive disorders.
Objective
To investigate the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) and BASIC Questionnaire (BASIC-Q) in a multicultural memory clinic sample across six European countries.
Methods
The study was a European cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine discriminative validity of BASIC and BASIC-Q in identifying cognitive impairment (mild cognitive impairment (MCI) or dementia) as compared to specialist diagnosis. Regression analysis was used to assess the influence of sociodemographic variables and assessment in a second language on scores.
Results
The study included a total of 479 participants of which 169 (36%) had immigrant background. BASIC and BASIC-Q had high diagnostic accuracy for cognitive impairment (MCI or dementia) with areas under the curve (AUC) of 0.93 and 0.92, respectively. Age had a significant, but small effect on BASIC, while both BASIC and BASIC-Q were unaffected by sex, education, immigrant status, and assessment in a second language. Among patients with affective/anxiety disorder, 80% scored below cutoff for cognitive impairment on BASIC and 94% on BASIC-Q. However, applying an Objective Performance vs. Subjective Complaints ratio to differentiate between patients with cognitive impairment and affective/anxiety disorder resulted in high overall classification accuracies, with AUC values of 0.80 and 0.74, respectively.
Conclusions
The present study suggests that BASIC and BASIC-Q are valid brief case-finding instruments for cognitive impairment in a multicultural setting.
NielsenTRAnteliusESpilkerRS, et al.Dementia care for people from ethnic minorities: a Nordic perspective. Int J Geriatr Psychiatry2015; 30: 217–218.
2.
WoodsRTMoniz-CookEIliffeS, et al.Dementia: issues in early recognition and intervention in primary care. J R Soc Med2003; 96: 320–324.
3.
CanevelliMLacorteECovaI, et al.Estimating dementia cases amongst migrants living in Europe. Eur J Neurol2019; 26: 1191–1199.
4.
CanevelliMZaccariaVLacorteE, et al.Mild cognitive impairment in the migrant population living in Europe: an epidemiological estimation of the phenomenon. J Alzheimers Dis2020; 73: 715–721.
5.
HaussmannRMayer-PelinskiRBeierF, et al.Neurocognitive profiles in affective and amnestic mild cognitive impairment. SN Compr Clin Med2019; 1: 1009–1014.
6.
SagbakkenMSpilkerRSNielsenTR. Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia. BMC Health Serv Res2018; 18: 910.
7.
NielsenTR. Cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe. Am J Alzheimers Dis Other Demen2022; 37: 15333175221117006.
8.
DiazEKumarBNEngedalK. Immigrant patients with dementia and memory impairment in primary health care in Norway: a national registry study. Dement Geriatr Cogn Disord2015; 39: 321–331.
9.
CasciniSCanevelliMAgabitiN, et al.Case identification and characterization of migrants with dementia in the Lazio region using health administrative data. J Alzheimers Dis2023; 92: 843–852.
10.
PhamTMPetersenIWaltersK, et al.Trends in dementia diagnosis rates in UK ethnic groups: analysis of UK primary care data. Clin Epidemiol2018; 10: 949–960.
11.
NielsenTRVogelAPhungTK, et al.Over- and under-diagnosis of dementia in ethnic minorities: a nationwide register-based study. Int J Geriatr Psychiatry2011; 26: 1128–1135.
12.
WändellPCarlssonACLiX, et al.Dementia in immigrant groups: a cohort study of all adults 45 years of age and older in Sweden. Arch Gerontol Geriatr2019; 82: 251–258.
13.
FolsteinMFFolsteinSEMcHughPR. Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189–198.
14.
NasreddineZSPhillipsNABedirianV, et al.The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53: 695–699.
15.
O'DriscollCShaikhM. Cross-cultural applicability of the Montreal cognitive assessment (MoCA): a systematic review. J Alzheimers Dis2017; 58: 789–801.
16.
SteisMRSchraufRW. A review of translations and adaptations of the Mini-mental state examination in languages other than English and Spanish. Res Gerontol Nurs2009; 2: 214–224.
17.
StoreyJERowlandJTBasicD, et al.The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr2004; 16: 13–31.
18.
NielsenTRJorgensenK. Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis. Int Psychogeriatr2020; 32: 1031–1044.
19.
JorgensenKNielsenTRNielsenA, et al.Brief assessment of impaired cognition (BASIC)-validation of a new dementia case-finding instrument integrating cognitive assessment with patient and informant report. Int J Geriatr Psychiatry2019; 34: 1724–1733.
20.
JorgensenKNielsenTRNielsenA, et al.Brief assessment of impaired cognition questionnaire (BASIC-Q)-development and validation of a new tool for identification of cognitive impairment in community settings. Int J Geriatr Psychiatry2020; 35: 693–701.
21.
MailletDMatharanFLe ClésiauH, et al.TNI-93: a new memory test for dementia detection in illiterate and low-educated patients. Arch Clin Neuropsychol2016; 31: 896–903.
22.
NielsenTRSegersKVanderaspoildenV, et al.Performance of middle-aged and elderly European minority and majority populations on a Cross-Cultural Neuropsychological Test Battery (CNTB). Clin Neuropsychol2018; 32: 1411–1430.
23.
NielsenTRSegersKVanderaspoildenV, et al.Validation of a European Cross-Cultural Neuropsychological Test Battery (CNTB) for evaluation of dementia. Int J Geriatr Psychiatry2019; 34: 144–152.
24.
JormAF. The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr2004; 16: 275–293.
25.
YuanXFZhangYZhangY, et al.Reliability and validity of the brief assessment of impaired cognition (Chinese version) for stroke patients. Appl Neuropsychol Adult2023; 30: 27–33.
26.
LiSCuiGJørgensenK, et al.Psychometric properties and measurement invariance of the Chinese version of the brief assessment of impaired cognition questionnaire in community-dwelling older adults. Front Public Health2022; 10: 908827.
27.
JorgensenKNielsenTRNielsenA, et al.Validation of the brief assessment of impaired cognition and the brief assessment of impaired cognition questionnaire for identification of mild cognitive impairment in a memory clinic setting. Int J Geriatr Psychiatry2020; 35: 907–915.
28.
OxbøllA-BJørgensenKNielsenTR, et al.Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting–a cross-validation study. BMC Geriatr2024; 24: 53.
29.
JørgensenKNielsenTRNielsenA, et al.Diagnostic accuracy of the brief assessment of impaired cognition case-finding instrument in a general practice setting and comparison with other widely used brief cognitive tests—a cross-validation study. Eur J Neurol2024; 31: e16418.
30.
AmariglioREDonohueMCMarshallGA, et al.Tracking early decline in cognitive function in older individuals at risk for Alzheimer disease dementia: the Alzheimer's disease cooperative study cognitive function instrument. JAMA Neurol2015; 72: 446–454.
31.
JormAFKortenAE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry1988; 152: 209–213.
32.
NguyenCMRampaSStaiosM, et al.Neuropsychological application of the international test commission guidelines for translation and adapting of tests. J Int Neuropsychol Soc2024; 30: 621–634.
33.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.Washington, DC: American Psychiatric Association, 2013.
34.
Gorno-TempiniMLHillisAEWeintraubS, et al.Classification of primary progressive aphasia and its variants. Neurology2011; 76: 1006–1014.
35.
McKeithIGBoeveBFDicksonDW, et al.Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB consortium. Neurology2017; 89: 88–100.
36.
McKhannGMKnopmanDSChertkowH, et al.The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement2011; 7: 263–269.
37.
RascovskyKHodgesJRKnopmanD, et al.Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011; 134: 2456–2477.
38.
SachdevPKalariaRO'BrienJ, et al.Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord2014; 28: 206–218.
39.
WinbladBPalmerKKivipeltoM, et al.Mild cognitive impairment–beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. J Intern Med2004; 256: 240–246.
40.
JessenFAmariglioREVan BoxtelM, et al.A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease. Alzheimers Dement2014; 10: 844–852.
41.
World Health Organization. The ICD 10 classification of mental and behavioral disorders: Diagnostic criteria for research. Geneva: World Health Organization, 1993.
42.
WeeksSKKenneySPaulEM, et al.Comparing various short-form Geriatric Depression Scales leads to the GDS-5/15. J Nurs Scholarsh2003; 35: 133–137.
43.
CohenJ. Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates, 1988.
44.
DeLongERDeLongDMClarke-PearsonDL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics1988; 44: 837–845.
45.
OxbollABJorgensenKNielsenTR, et al.Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study. BMC Geriatr2024; 24: 53.
46.
HarrisonJKFearonPNoel-StorrAH, et al.Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within a secondary care setting. Cochrane Database Syst Rev2021; 7: CD010772.
47.
NielsenTRVogelARiepeMW, et al.Assessment of dementia in ethnic minority patients in Europe: a European Alzheimer's Disease Consortium survey. Int Psychogeriatr2011; 23: 86–95.
48.
PrinceM. Methodological issues for population-based research into dementia in developing countries. A position paper from the 10/66 Dementia Research Group. Int J Geriatr Psychiatry2000; 15: 21–30.
49.
BhugraDAyonrindeO. Depression in migrants and ethnic minorities. Adv Psychiatr Treat2004; 10: 13–17.
50.
GoudsmitMvan de VorstIvan CampenJ, et al.Clinical characteristics and presenting symptoms of dementia - a case-control study of older ethnic minority patients in a Dutch urban memory clinic. Aging Ment Health2022; 26: 2277–2284.
51.
SegersKBenoitFColsonC, et al.Pioneers in migration, pioneering in dementia: first generation immigrants in a European metropolitan memory clinic. Acta Neurol Belg2013; 113: 435–440.
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