Research Digest – September 2019

Author: Gabriel Qi

For our September ANA Listserv Research Digest, I want to introduce two articles on
cognitive testing of community samples in rural and urban India.

Ganguli and colleagues (1996) used an adapted battery from the one developed by
the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). To make the
batteries appropriate and relevant for Asian Indians with minimal literacy levels and
from rural communities, the team made several adaptations to and a few omissions
of the tasks. For example, some important adaptations include:
⬥ Changing items on the Hindi Mental State Examination, such as substituting
orientation to the year to a more relevant piece of information to the illiterate rural
⬥ Adding a “cueing” strategy for verbal list learning, to help the subjects
understand the recall task better;
⬥ Using models of objects instead of line drawings in confrontational naming

Due to education levels, floor effect and/or unfamiliarity with paper and pencil tasks,
several tests were also eliminated: Phonemic verbal fluency; Temporal orientation
test; Trail-making tests; Tests of logical memory.

Eventually, the authors reported normative data of a sample of 374 nondemented
individuals, with age and gender stratification. Cultural considerations were further
discussed as well.

Authors of the second article reported a study of aging urban populations in India
(Nair et al., 2012). They used the Hindi Mental Status Examination developed by
Ganguli and colleagues (1995) and, in addition, an adapted blessed functional activity
scale, clinical dementia rating scale (CDR), Neuropsychiatric Inventory (NPI), and the
Geriatric Depression Scale (GDS). Characteristics of cognitive deficits and dementia in
this population were reported.

Food for thought this month:

What are some of your experiences and cultural considerations working with
illiterate and/or rural patients?

Here are the links to access the articles this month:



•Ganguli, M., Ratcliff, G., Chandra, V., Sharma, S., Gilby, J., Pandav, R., … & Dekosky,
S. (1995). A Hindi version of the MMSE: the development of a cognitive screening
instrument for a largely illiterate rural elderly population in India. International
Journal of Geriatric Psychiatry, 10, 367-377.
• Ganguli, M., Chandra, V., Gilby, J. E., Ratcliff, G., Sharma, S. D., Pandav, R., … &
Belle, S. (1996). Cognitive test performance in a community-based nondemented
elderly sample in rural India: the Indo-US Cross-National Dementia
Epidemiology Study. International Psychogeriatrics, 8, 507-524.
• Nair, G., Van Dyk, K., Shah, U., Purohit, D. P., Pinto, C., Shah, A. B., … & Sano, M.
(2012). Characterizing cognitive deficits and dementia in an aging urban population
in India. International Journal of Alzheimer’s Disease, 2012.