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. Copyright © 2004 John Wiley & Sons, Ltd.