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The KICA Carer: informant information to enhance the Kimberley Indigenous Cognitive Assessment

Published online by Cambridge University Press:  14 August 2015

K. Smith ,
L. Flicker ,
D. Atkinson ,
A. Dwyer ,
N.T. Lautenschlager ,
J. Thomas ,
O.P. Almeida  and
D. LoGiudice
K. Smith*
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
L. Flicker
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
D. Atkinson
Affiliation:
Rural Clinical School, University of Western Australia, Perth, Australia; and Kimberley Aboriginal Medical Services Council, Broome, Australia
A. Dwyer
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia
N.T. Lautenschlager
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia; and Department of Psychiatry, Royal Perth Hospital, Perth, Australia Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia; and North Western Mental Health, Melbourne Health, Melbourne, Australia
J. Thomas
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia
O.P. Almeida
Affiliation:
Western Australian Centre for Health and Ageing, Centre for Health Research, University of Western Australia, Perth, Australia School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia; and Department of Psychiatry, Royal Perth Hospital, Perth, Australia
D. LoGiudice
Affiliation:
National Ageing Research Institute, Melbourne, Australia; and Melbourne Health, Royal Park Campus, Melbourne, Australia
*
Correspondence should be addressed to: Dr Kate Smith, Western Australian Centre for Health and Ageing (M577), University of Western Australia, 35 Stirling Hwy Crawley, Western Australia 6009, Australia. Phone: +618-92242750; Fax: +618-92248009. Email: [email protected].
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Abstract

Background:

A quality dementia-screening tool is required for older remote Aboriginal Australians who have high rates of dementia and limited access to appropriate medical equipment and clinicians. The Kimberley Indigenous Cognitive Assessment (KICA Cog) is a valid cognitive test for dementia in Aboriginal and Torres Strait Islander peoples. The KICA cognitive informant questionnaire (KICA Carer) had yet to be analyzed to determine validity alone or in combination with the KICA Cog.

Methods:

The KICA Carer was completed by nominated informants of 349 remote-living Aboriginal Australians in the Kimberley region, Western Australia. Validity was assessed by comparing KICA Carer with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-10) consensus diagnoses based on a blinded specialist review. KICA Carer and KICA Cog were then compared to determine joint validity.

Results:

A KICA Carer score of ≥3/16 gave optimum sensitivity (76.2%) and specificity (81.4%), area under curve (AUC) 0.89 (95% CI = 0.85, 0.94) with positive predictive value (PPV) of 35.8%, and negative predictive value (NPV) of 96.2%. A KICA Cog score of ≤33/39 gave a sensitivity of 92.9% and specificity of 89.9%, AUC 0.96 (95% CI = 0.94, 0.98), with PPV of 55.6% and NPV of 98.9%. Cut-off scores of KICA Cog ≤ 33/39 and KICA Carer ≥ 2/16 in series indicate possible dementia, with sensitivity of 90.5% and specificity of 93.5%. In this setting, PPV was 66.5% and NPV was 98.6%.

Conclusions:

The KICA Carer is an important tool to accurately screen dementia in remote Aboriginal Australians when the KICA Cog is unable to be used for a patient. It is readily accepted by caregivers.

Key points:

  • • For the best practice in the cognitive assessment of an Aboriginal Australian aged over 45 years, KICA Cog should be utilized.

  • • In cases where Aboriginal patients are not assessed directly, KICA Carer should be conducted with an informant. A cut-off score of ≥3/16 should be used (these tools can be downloaded from www.wacha.org.au/kica.html).

Keywords

dementiaAboriginalcognitive assessmentinformant questionnaire
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 1 , January 2016 , pp. 101 - 107
Copyright
Copyright © International Psychogeriatric Association 2015 

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