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 Table of Contents  
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 189-190

Neuropsychological assessment of cognitively impaired Indian elderly: Challenges and implications

1 Department of Clinical Psychology, AIBAS, AMITY University, Jaipur, Rajasthan, India
2 Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India

Date of Web Publication13-Dec-2016

Correspondence Address:
Ravikesh Tripathi
Department of Clinical Psychology, AIBAS, AMITY University, Jaipur 302 001, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2348-9995.195690

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How to cite this article:
Simon S, Singh P, Rawat VS, Tripathi R. Neuropsychological assessment of cognitively impaired Indian elderly: Challenges and implications. J Geriatr Ment Health 2016;3:189-90

How to cite this URL:
Simon S, Singh P, Rawat VS, Tripathi R. Neuropsychological assessment of cognitively impaired Indian elderly: Challenges and implications. J Geriatr Ment Health [serial online] 2016 [cited 2020 Feb 28];3:189-90. Available from: http://www.jgmh.org/text.asp?2016/3/2/189/195690


The review article by Tiwari et al. [1] is comprehensive and informative. Authors' concern with regard to ecological validity and accessibility of neurocognitive measures is valid and genuine. We are often helpless and perplexed in the absence of established norms for our older population, especially those with minimal education and illiterates. Further, it is difficult to ascertain the reason behind illiteracy that may affect our test interpretation. Illiteracy could be the end outcome of a number of factors including subnormal intellectual functioning, learning disability, or social and financial reasons. Illiterate participants with learning disability or compromised intelligence would have benign cognitive deficits than illiterate participants due to social and financial reasons. In our observation and clinical experience, we find that the majority of the participants are illiterate due to social (absence of school) or financial reason. Some of the illiterate participants can read and write alphabets however they have not received formal training for the same. Taken together, low education and illiterates could be considered as a heterogeneous group, and comprehensive norms are needed for such a varied group. It is true that this heterogeneity in terms of education, language, and value systems makes developing normative data a herculean task. We hope that in near future this problem can be overcome through assiduous and collaborative research.

Several researchers from India have done commendable work in neuropsychology and geriatric neuropsychology that has shaped and changed our understanding of neuropsychology. Their contribution has not been even alluded to in the review. Therefore we wish to include their contribution through this letter.

Mukundan and Murthy developed "NIMHANS Neuropsychological Battery" [2] for Indian adults including geriatric population. This battery is based on Luria's principles of cerebral localization and lateralization of higher mental functions. This battery consists of several Western tests and a few indigenous tests standardized on the Indian population. The applicability of NIMHANS neuropsychological battery is limited as the normative data was developed on a small sample.

Ganguli et al. adapted a battery of neuropsychological tests (CERAD-NB) [3] and developed normative data for low educated Indian elderly. This battery includes a brief global cognitive scale or general mental status test (HMSE), a 10-item word list, verbal fluency tests (categories of fruits and animals), confrontation naming (Boston Naming Test, 15-item version), and tests of constructional praxis. This is the first study which provided information which could be useful in developing a test for older population in India. Further normative data have been collected by Das et al. [4] using a sample of 745 healthy normal urban elderly (age range of 50-95 years).

Rao et al., [5] reported norms for several commonly used Western neuropsychological tests, namely, measures of speed, attention, executive functions, comprehension, and learning and memory. Normative data have been provided in terms of percentiles for age ranging from 18 to 65 years.

Addenbrooke's Cognitive Examination [6] has been adapted for Malayalam speaking population by Mathuranath et al. Normative data on Addenbrooke's cognitive examination were developed on a larger sample (488 participants) by Mathuranath et al. [7] It was observed that education was a significant contributor than age and gender on cognitive performance. Normative data were expressed in terms of means, standard deviations, and percentiles.

Iype et al. [8] examined the usefulness of the translated version of Rowland Universal Dementia Assessment Scale (RUDAS) in Malayalam speaking Indian population. RUDAS is a brief six-item screening test which is short, easy to administer and portable. Authors noted that it is a sensitive tool for detecting cognitive impairment(s). RUDAS had a similar sensitivity but better specificity than MMSE. Further, it was observed that the scores on RUDAS were affected by education.

Test performance seems to be influenced by education; however, this gain in performance translates into real life adaptive functioning seems to be an intriguing question.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Tiwari S, Pandey NM, Singh P, Tiwari SC. Neuropsychological assessment of cognitively impaired Indian elderly: Challenges and implications. J Geriatr Ment Health 2016;3:29-35.  Back to cited text no. 1
  Medknow Journal  
Mukundan CR, Murthy VN. Lateralization and Localizing Cerebral Lesions by a Battery of Neuropsychological Tests. Paper Presented at the Joint Conference of Neurology, Psychiatry, Clinical Psychology and Psychiatric Social Work Societies of India. Bangalore: National Institute of Mental Health and Neurosciences; 1979.  Back to cited text no. 2
Ganguli M, Chandra V, Gilby JE, Ratcliff G, Sharma SD, Pandav R, et al. Cognitive test performance in a community-based nondemented elderly sample in rural India: The Indo-U.S. cross-national dementia epidemiology study. Int Psychogeriatr 1996;8:507-24.  Back to cited text no. 3
Das SK, Banerjee TK, Mukherjee CS, Bose P, Biswas A, Hazra A, et al. An urban community-based study cognitive function among non-demented elderly population in India. Neurol Asia 2006;11:37-48.  Back to cited text no. 4
Rao SL, Subbakrishna DK, Gopukumar K. NIMHANS Neuropsychological Battery-Manual. Bangalore: National Institute of Mental Health and Neurosciences; 2004.  Back to cited text no. 5
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in Southern India. Int J Geriatr Psychiatry 2004;19:1188-94.  Back to cited text no. 6
Mathuranath PS, Cherian JP, Mathew R, George A, Alexander A, Sarma SP. Mini mental state examination and the Addenbrooke′s cognitive examination: Effect of education and norms for a multicultural population. Neurol India 2007;55:106-10.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Iype T, Ajitha BK, Antony P, Ajeeth NB, Job S, Shaji KS. Usefulness of the Rowland Universal Dementia Assessment scale in South India. J Neurol Neurosurg Psychiatry 2006;77:513-4.  Back to cited text no. 8


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