The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals

Abstract

The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test-retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable differences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r=0.57) and the test-retest reliability was satisfactory (r=0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly.