The Indianapolis-Ibadan cross-cultural study compares African-Americans with Yoruba-Africans with respect to the prevalence and incidence of dementia and Alzheimer’s disease as well as the risk factors. The Community Screening Instrument for Dementia (CSI’D) was used to screen consenting community-dwelling, elderly subjects in Indianapolis, USA and Ibadan, Nigeria during the three waves of the study (prevalence and two incidence waves). The validated CSI’D which was harmonized to the Yoruba culture had a sensitivity of 87.02% and specificity of 83.12% for dementia diagnosis in that population. A stratified sample of the participants at the two sites was selected for clinical assessment based on their performance on the CSI’D.
The diagnostic process included consideration of data collected from a structured interview with a key informant and from a neuropsychological test battery modified from the Consortium to Establish a Registry for Alzheimer’s disease (CERAD. Interpretation of this was based on local normative data. Detailed examination by a physician followed by laboratory investigations including imaging studies completed the assessments. The diagnoses of dementia and the subtypes were made according to the Diagnostic and Statistical Manual –Third edition revised (DSM-IIIR) and the International Classification of Diseases 10th edition (ICD-10). Final diagnoses were arrived at during consensus conferences (both on-site and inter-site with blinding). Discrepant diagnoses were reviewed at joint consensus conference. The coefficients of agreement for dementia diagnosis between sites (kappa) varied between 0.79 and 0.87. The use of identical methods at the two sites and consistent performance on the screening instrument as well as consensus diagnoses made comparability of results possible. The presentation will highlight the implication of the results.
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