Cross-cultural adaptation of the everyday cognition scale (M-ECog) in older Mexican adults with cognitive impairment

Aguilar-Navarro, Sara Gloria; Sánchez, Brenda Lorena Pillajo; Gutiérrez, Lidia Antonia Gutiérrez; Arias-Trejo, Natalia; Quiroz, Yakeel T.; Alvarado, Alberto José Mimenza

doi:10.1590/1980-5764-DN-2023-0011

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2023-0011 copy

Cross-cultural adaptation of the everyday cognition scale (M-ECog) in older Mexican adults with cognitive impairment

Adaptação transcultural da escala de cognição cotidiana (M-ECog) em idosos mexicanos com comprometimento cognitivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs).

Objective:

To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic.

Methods:

There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog).

Results:

The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach’s alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval — CI, 0.850–0.902; p<0.001). The patient’s group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58–0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89–0.99, p<0.001) and for dementia 0.86 (95%CI 0.79–0.92, p<0.001).

Conclusion:

The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.

Keywords:
Cognitive Dysfunction; Dementia; Questionnaires; Elderly; Memory

Participants	CH	SCD	MCI	Dementia	p
Participants	n=50	n=50	n=50	n=50	p
Age (years), Mean (SD)	70.1±7.7	72.32±7.96^a Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	73.3±6.9^b Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	77.9±9.8^c Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	<0.001
Women (n)%	28 (56)	34 (68)	36 (72)	28 (56)	0.02
Marital status (n)%
Married	28 (56)	21 (42)	24 (48)	26 (52)	<0.001
Single	9 (18)	11 (22)	8 (16)	3 (6)	<0.001
Divorced	2 (4)	4 (8)	4 (8)	5 (10)	<0.001
Widower	9 (18)	12 (24)	14 (28)	16 (32)	<0.001
Education, mean (SD)	14.4±6.3	11.9±5.1	10.4 ±4.8	9.30 ±4.9	<0.001
MMSE, mean (SD)	28.8±1.1	27.6±1.5	26.2±1.9	21.9±3.3	<0.001
MoCA-E, mean (SD)	28.0±1.1	26.1±2.2	21.3±2.6	15.6±3.3	<0.001
Katz, mean (SD)	6±0.0	6±0.0	6±0.5	5±0.8	<0.001
Lawton & Brody, mean(SD)	8±0.0	8±0.0	7.7±0.5	5±1.5	<0.001
M-ECog, mean (SD)	43.5±2.6	52.7±5.4	67.4±9.8	85.2±26.2	<0.001
Memory, mean (SD)	10.6±1.5	13.1±3.3	16.8±3.4	20.5 ±6.1	<0.001
Language, mean (SD)	9.4±1.0	13.4±2.6	14.7±3.7	18.9±6.8	<0.001
Visuospatial, mean (SD)	7.8±1.0	8.2±1.6	10.1±2.7	13.3±6.9	<0.001
Planning, mean (SD)	5.2±0.6	5.7±1.2	7.1±2.5	10.7±4.2	<0.001
Organization, mean (SD)	4.9±1.2	6.9± 1.2	8.5±2.5	12.6±4.4	<0.001
Divided attention, mean (SD)	5.9±0.7	6.6±2.3	8.5±2.9	9.8±3.8	<0.001
Informants	n=50	n=50	n=50	n=50
Age (years), mean (SD)	53.7±16.5	53.4±16.8^a Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	53.4 ±16.3^b Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	53.7±14.9^c Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	<0.001
Woman, (n)%	34 (68)	35 (70)	34 (68)	43 (86)	0.12
Marital status (n)%
Married	24 (48)	13 (41.9)	27 (54)	28 (56)	<0.001
Single	18 (36)	12 (38.7)	19 (38)	17 (34)	<0.001
Divorced	4 (8)	3 (3.7)	2 (4)	2 (4)	<0.001
Widower	2 (4)	2 (6.5)	2 (4)	1 (2)	<0.001
Education, mean (SD)	13.6±4.5	13.9±3.9	13.3±5.1	13.70±3.9	0.93
Caregiver’s burden	5.5±8.6	11.8± 11.7	14.18±14.8	24±13.0	0.16
M-ECog, mean (SD)	45.1±8	54.4±12.9^a Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	68.3±13.8^b Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	94.4±25.3^c Abbreviations: CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment; SD, standard deviation. Notes: a,b,cPost-hoc comparisons, Bonferroni correction; ap≤0.001 between CH and SCD; bp≤0.001 between CH and MCI; cp≤0.001 between CH and dementia.	<0.001
Memory, mean (SD)	11.0 ±2.4	14.1±3.1	17.7±4.9	23.7±6.6	<0.001
Language, mean (SD)	9.6±2.3	12.1±3.8	14.6±4.4	19.4±6.5	<0.001
Visuospatial, mean (SD)	7.9±1.6	9.1±2.7	11.2±3.7	14.5±6.8	<0.001
Planning, mean (SD)	5.2±0.8	5.9±1.9	8.2±2.8	11.5±5.3	<0.001
Organization, mean (SD)	6.3±1.5	7.2±2.6	9.1±3.0	15.2±5.4	<0.001
Divided attention, mean (SD)	5.4±1.6	6.1±2.5	7.8±2.6	10.4±3.3	<0.001

M-ECog		CH	SCD	MCI	Dementia	Correlation Spearman	p
MMSE, mean, (SD)	Global cognition	28.8±1.1	27.6±1.5	26.2±1.9	21.9±3.3	-0.635	<0.001^* Abbreviations: M-ECog, Everyday Cognition Scale Mexican version; MMSE, Mini-Mental State Evaluation; SD, standard deviation; MoCA-E, Montreal Cognitive Assessment Spanish version; ADLs, activities of daily living; CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment.
	Memory	3.0±0.0	3.0±0.0	3.0±0.0	2.9±0.4	-0.244	0.006
	Language	2.0±0.0	2.0±0.0	2.0±0.0	1.9±0.2	-0.660	0.464
	Visuospatial	0.62±0.5	0.4±0.5	0.3±0.5	0.1±0.3	-0.266	0.003
	Attention	4.82±0.38	4.82±0.40	4.4±0.9	3.7±1.5	-0.224	0.120
MoCA-E, mean, (SD)	Global cognition	28.0±1.1	26.1±2.2	21.3±2.6	15.6±3.3	-0.701	<0.001^* Abbreviations: M-ECog, Everyday Cognition Scale Mexican version; MMSE, Mini-Mental State Evaluation; SD, standard deviation; MoCA-E, Montreal Cognitive Assessment Spanish version; ADLs, activities of daily living; CH, cognitively healthy; SCD, subjective cognitive decline; MCI, mild cognitive impairment.
	Memory	4.1±0.8	3.4±1.3	2.0±1.8	1.2±1.3	-0.761	<0.001
	Language	2.9±0.3	2.7±0.6	2.0±0.9	0.9±0.9	-0.308	<0.001
	Visuospatial	4.2±0.73	3.5±0.9	3.2±4.4	1.7±1.1	-0.264	0.003
	Planning	13.6±1.5	12.2±2.9	9.3±4.1	7.4±3.4	-0.273	0.002
	Organization	2.9±0.2	2.9±0.3	2.7±0.5	2.4±0.7	-0.211	0.017
	Attention	5.7±0.6	5.4±0.9	4.3±1.1	2.9±1.4	-0.267	0.002
ADLs (Katz) mean, (SD)	Global function	6±0.0	6±0.0	6.0±0.5	5.±0.8	-0.383	<.0001
	Memory	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.353	<0.001
	Language	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.362	<0.001
	Visuospatial	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.102	0.252
	Planning	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.299	0.001
	Organization	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.393	<0.001
	Attention	6±0.0	6±0.0	5.9±0.2	5±0.8	-0.284	0.001
ADLs (Lawton & Brody) mean, (SD)	Global function	8±0.0	8±0.0	7.7±0.5	5±1.5	-0.409	<0.001
	Memory	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.404	<0.001
	Language	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.364	<0.001
	Visuospatial	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.152	0.086
	Planning	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.407	<0.001
	Organization	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.456	<0.001
	Attention	8±0.0	8±0.0	7.5±0.5	4.5±1.5	-0.249	0.005

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E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Alberto José Mimenza Alvarado; Email: a.mimenza@hotmail.com.