Normative Data for the Montreal Cognitive Assessment in a Lebanese Older Adult Population.

INTRODUCTION: The Montreal Cognitive Assessment (MoCA), a neuropsychological tool for cognitive decline screening is widely used. In the absence of normative data in Lebanon, this study offers normative data for the MoCA in Lebanese community-dwelling older people and compare scores to those of other countries. METHODS: 164 literate subjects aged 60 and above were recruited to complete the MoCA. RESULTS: The mean MoCA score observed (24.20 points) was lower than that for normal controls (27.4 points) in the original validation study of the MoCA. Regression analysis showed that fewer years of education were associated with lower MoCA scores (p < .000). CONCLUSIONS: This study presents normative data and the findings suggest that cultural differences are evident in cognitive testing.

Comparative study between prison- and community-based treatment satisfaction for opioid use disorder in Lebanon.

PURPOSE: Opioid substitution treatment (OST), such as Buprenorphine, has become a well-established evidence-based approach for the treatment of inmates with opioid use disorder (OUD) in most of the developed world. However, its application in Lebanon remains mainly as a community-based intervention. The purpose of this paper is to highlight the need of its implementation within the Lebanese correctional system. DESIGN/METHODOLOGY/APPROACH: The work is a pilot cross-sectional study that compares two groups: 30 male adult prisoners with OUD convictions receiving symptomatic treatment and 30 male adult community patients with OUD receiving Buprenorphine. The objective was to measure the difference in the patients' general perception and satisfaction of the treatments available. OUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria and the level of satisfaction was measured by "Treatment Perceptions Questionnaire (TPQ)." FINDINGS: The prison group reported significantly lower satisfaction when compared to the community group (total TPQ mean scores: M=34.73, SD =4.12 and M=16.67, SD =4.78, respectively, with t (56.76) =15.68, p=0.000). Furthermore, age, marital status, education level and elapsed time in treatment had no significant interactions with the total TPQ score. ORIGINALITY/VALUE: The major principles of the ethics of care and evidence-based safe practices will be proposed for the introduction of Buprenorphine to Lebanese prisons. This work provides an opportunity for the expansion of the Lebanese OST program and consequently other countries in the region could benefit from this experience.

Screening for dementia in Arabic: normative data from an elderly Lebanese sample.

OBJECTIVE: Prevention and treatment of dementia is a global concern that requires involvement of international samples. The purpose of this study is to develop culturally sensitive norms based on normal older Lebanese adults using multiple cognitive screening measures translated into Arabic for regional use. METHODS: Participants were 164 community dwelling older Lebanese adults without cognitive complaints. They were administered the following cognitive measures in Arabic: Alzheimer's Disease 8-item questionnaire, Montreal Cognitive Assessment, Mini Mental Status Exam, Modified Mini Mental Status, Brief Visuospatial Memory Test-Revised, Lebanese Digit Span, Cross-Linguistic Naming Test, and phonemic and semantic fluency tests. RESULTS: Sample characteristics and descriptive statistics for the demographically unadjusted raw scores are first presented (N = 164). Same-form test-retest reliability for each test were computed for 24 participants retested over 2-5 weeks, with reliabilities ranging from .55 to .90; Cronbach alpha coefficients ranged from .34 to .93. Two sets of normative data were constructed. First, base-rates for demographically unadjusted raw scores for the 5th, 10th and 15th percentiles are presented to identify relatively rare occurring performances. Second, using standardized regression-based procedures demographically corrected normative information adjusted for age, education and sex were generated for normative interpretation. CONCLUSIONS: Adapting cognitive tests for use in culturally and linguistically diverse regions of the world not only requires careful translation of test instructions and materials, but construction of culturally sensitive local norms. Our normative data should allow for more accurate identification of cognitive impairment and dementia in Arabic-speaking patients, especially those living in Lebanon.

Sociolinguistic reflection on neuropsychological assessment: an insight into selected culturally adapted battery of Lebanese Arabic cognitive testing.

Neuropsychological tests (NPTs) are highly dependent on education, culture differences as well as age and sex. It is therefore essential to take these factors into consideration when translating NPTs to be used in screening for cognitive impairment. Translations into Arabic must respect the principles of linguistic relativity and cultural specificity of the population under study. The objective is to assess feasibility and outcome of translating neuropsychological tests to Arabic. A team of Lebanese professionals selected a battery of screening NPTs. These tests were translated into Arabic and independently back translated by a team of sociolinguists and cultural specialists. The translations were adapted to suit the Lebanese culture. The final NPT translated versions were reached by consensus of an expert panel and tested on a group of independently living community-dwelling elderly. Translated items had to be modified when: (1) terms could not be translated using one word as required by the test; (2) Concepts were foreign to the culture; (3) Translated words carried multiple meanings; (4) Words were rarely used in Lebanon; (5) Sentences did not have an equivalent; and (6) Words had letters pronounced differently by subgroups in Lebanon. Despite all measures to maintain cultural sensitivity in translations, non-linguistic challenges remained. A battery of cognitive screening tests were translated into Arabic and adapted for the Lebanese population. These adaptations allow for a better assessment of cognitive abilities since they reflect the thought patterns of the population. The challenge is to establish local normative data.