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T 25: Cultural Adaptation of the TOMMORROW Cognitive Battery in Russia, Switzerland, and Italy

Poster Presenter

      Alexandra S. Atkins

      • Senior Scientific Director
      • NeuroCog Trials
        United States


To describe methods and results from a comprehensive linguistic and cultural adaptation of the TOMMORROW cognitive battery, designed to detect transition from normal aging to mild cognitive impairment due to Alzheimer’s disease (MCI-AD) in multi-national clinical trials.


Linguistic and cultural adaptation of the cognitive battery was completed in Russia, Switzerland (German), and Italy. Professional translation was followed by in-country cognitive debriefing. In-country psychologists provided input on construct validity and appropriateness for the target population.


Final recommendations for revisions to translated tests were based on feedback from in-house psychologists, expert reviewers, testers, and subjects engaged in cognitive debriefing. In all countries, alternative wording was recommended to clarify task demands and increase understanding by the target population. Significant adaptations to the Multilingual Naming Test (MINT) were requested. Regional responses were incorporated and improved pictures were provided. The picture of one naming item, the “plug,” was adapted for each region. For Russian measures, changes to initial translations were made to achieve cultural equivalency of task instructions. In addition, Russian feedback indicated potential differences in speed of processing tasks due to a cultural emphasis on accuracy, reduced exposure to alphabetical sequencing (TMT-B), and relative unfamiliarity with timed testing. A significant change to the Italian MMSE included revision of the “No ifs, ands, or buts” equivalent to improve construct equivalency and maintain consistency with common practice. Additional changes included revision of the TMT-B to remove letters J and K, and substitution of letters for the lexical fluency task. Regarding the German language, Swiss reviewers expressed a preference for Swiss German over High German words. To facilitate more widespread use of the final adapted measure, the decision was made to adhere to High German vocabulary. Suggestions regarding revisions of CVLT-II categories were beyond the scope of the present project. As such, recommendations for improved translation of items were incorporated, but alternate words and word lists were not. Although cultural differences in CVLT-II category frequency have the potential to influence raw scores, collection of region-specific normative data completed following cultural adaption can mitigate the impact of these differences by allowing for normalization of raw scores relative to a culturally appropriate standard.


Cultural adaptation of cognitive assessments improves the quality of translated instruments by ensuring tasks, stimuli, and instructions are understood and are appropriate for use in populations of interest. Successful adaptation for clinical trials ensures cultural appropriateness of performance-based tests while maintaining the construct validity and integrity of the original instruments. Linguistic and cultural adaptation activities contributed to the development of improved, culturally appropriate versions of the TOMMORROW cognitive battery for use in German, Russian, and Italian. Results suggest proposed methods for cultural adaptation of performance-based assessments can identify and correct errors prior to use in clinical trials, yielding potentially widespread gains in the reliability and validity of translated instruments. Authors: Alexandra S. Atkins, PhD1,11, Adam W. Vaughan, PhD1,11, Nicole M. Turcotte, MA1, Oksana A. Makeeva, PhD2, Andreas U. Monsch, PhD3, Giovanni B. Frisoni, MD4,10, Maura Parapini, MS10, Irina Zhukova, MD, PhD2, Zara Melikyan, PhD5, Shyama Brewster, BSc Joint (Hons)5, Kumar Budur, MD, MS6, Janet O’Neil, MBA6, Heather R. Romero, PhD8, Brenda L. Plassman, PhD7,8, Kathleen M. Hayden, PhD7,8,9, Kathleen A. Welsh-Bohmer, PhD 7,8, Richard S.E. Keefe, PhD1,8,11 (1) NeuroCog Trials, Durham, NC;(2)Neuropsychology Testing Center, Nebbiolo, LLC, Tomsk, RU;(3) University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, CH;(4) IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, IT;(5) Zinfandel Pharmaceuticals Inc., Chapel Hill, NC;(6) Takeda Development Center Americas, Inc., Deerfield, IL;(7) Joseph and Kathleen Bryan ADRC, Duke University Medical Center, Durham, NC;(8) Dept. of Psychiatry, Duke University Medical Center, Durham, NC; (9) Wake Forest School of Medicine, Winston-Salem, NC;(10) University Hospitals and University of Geneva, Geneva, CH;(11) NCT Linguistics, Durham, NC