Translation, Validation, Diagnostic Accuracy, and Reliability of Screening Questionnaire for Parkinsonism in Three African Countries

Article type: Research Article

Authors: Shalash, Ali^{a; *} | Okubadejo, Njideka U.^b | Doumbe, Jacques^c | Ojo, Oluwadamilola O.^b | Hamid, Eman^a | Kuate, Callixte^c | Calvo, Sara^d | Helmi, Asmaa^a | Agabi, Osigwe P.^e | Essam, Mohamed^a | Aguado, Laura^d | Elrassas, Hanan^f | Roushdy, Tamer^a | Tanner, Caroline M.^g | Cubo, Esther^d

Affiliations: [a] Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt | [b] Neurology Unit, Department of Medicine, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria | [c] Department of Neurology, University of Douala, Douala, Cameroon | [d] Neurology Department, University Hospital, Burgos, Spain | [e] Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria | [f] Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt | [g] Department of Neurology, Weill Institute for Neurosciences, University of California - San Francisco, San Francisco, CA, USA

Correspondence: [*] Correspondence to: Ali Shalash, PhD, MD, Professor of Neurology, Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt. Tel.: +002 27757457, 00201111124815; Fax: +0020224346742; E-mails: ali_neuro@yahoo.com., Drali_shalash@med.asu.edu.eg.

Abstract: Background:Availability of validated Parkinson’s disease (PD) questionnaires in languages spoken in Africa will enable the conduct of epidemiological studies. Objective:The aims of the current study were to develop cross-cultural translated and validated Arabic and French versions of a PD screening questionnaire, and determine its diagnostic accuracy for recognition of parkinsonism in early and moderate-advanced PD in three countries (Cameroon (French), Egypt (Arabic), and Nigeria (English)). Methods:This cross-sectional study screened 159 participants (81 PD and 78 controls) using the PD screening questionnaire. The questionnaire was translated into Arabic and French versions using standard protocols. Cognitive function was assessed using the Montreal Cognitive Assessment and the Identification and Intervention for Dementia in Elderly Africans cognitive screen. Co-morbidity burden was documented using the Charlson Comorbidity Index. PD severity and stage were evaluated using the MDS Unified Parkinson Disease Rating Scale and the Hoehn and Yahr scale respectively. Results:Both PD patients and controls were matched regarding age, gender, education, and co-morbidity burden. The PD screening questionnaire scores were significantly higher in PD (median 8.0, IQR 6.0–10.0) in contrast to controls (0.0, IQR 0.0–0.0) (p < 0.0001), with a similar pattern and level of significance across all country sites. In ROC analysis, the questionnaire demonstrated high diagnostic accuracy for PD overall, with an AUC of 0.992 (95% CI 0.981–1.002). Conclusion:The Arabic, French, and English versions of this PD screening questionnaire are valid and accurate screening instruments for recognition of Parkinsonism. This paves the way for conducting epidemiological studies in many African countries.

Keywords: Parkinson’s disease, screening, questionnaire, African countries, translation, validation

DOI: 10.3233/JPD-202040

Journal: Journal of Parkinson's Disease, vol. 10, no. 3, pp. 1113-1122, 2020