Assessing cognitive impairment in Indigenous Australians: Re-evaluation of the Kimberley Indigenous Cognitive Assessment in Western Australia and the Northern Territory KATE SMITH 1 , LEON FLICKER 1,2 , ANNA DWYER 1 , GAIL MARSH 3 , SADHANA MAHAJANI 4 , OSVALDO ALMEIDA 1,5 , NICOLA LAUTENSCHLAGER 1,5,6 , DAVID ATKINSON 7 , & DINA LOGIUDICE 8 1 Western Australian Centre for Health and Ageing, Schools of 2 Medicine and Pharmacology and 5 Psychiatry and Clinical Neurosciences, and 7 Kimberley Aboriginal Medical Services Council and Rural Clinical School, University of Western Australia, Broome, Western Australia, 3 Alzheimer’s Australia (Northern Territory), 4 Aged Care Assessment Team, Darwin, Northern Territory, 6 Academic Unit for Psychiatry of Old Age, St Vincent’s Health, Department of Psychiatry, University of Melbourne and 8 Royal Park, Melbourne Health and National Ageing Research Institute, Melbourne, Victoria, Australia Abstract The Kimberley Indigenous Cognitive Assessment (KICA) was initially developed and validated as a culturally appropriate dementia screening tool for older Indigenous people living in the Kimberley. This paper describes the re-evaluation of the psychometric properties of the cognitive section (KICA-Cog) of this tool in two different populations, including a Northern Territory sample, and a larger population-based cohort from the Kimberley. In both populations, participants were evaluated on the KICA-Cog tool, and independently assessed by expert clinical raters blinded to the KICA scores, to determine validity and reliability of dementia diagnosis for both groups. Community consultation, feedback and education were integral parts of the research. For the Northern Territory sample, 52 participants were selected primarily through health services. Sensitivity was 82.4% and specificity was 87.5% for diagnosis of dementia, with area under the curve (AUC) of .95, based on a cut-off score of 31/32 of a possible 39. For the Kimberley sample, 363 participants from multiple communities formed part of a prevalence study of dementia. Sensitivity was 93.3% and specificity was 98.4% for a cut-off score of 33/34, with AUC ¼ .98 (95% confidence interval: 0.97–0.99). There was no education bias found. The KICA-Cog appears to be most reliable at a cut-off of 33/39. Key words: Aboriginal, cognitive assessment, cross-cultural, dementia. Dementia is a term that encompasses a group of disorders that impair brain function, leading to progressive cognitive, behavioural and psychiatric changes and functional disability (American Psychia- tric Association [APA], 1994; World Health Orga- nization [WHO], 1992). This is a complex and challenging condition for the individual, their carers and families, and health professionals (Brodaty, Draper, & Low, 2003). This paper reports on the re-evaluation of a cognitive assessment tool for Indigenous older people, in two different settings. The Kimberley Indigenous Cognitive Assessment (KICA) tool was initially developed to address a gap in the availability of a culturally appropriate assessment tool specifi- cally for older Indigenous people living in remote and rural areas (LoGiudice et al., 2006). Initial results describing the psychometric properties of the cognitive assessment section of the tool (KICA- Cog), demonstrated its effectiveness in detecting those with cognitive impairment and dementia (LoGiudice et al., 2006). Yet evaluation of the tool in different settings was needed to ensure appro- priateness for other communities and regions. This required a respect of unique differences in culture and language with variable perceptions of dementia, Correspondence: K. Smith, WA Centre for Health and Ageing, University of Western Australia, GPO Box X 2213, Perth, WA 6847, Australia. E-mail: ksmith@meddent.uwa.edu.au Australian Psychologist, March 2009; 44(1): 54–61 ISSN 0005-0067 print/ISSN 1742-9544 online Ó The Australian Psychological Society Ltd Published by Taylor & Francis DOI: 10.1080/00050060802563463