THE BANGLA ADAPTATION OF MINI- MENTAL STATE EXAMINATION (BAMSE): AN INSTRUMENT TO ASSESS COGNITIVE FUNCTION IN ILLITERATE AND LITERATE INDIVIDUALS ZARINA NAHAR KABIR 1,2,3 * AND AGNETA HERLITZ 1,4 1 Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Division of Geriatric Medicine, Karolinska Institutet, Stockholm, Sweden 2 Stockholm Gerontology Research Center, Stockholm, Sweden 3 Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 4 Department of Psychology, University of Stockholm, Stockholm, Sweden ABSTRACT The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test±retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable dierences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r  0.57) and the test±retest reliability was satisfactory (r  0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly. Copyright # 2000 John Wiley & Sons, Ltd. KEY WORDS ÐMMSE; BAMSE; illiteracy; elderly; Bangladesh; low income country The elderly population is increasing all over the world, particularly in the low-income regions, and this trend is expected to continue well into the next century (Levko et al., 1995). Not only is the number of elderly people rising, but also life expectancy in the low-income parts of the world is increasing. As increasing age is associated with cognitive decline (Fillenbaum, 1984; BaÈ ckman et al., 1990; Dellasega and Morris, 1993) and dementia (Levko et al., 1995; Liu et al., 1994; Teng et al., 1994; Fratiglioni et al., 1997), the low- income countries can anticipate a high incidence of the disease in the coming years (Chandra et al., 1994). With increasing prevalence of dementia comes the need for reliable assessment of cognitive function in the elderly. Standardised instruments for cognitive testing in the elderly can be used to assess the cognitive level of a population, to screen for and stage dementia diseases (Fratiglioni et al., 1993; Herlitz et al., 1995; Liu et al., 1994), and to enable the comparison between dierent populations inter- nationally. The utility of assessing cognitive func- tion in multidimensional surveys has also been emphasised by researchers for evaluating the Copyright # 2000 John Wiley & Sons, Ltd. Received 9 June 1999 Accepted 29 September 1999 INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int. J. Geriat. Psychiatry 15, 441±450 (2000) *Correspondence to: Z. N. Kabir, Stockholm Gerontology Research Center, Box 6401, S-11382 Stockholm, Sweden. Tel: 46-8-6905829. Fax: 46-8-335275. e-mail: zarkab@ki.se Contract/grant sponsor: Swedish Agency for Research Cooperation/Swedish International Development Agency. Contract/grant number: SWE-95-185