The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact.

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

Assessing the construct validity of a theory of mind battery adapted to Tunisian school-aged children.

Background: Theory of mind (ToM) refers to the ability to understand others' states of mind, desires, emotions, beliefs, and intentions to predict the content of their mental representations. Two major dimensions within ToM have been studied. The first is the type of inferred mental state, which can be cognitive or affective. The second comprises the types of processes involved according to their degree of complexity (first- and second-order false belief and advanced ToM). ToM acquisition is fundamental-a key component in the development of everyday human social interactions. ToM deficits have been reported in various neurodevelopmental disorders through various tools assessing disparate facets of social cognition. Nevertheless, Tunisian practitioners and researchers lack a linguistically and culturally appropriate psychometric tool for ToM assessment among school-aged children. Objective: To assess the construct validity of a translated and adapted French ToM Battery for Arabic-speaking Tunisian school-aged children. Methods: The focal ToM Battery was designed with neuropsychological and neurodevelopmental theory and composed of 10 subtests distributed evenly in three parts: Pre-conceptual, cognitive, and affective ToM. Translated and adapted to the Tunisian sociocultural context, this ToM battery was individually administered to 179 neurotypical Tunisian children (90 girls and 89 boys) aged 7-12 years. Results: After controlling for the age effect, construct validity was empirically confirmed on two dimensions (cognitive and affective) via structural equation modeling (SEM) analysis, demonstrating that this solution has a good fit. The results confirmed that the age affected differentially the performance obtained on ToM tasks based on the two components of the battery. Conclusion: Our findings confirm that the Tunisian version of the ToM Battery has robust construct validity for the assessment of cognitive and affective ToM in Tunisian school-aged children; hence, it could be adopted in clinical and research settings.

Assessment of executive functions in school-aged children: A narrative review.

Introduction: In the past three decades, there has been increasing interest in assessing children's Executive Functions (EF). However, studies on the conceptualization and operationalization of this construct are incongruent and guidance for clinicians and researchers aiming to assess EF is insufficient due to measurement variability. Aims: The purpose of this article was to examine current theories and models of EF in children, identify their assessment instruments, issues, and challenges, and discuss their impact on children's cognitive, behavioral, social and/or emotional development. Methods: This narrative review reflected on English and French scholarly articles on EF assessment in children. References were identified through searches of PubMed, Medline, ScienceDirect, Google Scholar, and APA PsychNet throughout the last two decades up to June 2022. Results: There are commonalities despite divergence in the definition and operationalization of EF. Assessment of EF requires psychometric tests as well as rating scales that must be integrated and interpreted considering the child's biological makeup, environmental background, and cultural specificities. Conclusion: Current EF theories, assessment tools, issues, and challenges were discussed in addition to the impact of their components' dysfunctions on children's development. Further studies should be conducted to develop new measurement methods and technologies to improve the ecological and ethological validity of youth assessment, treatment, and interventions.

Exploring the stability of HEXACO-60 structure and the association of gender, age, and social position with personality traits across 18 countries.

OBJECTIVES: The present paper tests the cross-national stability of the HEXACO-60 structure across 18 countries from four continents. Gender and age differences across countries will be examined. Finally, this is the first study to explicitly analyze the relationships between the HEXACO and social position. METHOD: Ten thousand two hundred and ninety eight subjects (5,410 women and 4,888 men) from 18 countries and 13 languages were analyzed. Confirmatory factor analysis techniques were used to test configural, metric and scalar invariance models. Congruence coefficients with the original structure of the HEXACO-60 were computed for every culture. Effect sizes of gender, age, and social position factors across countries were also computed. RESULTS: HEXACO-60 demonstrates configural and metric invariance, but not scalar invariance. Congruence coefficients show a great equivalence in almost all countries and factors. Only Emotionality presents a large gender difference across countries. No relevant effect of age is observed. A profile of high scores on Honesty-Humility, Extraversion, Conscientiousness, and Openness to Experience, and low scores on Emotionality increases the likelihood of achieving a higher social position, although the effect sizes are small. CONCLUSIONS: HEXACO-60 is a useful instrument to conduct personality trait research and practice around the world. Implications of gender, social position, and country differences are discussed.

Prevalence and Potential Determinants of COVID-19 Vaccine Hesitancy and Resistance in Qatar: Results from a Nationally Representative Survey of Qatari Nationals and Migrants between December 2020 and January 2021.

Global COVID-19 pandemic containment necessitates understanding the risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lack vital representative vaccine hesitancy data. We conducted the first representative national phone survey among the adult population of Qatar, between December 2020 and January 2021, to estimate the prevalence and identify potential determinants of vaccine willingness: acceptance (strongly agree), resistance (strongly disagree), and hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between willingness groups and fifteen variables. In the total sample, 42.7% (95% CI: 39.5-46.1) were accepting, 45.2% (95% CI: 41.9-48.4) hesitant, and 12.1% (95% CI: 10.1-14.4) resistant. Vaccine resistant compared with hesistant and accepting groups reported no endorsement source will increase vaccine confidence (58.9% vs. 5.6% vs. 0.2%, respectively). Female gender, Arab ethnicity, migrant status/type, and vaccine side-effects concerns were associated with hesitancy and resistance. COVID-19 related bereavement, infection, and quarantine status were not significantly associated with any willingness group. Absence of or lack of concern about contracting the virus was solely associated with resistance. COVID-19 vaccine resistance, hesitance, and side-effects concerns are high in Qatar's population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants), and those of Arab ethnicity.

Multicultural Validation of the Zuckerman-Kuhlman-Aluja Personality Questionnaire Shortened Form (ZKA-PQ/SF) Across 18 Countries.

The aim of this study was to assess the psychometric properties of the Zuckerman-Kuhlman-Aluja Personality Questionnaire shortened form (ZKA-PQ/SF) in 18 cultures and 13 languages of different African, American, Asian, and European cultures and languages. The results showed that the five-factor structure with 20 facets replicated well across cultures with a total congruence coefficient of .97. A confirmatory factor analysis (CFA) resulted in adequate fit indices for the five factors based on the comparative fit index (CFI), Tucker-Lewis index (TLI; >.90), and RMSEA (.031-.081). A series of CFA to assess measurement invariance across cultures resulted in adequate CFIs and TLIs for configural and metric invariance. However, factors did not show scalar invariance. Alpha internal consistencies of five factors ranged between .77 (Sensation Seeking) and .86 (Neuroticism). The average alpha of the 20 facets was .64 with a range from .43 (SS4) to .75 (AG1). Nevertheless, alpha reliabilities were lower in some facets and cultures, especially for Senegal and Togo. The average percentage of the variance explained based on the adjusted R2 was 2.9%, 1.7%, and 5.1% for age, sex, and, cultures, respectively. Finally, multidimensional scaling suggested that geographically or culturally close cultures share mean profile similarities.

The Adaptation and Validation of an Arabic Version of the Cornell Scale for Depression in Dementia (A-CSDD).

BACKGROUND: Depression is a major disorder that can be ttriggering, exacerbating, or co-occurring with dementia symptoms. Its assessment is paramount to achieve diagnostic, prognostic, and therapeutic decisions. The Cornell Scale for Depression in Dementia (CSDD) is purposely designed to address clinically this issue. OBJECTIVE: To examine the reliability and validity of an Arabic version of the CSDD (A-CSDD) in the Tunisian population. METHODS: Fifty-seven participants took part in this study: 20 as a control group (NC), 18 as dementia patients with depression (DD), and 19 as depressed patients without dementia (DND); all patients met the DSM IV criteria for depression and/or dementia. A translated, back-translated and adapted Arabic version of the CSDD was administered in parallel with the Geriatric Depression Scale (GDS), the non-cognitive part of the Alzheimer's disease Assessment Scale, and the Mini-Mental State Examination. RESULTS: The A-CSDD had good internal consistency (Cronbach's alpha = 0.85) and high test-retest reliability (Rho = 0.897, p < 0.001). The A-CSDD had excellent discriminatory power to diagnose depression in dementia patients (AUC = 0.90, p < 0.001) and good concurrent validity with the GDS (Rho = 0.70, p < 0.001). A principal component analysis with varimax rotation, performed on the DD group, led to a configuration of five factors explaining 75% of the variance. CONCLUSIONS: The results showed that this Arabic-Tunisian version of the A-CSDD is reliable and valid for diagnosing depression in an elderly Tunisian population with dementia and can be used in clinical and research settings.

The Development of the Dementia Screening Battery-100: Instrument Presentation, Reliability, and Construct Validity.

BACKGROUND/AIM: The screening of dementia in non-Westerners has so far relied on translations and adaptations of reputed instruments. Other efforts focused on developing culturally appropriate tests or tests in touch with new developments in the field. This study presents the rationale behind the construction of a new dementia screening test: the Dementia Screening Battery-100 (DSB-100). METHODS: The DSB-100 was administered to 46 demented individuals and 159 healthy matched controls. All demented participants met the DSM-IV criteria for dementia. The healthy controls showed no cognitive impairment and were independent in activities of daily living. The DSB-100 was administered as part of a larger neuropsychological assessment to collect additional indices on the severity of patients' dementia, depression, and frontal dysfunctions. The same information was used for comparisons with DSB-100 scores. RESULTS: Multiple regression analysis suggested that age and education, but not the variable sex, are essential in predicting cognitive performance. Construct validation yielded 4 factors, namely attention-visuospatial factors, memory, language, and executive functions. The results showed that the DSB-100 has a high interrater reliability and an acceptable overall internal homogeneity. CONCLUSION: These results validate the DSB-100 and suggest its appropriateness for dementia screening in Tunisian elderly and possibly elderly people from other cultures with modifications to some subscales.

An Arabic Version of the Cognitive Subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog): Reliability, Validity, and Normative Data.

The Alzheimer's Disease Assessment Scale's cognitive subscale (ADAS-Cog) is the most widely used instrument for screening cognitive dysfunction in Alzheimer's disease. The aim of the present study was to develop an Arabic version of this scale (A-ADAS-Cog), examine its psychometric properties (reliability and validity), and provide normative data. The A-ADAS-Cog), an Arabic version of the Mini-Mental State Examination (A-MMSE), and a Standardized Clinical Dementia Rating Scale (CDR) were administered to three Tunisian groups: 124 normal controls (NC), 33 patients with non-Alzheimer dementia (N-AD), and 25 patients with Alzheimer's disease (AD). The A-ADAS-Cog scores were significantly affected by age and education. A correction table was constructed to control these effects. The results showed that the A-ADAS-Cog has good internal consistency and reliability (α= 0.82 for AD). The test-retest reliability of the A-ADAS-Cog was stable over time (r = 0.97). An evaluation of the construct validity of the A-ADAS-Cog using principal component analysis led to a solution with three factors (memory, language and praxis), which explained 72% of the variance. The concurrent validity of the A-ADAS-Cog was established using the A-MMSE score (r = -0.86), CDR Sum of Boxes score (CDR-SB; r = 0.87), and global CDR score (CDR-Global; r = 0.74). Finally, the A-ADAS-Cog has an excellent discriminating power in the diagnosis of AD (ROC area = 0.92). A cut-off score of 10 (sensitivity = 84% and specificity = 91%) is indicated for the screening of the AD. Overall, the results indicated that the A-ADAS-Cog is psychometrically reliable and valid and provides promising results for screening of dementia in Arabic speaking patients.

Psychological and Psychosocial Consequences of Zoonotic Cutaneous Leishmaniasis among Women in Tunisia: Preliminary Findings from an Exploratory Study.

BACKGROUND: The incidence of zoonotic cutaneous leishmaniasis (ZCL) makes it the most widespread parasitic disease in Tunisia and the Arab world. Yet, few studies have addressed its psychological and psychosocial effects. The purpose of this study was to examine the psychosocial impact of ZCL scars among Tunisian women. METHODS: We conducted an exploratory study, we administered Revised Illness Perception Questionnaire (IPQ-R), World Health Organization Quality Of Life-26 (WHOQOL-26) and Psoriasis Life Stress Inventory (PLSI) to a group of girls and women with ZCL scar in the region of Sidi Bouzid. This group was randomly selected from volunteers who came to primary health care facilities to seek for treatment for any pathology. RESULTS: Descriptive statistics showed that the collected scores from the three scales exhibit heterogeneous distributions: IPQ-R (M = 63.6, SD = 15.6), PSLI (M = 9.5, SD = 6.7), WHOQOL-Physical (M = 63, SD = 12.9), WHOQOL-Psychological (M = 52.6, SD = 11.1), WHOQOL-Social (M = 61.8, SD = 17.5), and WHOQOL-Environmental (M = 47.8, SD = 13.3). The correlation analyses performed on Inter and intra-subscales showed that the emotional representations associated with ZCL were correlated with the loss of self-esteem and feelings of inferiority (r = 0.77, p<0.05). In addition, high education level and the knowledge about ZCL are positively correlated with cognitive and emotional representation in the IPQ-R (r = 0.33, p<0.05). "Rejection experiences" and the "anticipation and avoidance of stress" were respectively negatively correlated with age (r = -0.33, p<0.05 and r = -0.31, p<0.05). Correlations between the scores on IPQ-R domains and PLSI factors were significant. The results showed that anticipation of rejection and avoidance of stress are strongly correlated with a negative perception of ZCL. Quality of life scores were not correlated with either age, education level, time of illness, or the number of facial or body scars. However, the correlations between quality of life scores and the multiple IPQ-R domains were all insignificant. Finally, there was a negative correlation between the scores on the perceived quality of social life and the knowledge about ZCL (r = -0.34, p<0.05). CONCLUSIONS: This makes it vital to strengthen preventive health education. Conducting studies on ways to establish a holistic support system for managing ZCL, a system that covers the psychological challenges and the barriers it causes to women's social and professional integration, is a vital first step.

Development of executive functioning in school-age Tunisian children.

Research regarding executive functioning (EF) in children rarely focuses on populations in African or Middle-Eastern Arabic-speaking countries. The current study used a cross-sectional design to examine the developmental trajectories of school-age Tunisian children in three domains of executive control (inhibition of prepotent responses, cognitive flexibility, and working memory) as well as their mutual interactions and the effects of gender and parents' education level. Inhibitory processes, cognitive flexibility, and working memory were assessed using the Stroop test, a version of the Hayling test adapted for children, simple and alternating tasks of verbal fluency, and verbal and visuospatial span tasks (forward and backward spans). The study population included 120 7- to 12-year-old Tunisian children (60 girls, 60 boys) who were grouped and matched for age, gender, and parents' education level. The results revealed an overall effect of age on executive performance, whereas gender and parents' education level showed non-significant effects. In addition, executive indices were significantly associated with fluid intelligence level. Partial correlation analyses (controlled for age) found significant links between indices that assessed the same executive process, except for inhibitory processes; the temporal indices for inhibitory processes showed relative independence. The correlations between indices that assessed distinct executive processes were weaker (but significant). Overall, the results suggest that executive components in school-age Tunisian children operate according to relatively homogeneous developmental trajectories, marked by peaks of maturity that differ according to the assessed index. A transcultural approach to EF is discussed in terms of the unity and diversity of its components.

The contribution of Facebook to the 2011 Tunisian revolution: a cyberpsychological insight.

The influence of Facebook in social life keeps constantly growing. Recently, the communication of information has been vital to the success of the Tunisian revolution, and Facebook was its main "catalyst." This study examines the key reasons that explain Facebook's contribution to this historical event, as perceived by Tunisian Internet users. To do so, we launched this study 5 days after the fall of the regime using an online questionnaire in which participants (N=333) first rated the importance of Facebook in the Tunisian revolution and then explained the reasons for their ratings. A cluster analysis based on the Euclidean distance between the most frequent words in the participants' text corpus (6,640 words), revealed three main clusters that we interpret as follows: 1: Facebook political function, 2: Facebook informational function, and 3: Facebook media platform function. It is likely that these factors reflect the dynamic of Tunisian cyberspace and the Tunisian Internet users' collective consciousness during the revolution.