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. 2023 Nov 7;9(4):e12432. doi: 10.1002/trc2.12432

TABLE 3.

A detailed description of the 45 selected articles about cognitive abilities assessment in the MENA region.

Tests used / battery Country Cognitive domain Age and number Language/dialect Translation/adaptation Norm data/cutoff Limitations Question of interest*
Fakhry (2013) 100 MMSE, MTS, CDT UAE Not mentioned by authors Age = 20–40, N = 60 bipolar patients, 30 controls Not mentioned NA

Cognitive impairment:

MMSE < 25

MTS < 27

Psychotropic drugs’ effects on cognition could not be eliminated. Q1
Khedr (2015) 54 MES, MMSE Egypt Memory, executive function, orientation, recall, attention, calculation, language processing, and constructional praxis Age = 30–60, ≥ 60, n = 691 Not mentioned Not mentioned

Normal: MES >75,

MCI: MES= 62‐75,

Dementia: MES<62

MMSE = 23/30 (Educated)

MMSE =21/28 (illiterate)

No limitations reported by authors. Q1
Darwish (2015) 46 MoCA‐Arabic, RCFT, SDMT Lebanon Visual spatial memory, speed of processing Age ≥30, n = 254

Arabic for instructions (unspecified dialect)

Lebanese dialect for verbal fluency.

MoCA‐Arabic: previously translated

RCFT: translation of instructions, revision, pilot testing on 10 subjects

SDMT: translation of instructions, revision.

Cognitive impairment:

MoCA ≤26

RCFT ≤5th percentile

SDMT: not mentioned

‐MoCA cutoff values and items were not appropriate for the tested population.

‐MoCA scores do not consider years of education.

Q2
Chaaya (2016) 74 A‐RUDAS Lebanon Memory (registration and recall), body orientation, praxis, drawing, judgment, and language Age ≥65, n = 232 elderly Classical Arabic Translation by native speakers, pilot testing on 10 individuals Dementia: A‐RUDAS ≤22 GMS (used for depression diagnosis) has not been separately validated in Arabic Q4
Nielsen (2016) 105 RUDAS, IQCODE Lebanon Body orientation, praxis, drawing, judgment, memory, language. Age ≥65, n = 225 elderly RUDAS: classical Arabic, IQCODE: Arabic (unspecified dialect) Previously translated and validated Dementia: RUDAS <23/30, IQCODE >3.34/5

‐Diagnosis was not supported by in‐depth neuropsychological testing or ancillary investigations.

‐Inclusion of participants from long‐term care settings.

‐RUDAS might need clinical expertise to perform the task.

Q4
Ibrahim (2016) 101 Arabic version of the Penn Computerized Neurocognitive Battery Egypt Sensorimotor integration speed, attention, face memory, abstraction, mental flexibility, manual dexterity, visual object learning and memory, nonverbal reasoning, spatial orientation, social cognition, emotion recognition, working memory. Age = 21–62, n = 258 Arabic (unspecified dialect) Previously translated NA, correlations between cognitive functions and antibody titers

‐Hepatic functions were not estimated

‐Urine analysis for illicit drugs was not performed

‐HIV infection was not screened

Q2
Al‐Momani (2016) 56 MMSE‐Arabic Jordan Not mentioned by authors Age = 18–100, n = 221 nursing home residents Arabic (unspecified dialect) NA

Impaired cognitive function:

MMSE‐Arabic<25

‐Including a wide range of participants’ age.

‐Not all factors affecting gait and balance were considered

‐Cutoff scores of the tests were based on previous studies

Q3
Abou‐Mrad (2017) 45 AD8, MoCA, MMSE, 3MS, BVMT‐R, LDS, CLNT, phonemic fluency, semantic fluency. Lebanon Memory, attention, language, construction, executive functioning, orientation, and visuospatial function, phonemic paraphasias, semantic paraphasias, circumlocutions, phonemic fluency, semantic fluency. Age ≥60, n = 164 community dwelling older Lebanese adults without cognitive complaints. Literary Arabic Translation by linguistic experts, back‐translation. Regression based norms.

‐There was no comparison to a gold standard screening.

‐Medical imaging was not used to exclude significant intracranial findings.

‐Most participants were tested only once.

Q4
Albanna (2017) 20 MMSE‐2:SV, Mini‐Cog Qatar Orientation, recall, attention, calculation, language processing and constructional praxis–cognitive function, memory, language comprehension, visual‐motor skills, and executive function Age >60, n = 134 Formal Arabic Translation by experts, pilot testing on 20 subjects, back translation.

Dementia:

Combined score of MMSE‐2:SV and Mini‐Cog: 20/21.

‐Some items of the batteries were not doable by the elderly.

‐The test sample was mostly from Qatar

‐Male subjects were more the females.

‐Arabic MMSE‐2 has low sensitivity to mild dementia.

Q4
Ben Jemaa (2017) 106 A‐ADAS‐Cog Tunisia Memory, language, praxis Age: 50–90, n = 124 NC, 33 N‐AD, 25 AD Arabic, meeting cultural and linguistic need of the Arab populations. Translation was based on equivalency

AD

ADAS‐Cog =10

No limitations reported by authors Q4
Bou‐Orm (2018) 102 A‐IQCODE Lebanon Not mentioned by authors Age ≥65, n = 502 Arabic (unspecified dialect) Previously translated and validated

Cognitive decline:

A‐IQCODE<3.34

No limitations reported by authors Q2
Alkhunizan (2018) 21 MoCA Saudi Arabia Not mentioned by authors Age ≥60, n = 171 patients (clinic) MSA Arabic Previously translated and validated

MCI: A‐MoCA<26

Dementia: A‐MoCA<17

No limitations reported by authors

Q1

Farghaly (2018) 107 Phonemic and Categorical verbal fluency (Using letter Haa only) Egypt Verbal fluency Age >40, n = 79 NC, 32 CD Arabic (dialect unspecified) NA

ROC analysis

Dementia: animal <11

vegetables <11

Names <18

‐MMSE was used to classify cognitive status of the participants (cut‐offs not validated to Arabic populations)

‐Verbal fluency was used solely as an indicator for cognitive impairments

Q4
Saleh (2019) 47 MoCA‐B‐Arabic Egypt Executive function, verbal fluency, calculation, abstraction, recall, naming, attention, orientation, visuospatial functions. Age ≥ 60, n = 39 mild NCD,54 major NCD, 112 NC MSA Translated without cultural or linguistic modifications

Mild NCD:

A‐MoCA‐B: 21/22

Major NCD: A‐MoCA‐B:16/17

‐Small sample size.

‐Inability to measure inter‐rater or test–retest reliability.

‐Limited generalizability

‐Patients recruited from medical centers not a primary care facility

Q4
Almubark (2019) 69 Arabic version of Cognistat Saudi Arabia Language construction, memory, calculations, reasoning, consciousness, orientation, attention. Age = 18–60, n = 30 stroke and 32 TBI patients, 107 healthy adults Standard Arabic Translation by Native Arabic speakers, cultural adaptation, backward translation, pretest on 22 subjects.

Percentile norms were reported.

‐Sampling was restricted to 2 age groups, limiting the generalizability of the normative Cognistat profile. Q4
Al‐Joudi (2019) 70 NTB used in the Division of Medical Psychology of the Johns Hopkins University School of Medicine Saudi Arabia Intelligence, confrontation naming ability, verbal comprehension and fluency, episodic memory, visuospatial learning and memory, frontal and executive functioning, psychomotor speed, fine motor control. Age = 15–67, n = 56 Formal Arabic language & common colloquial Arabic (not Saudi) Translation by native Arabic speakers, cultural adaptation, backward translation. NA, data analysis is done to investigate the battery test's ability in differentiating between controls and patients and between left and right temporal Epilepsy

‐Many disease factors were not investigated for their relation to test performance.

‐Limited number of participants in the mesial temporal sclerosis group.

‐Not all battery tests were investigated for reliability

‐Degree of mesial temporal sclerosis was not accounted for in this study

Q4
El‐Hayeck (2019) 55 A‐MMSE (GTD‐USJ) Lebanon Attention, registration, attention, calculation, language, visuospatial processing. Age ≥55, n = 1010 literate community‐dwelling Lebanese residents Arabic (unspecified dialect) Translation and adaptation of the French version by the Working Group on Dementia at Saint Joseph University

Cognitive impairment: A‐MMSE (GTD‐USJ) <23

‐Population may not be a random sample

‐Demographic information were not collected from subjects who declined participation

‐Insufficient number of subjects per categories

‐ Subjects with (A‐MMSE(GTD‐USJ) a score <16 was decided to need medical evaluation prior to validation of the tool

‐Including the data from participants who did not attend the medical consultation in the normative data

‐MMSE does not cover all cognitive domains

Q4
Ibrahim (2019) 57 The Arabic version of Penn computerized neuropsychological battery, TMT‐ A&B, MMSE Egypt Sensorimotor integration speed, abstraction, mental flexibility, manual dexterity, visual object learning, memory, nonverbal reasoning, spatial orientation, social cognition, emotion recognition, attention, visual motor speed. Age = 18–50, n = 94

Penn: Arabic (unspecified dialect)

TMT and MMSE: not mentioned

Previously translated NA, significant difference between two groups

‐Small sample size

‐All patients were stabilized on antipsychotic medications

Q5
Elsaid (2020) 111 SF‐12v2 questionnaire Egypt Physical and mental component, eight health‐related domain scores Age >56, n = 40 males, 20 females Arabic (unspecified dialect) Previously translated Scores from excellent to poor: 5.0, 4.4, 3.4, 2.0, and 1.0

‐Small sample size

‐Immunological changes induced by Biobran/MGN‐3 were not assessed due to cost limitations.

Q5
Salama (2020) 48 A‐MoCA, A‐BICAMS Egypt Associative learning, attention, executive function, inhibition, memory, processing speed Mean age = 34.4, n = 20 NMOSD patients, 18 NC Arabic (unspecified dialect) Previously translated significant difference between patients and controls Small number of patients included from a single center Q3
Shalash (2020) 104 NMSS, PDQ‐39‐Arabic Egypt NMSS measures 9 domains: (cardiovascular, sleep/fatigue, mood/cognition, perception/hallucinations, memory/attention, gastrointestinal, urinary, sexual, and miscellaneous symptoms) Age = 35–77, n = 40 PD male patients, 25 NC

NMSS: not mentioned.

PDQ‐39: Arabic (unspecified dialect)

Previously translated NA, correlation between IIEF and the PDQ‐39 and NMSS

‐Small sample size

‐Limited participants’ age range

‐Investigating the association of cognitive and autonomic factors with sexual dysfunction using more objective and specific tests is recommended.

Q3
Al‐Adawi (2020) 110 A‐IQCODE, The modified Wisconsin Card‐Sorting Test, the tower of London, TMT, backward DS, verbal fluency. Oman Set‐shifting, cognitive flexibility, planning, the temporal organization of behavior, processing speed, initiation, speed of verbal responses. Age = 18–35, n = 24 patients with executive dysfunction Arabic (unspecified dialect) Previously translated IQCODE: “major improvement” = 1, “minor improvement” = 2, “did not change much” = 3, “minor deterioration” = 4, “major deterioration” = 5

‐ Open‐label study, without controls and with a relatively small sample size

‐Was not validated by a another catecholaminergic agonist

‐Limited generalizability as motor and functional metrics were not included

‐Include another cohort of TBI rather than those with executive functioning

‐Improvements could be a result of other factors

Q5
Qassem (2020) 65 ACE‐III Egypt Attention and orientation, memory, verbal fluency, language, and visuospatial abilities Age ≥60 patients, n = 37 dementia patients, 43 controls Egyptian Arabic Previously translated Dementia: ACE‐III 72/100

Generalizability to rarer types of dementia was limited

Cut‐offs were not validated in a second independent sample

Specific cut‐offs could not be established for different age groups

Subjects were recruited from one city

Tested population did not include illiterates.

Q4
Zeinoun (2020) 60 VMAT Lebanon Verbal memory

Age ≥16, pilot study: 12 participants;

study2: 199 NC, 16 MS population

MSA and colloquial Arabic The task was developed in Arabic regression‐based norms

‐Sample was not representative of national age demographics

‐Participants were young and educated

‐MS group was assumed to have verbal learning and memory deficits without verification

‐VMAT scores were not correlated with other Arabic memory tests

Q4
Allataifeh (2020) 62 BICAMS, Stroop test Jordan Learning, memory and mental processing speed, selective attention Age >18, n = 110 individuals with MS Arabic (unspecified dialect) NA regression‐based norms

Participants were recruited from one geographical area

Most participants had relapsing‐remitting MS (RM MS)

Q3
Qassem (2020) 65 ACE‐III Egypt Attention, memory, fluency, language, visuospatial processing. Age >60, n = 24 MCI patients, 54 controls Egyptian Arabic Previously translated

Using ROC

MCI:

ACE‐III 81 /100

‐Lack of specific cut‐offs for different age groups

‐Cut‐offs were not validated in a second independent sample

Q4
Alshammari (2020) 58 MMSE Saudi Arabia Orientation, registration, attention, calculation, recall, language. Age = 60–93, n = 1299 Arabic (unspecified dialect) Previously translated

Intact: 24‐30

Mild: 18‐23

severe: 0‐17

‐The cross‐sectional design of this study prevented us from establishing causality

‐Limited generalizability

Q1
Muayqil (2021) 49 MoCA (A & B) Saudi Arabia Not mentioned by authors Age = 18–80, n = 311 MSA Modifications to suit the culture and dialect, validation by a pilot study on 15 participants.

Mean test value:

MoCA‐A: 21.47

MoCA‐B: 24.37

‐Most participants had pervious concerns about their cognition (risk of bias)

‐ There was no screening to exclude any occult cognitive problems

Q4
Qassem (2021) 66 m‐ACE‐III Egypt Attention, memory, fluency, language, visuospatial processing. Age ≥, n = 24 MCI, 52 NC Arabic (unspecified dialect) Previously translated

Using ROC

MCI: ACE‐III = 21/30

Lack of specific cut‐offs for different age groups

Cut‐offs were not validated in a second independent sample

Q4
Rababa (2021) 50 MoCA Jordan Visuospatial/executive, naming, memory, attention, abstraction, detailed recall, language Age = 55–103, n = 215 older adults MSA Previously translated MCI: MoCA<30.

PPI data was collected using medication cards which might have resulted in missing that could bias the output

Limited generalizability due to the small sample size and inclusion of subjects from one geographical area

Q3
Assaf (2021) 51 A‐MoCA, GDS, IADL Lebanon Not mentioned by authors Age ≥60, n = 337 Arabic (unspecified dialect) Previously translated

Objective cognitive impairment: MoCA≥26

MCI: MoCA <26, IADL (7/8).

Dementia: MoCA <26, IADL <7.

‐Limited generalizability as subjects had high socioeconomic and educational attainment

‐MoCA is subject to ceiling effects

‐Depression could be affecting MoCA results

‐Overlooking variables that could affect performance

Q2
Darwish (2022) 63 BICAMS, SDMT, BVMT‐R, VMAT Lebanon Verbal learning, short‐term memory, long‐term memory, and recognition. Age = 16–80, n = 180 healthy participants

Lebanese Arabic dialect for administration

MSA for tests

Previously translated Regression‐based norms

‐Most of the MS sample was RRMS.

‐Unbalanced sex distribution.

‐More evidence is needed to support the validity of the BICAMS

‐Age groups were not matched in years of education.

Q4
Farahat (2022) 103 WCST Egypt Executive function Age = 25–52, n = 81 HCW (50 physicians, 31 nurses) NA NA Compared cognitive performance in HCW before and after a 2‐week break.

‐Executive dysfunction does not reflect a general cognitive decline.

‐HCW executive functioning baseline before their hospital stay was not measured

‐WCST results are impacted by IQ scores

‐limited study sample

Q2
Souissi (2022) 64 T‐BICAM: SDMT, BVMT‐R, and TVLT Tunisia Processing speed, auditory/verbal learning, visuospatial memory Age = 18–65, n = 104 MS patients and 104 NC Tunisian Arabic Instructions and stimuli were translated and standardized for Tunisian culture.

MS: ROC analysis

SDMT:39−40, BVMT‐R:26−27, TVLT:43−44

Most participants were highly educated. Q4
Alkeridy (2022) 109 BADLS Saudi Arabia dependency in performing basic and instrumental activities of daily living. N = 69, median age = 77 Modern standard Arabic Forward‐backward translation followed by pilot testing. Non reported Confirmatory factor analysis was not performed. The psychometric properties of the scale could change according to the change in literacy level in Saudi Arabia. Q4
Saguem (2022) 73 BCIS Tunisia Self‐certainty and self‐reflectiveness Age = 42±12.52, n = 150 patients Literary Arabic Repeated forward‐backward translation. Non reported No limitations reported by authors Q4
Haddad (2022) 53 MoCA Lebanon Visuospatial abilities, short term memory, executive function, naming, attention, concentration, working memory, language, abstract reasoning, orientation Age = 18–60, n = 120 patients Arabic (unspecified dialect) Previously translated

MCI: A‐MoCA =21;

Moderate cognitive impairments: A‐MoCA = 20.5;

Severe cognitive impairments: A‐MoCA =19.5

‐Possibility of selection bias, participants cognitive function might be severely impaired

‐Limited sample size

‐Information bias might have occurred in the face‐face interview.

‐Some cognitive factors were not included

‐Missing some validity measures

‐MoCA is not compatible for illiterate participants.

Q4
El‐Hayeck (2022) 108 A‐TNI93 (GTD‐USJ) Lebanon Episodic memory Age ≥55, n = 332 Assessment language was not mentioned Pictures adapted to Lebanese culture

Dementia: Free recall (FR) ≤6

Or total recall ≤8

‐Sample selection was not randomized

‐FR score was used to determine the participants who needed consultation before validation.

‐Possible selection bias if participation decline was due to cognitive dysfunction.

−47% of individuals who needed a medical evaluation dropped out.

‐The CDR fails to detect frontotemporal dementia.

‐Target number of participants per group was not reached.

‐The low inter‐rater reproducibility suggests the need for more training before implementation.

‐Not all cognitive functions were evaluated by the tool

Q4
Kacem (2022) 71 ECAS‐AR Tunisia Language, verbal fluency, executive functions, visuospatial domain, memory. Age = 47–71, n = 85 ALS patients, 200 NC MSA Translated and double checked by an expert in Arabic language, back translated. 2 SD below the mean control group score

‐ECAS‐Ar efficiency might have been affected by the lack of a heterogeneous cohort from MENA.

‐Genetic mutations were not considered

‐Limited number of cases with a high level of education and with advanced ages.

Q4
Boujelbane (2022) 72 The Neurotrack digital cognitive battery. Tunisia Processing speed, visual associative learning, attention, executive function, inhibition, associative and recognition memory. Age = 62.24±7.52 years, n = 155 Arabic (unspecified dialect) Back translation and piloting using 15 subjects Significant difference between groups

‐Additional research is needed to compare the digital battery with traditional paper‐and‐pen assessments

‐Cultural adaptation was not performed

‐Groups were not matched by age or education.

Q4
Khatib (2022) 52 MoCA 8.1 Morocco Visuospatial and executive functions, naming, memory, attention, language, abstraction, recall, orientation. Age >50, n = 106 Darija, Tamazight in its three variants (Tachelhit, Tarifit, Atlas Tamazight), and Arabic. Translation by native speakers, back translation, pretest on 20 subjects

Using ROC

Dementia: MoCA <24.5, MMS<27.5

No limitations reported by authors Q4
Fray (2022) 59 MMSE, ADAS‐Cog, FAB, GDS, IADLS, CDR Tunisia Attentional process, episodic memory, executive function, visuospatial function, praxis, gnosis, language.

AD patients: 70.14±10.44, n = 144

NC: 69.13±14.56, n= 90

Arabic (unspecified dialect) Previously translated Differences in performance between the two groups on the domains of interest.

‐Small sample size

‐The lack of correlation between APOE and other parameters involved in the pathophysiology of AD.

Q2
Alsebayel (2022) 22 AD8 Saudi Arabia Not mentioned Age > 60, n = 379 Arabic (unspecified dialect) Previously translated AD8≥3 or AD8 ≥4

Causality is not confirmed.

Probability of sampling bias

The effect of risk factors control was not assessed

Q1
Soliman (2023) 67 ECAS‐EG Egypt Executive function, verbal fluency, and language, memory, and visuospatial abilities Age = 28–68, n = patient: 62, healthy controls:60. Egyptian Arabic translation‐backtranslation, adaptation

ALS ≤104,

ALS‐specific ≤72.

Small sample size

Participants were recruited from one center only (limited variability in demographic data).

Q4
Hassan (2023) 68 FACT‐Cog version 3 Lebanon Not mentioned Age = 52.05 ± 9.95, n = 134 patients. Simple and acceptable language for the Lebanese population The standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology FACT‐Cog mean population score of 83

Test–retest reliability and the construct validity of the scale were not assessed.

The use of ‘QLQ‐30’ test for construct validity even though it is not the standard (it was the only available validated questionnaire for cognitive domains assessment in cancer patients)

Difficulty in assessing reverse causality given that the study is cross‐sectional.

The test has been used among female breast cancer patients only.

Q3

Abbreviations: 25(OH)D, serum 25‐hydroxyvitamin D; 3MS, Modified Mini‐State test; A‐ADAS‐Cog, Arabic version Alzheimer's Disease Assessment Scale Cognitive subscale; ACE‐III, Addenbrooke's Cognitive Examination III; ADAS‐Cog, Alzheimer's Disease Assessment Scale Cognitive subscale; AD, Alzheimer's disease patients; AD8, Eight‐item Informant Interview to Differentiate Aging and Dementia; A‐IQCODE, Arabic version of Informant Questionnaire on Cognitive Decline in the Elderly; ALS, amyotrophic lateral sclerosis; A‐MMSE (GTD‐USJ), Arabic version of Mini‐Mental State Examination developed by the “Groupe de Travail sur les D ´emences de l'Université Saint Joseph”; APOE, apolipoprotein E; A‐RUDAS, Arabic Rowland Universal Dementia Assessment Scale; A‐TNI93 (GTD‐USJ): the Test of Nine Images developed by the “Groupe de Travail sur lesD ´emences de l'Université Saint Joseph”; BADLS, basic activities of daily living; BCIS, Beck Cognitive Insight Scale; BICAMS, Brief International Cognitive Assessment for Multiple Sclerosis; BVMT‐R, Brief Visuospatial Memory Test‐Revised; CD, clinically demented; CDR, Clinical Dementia Rating; CDT, Clock Drawing Test; DS, Digit Span; CLNT, Cross‐Linguistic Naming Test; ECAS‐AR, Arabic Edinburgh cognitive and behavioral Amyotrophic lateral sclerosis screen; ECAS‐EG, Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen; FAB, Frontal Assessment Battery; FACT‐Cog, The Functional Assessment of Cancer Therapy‐Cognitive Function; GDS, Geriatric Depression Scale; GMS, Geriatric Mental State; HCW, health‐care workers; IADL, Instrumental Activities of Daily Living Scale; IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly; MCI, mild cognitive impairment; MES, Memory and Executive Screening test; MMSE, Mini‐Mental State Examination; MMSE‐2:SV, MMSE‐2 standard version; MoCA, Montreal Cognitive Assessment; MTS, Mental Test Score; NA, not applicable; N‐AD, non‐Alzheimer's disease dementia patients; NC, normal controls; NMOSD, Neuromyelitis optica spectrum disorder; NMSS, Non‐Motor Symptom Scale; NTB, Neuropsychological Test Battery; PDQ‐39, Parkinson's‐Disease Questionnaire; RCFT, Rey Complex Figure and Recognition Trial Test; ROC, receiver operating characteristic; RRMS, Relapsing remitting multiple sclerosis; SDMT, Symbol Digit Modalities; TMT, Trail Making Test; VMAT, Verbal Memory Arabic Test; WCST, Wisconsin Card Sorting Test.

(*) Questions of interest:

Q1: Assessing the cognitive status and screening for cognitive impairments in specific populations.

Q2: Risk factors for cognitive impairments.

Q3: Cognitive functions impact on other disorders.

Q4: Translation/adaptation/validation of classic tasks to be used in Arabic populations.

Q5: Therapy/intervention.