Abstract / Summary
Introduction: Early detection of neurocognitive disorders is crucial for timely intervention in older adults. The Six-Item Cognitive Impairment Test (6-CIT) is a brief screening tool designed for rapid cognitive assessment, but a validated Persian version has not been available to date. This study aimed to translate, culturally adapt, and psychometrically evaluate the Persian version of the 6-CIT among Iranian older adults.
Methods: In this prospective cross-sectional psychometric validation and diagnostic accuracy study, 180 participants aged ≥ 60 years were recruited from outpatient geriatric clinics and categorized into three equal groups: normal cognition, Mild Cognitive Impairment (MCI), and dementia. Diagnoses were established by a geriatric psychiatrist using DSM-5 criteria, and severity was staged using the Clinical Dementia Rating (CDR) criteria. Reliability was assessed through internal consistency (Cronbach's α) and test-retest stability (intraclass correlation coefficient, ICC 3,1). Validity was examined via convergent validity with the Mini-Mental State Examination (MMSE) and exploratory principal component analysis (PCA). Diagnostic accuracy, sensitivity, and specificity were evaluated using receiver operating characteristic (ROC) analysis and Youden's J index.
Results: The Persian 6-CIT demonstrated good internal consistency (Cronbach's α = 0.836) and strong test-retest reliability (ICC = 0.849). A strong negative correlation with the MMSE supported convergent validity (ρ = -0.919, p < 0.001). PCA supported a unidimensional structure explaining 71.72% of the total variance. ROC analysis for dementia yielded an AUC of 0.984 (95% CI: 0.961-1.000); a cutoff score of ≥ 11 provided 96.7% sensitivity and 85.8% specificity, while a cutoff of ≥ 14 maximized overall mathematical accuracy (93.3% sensitivity, 94.2% specificity). Furthermore, diagnostic accuracy for MCI was also high (AUC = 0.976, 95% CI: 0.947-0.997), with an optimal cutoff of ≥ 2 yielding 96.7% sensitivity and 96.7% specificity.
Conclusions: The Persian 6-CIT is a brief, reliable, and valid instrument for screening both MCI and dementia among Iranian older adults in specialized outpatient settings.