Addressing Alzheimer's Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project - The Addressing Alzheimer’s Disease and Related Dementias Disparities: The American Indigenous Cognitive
Assessment (AMICA) Project tackles the significant dementia disparity that exists for Indigenous populations by
determining the scalability of recently developed, culturally tailored, brief cognitive tests for dementia for use in
diverse American Indian (AI) populations. Compared to the majority population, Indigenous rates of Alzheimer’s
disease and related dementias (ADRD) are approximately 3 times higher. This research will adapt and validate
a battery of complementary Indigenous cognitive assessment tools developed in Canada and Australia for use
among AI populations in the United States. This battery expands and adapts the Canadian Indigenous Cognitive
Assessment (CICA), as well as the Australian Kimberley Indigenous assessments for depression (KICA
depression), Activities of Daily Living (KICA-ADL) and a caregiver report (KICA-Carer).
Culture and context are central to Indigenous peoples’ experience with dementia and dementia diagnosis. Due
to significant cultural differences between tribal populations in Australia, Canada, and the US, existing
Indigenous culturally valid clinical tools cannot be used in the US until they are first adapted and re-validated.
Until unbiased tools are developed, we run the risk of basing critical clinical and policy decisions on flawed
epidemiological estimates of ADRD which, in turn, further exacerbates dementia inequities. Using community-
based participatory research approaches blended with Indigenous methodologies, we will revise existing
Indigenous assessments to align with AI cultural context as well as the neuropsychiatric properties. We intend
to measure and assess the reliability, validity, and cultural acceptance of the adapted instruments with a total of
390 dyads of people with dementia and their caregivers (n=780) in in two culturally distinct tribal communities in
Minnesota, Wisconsin, and an urban AI population in New Mexico. Our central hypothesis is that developing a
culturally safe cognitive assessment approach that accounts for cultural context will provide accurate diagnoses,
which in turn will help us achieve our long-term goal of improving the diagnosis and care of Indigenous persons
with dementia across the ADRD continuum. Our specific aims are to: 1) create American Indian appropriate
versions of the CICA Cog, KICA Carer, KICA depression and KICA-ADL (the “AMICA battery”); 2) assess the
psychometric properties and cultural acceptability of the four tools in the AMICA battery. We hypothesize that
the AMICA battery will demonstrate strong reliability, validity, sensitivity, specificity, positive and negative
predictive value relative to the two-eyed seeing consensus diagnosis. Thus the AMICA battery will produce the
same diagnoses, while providing greater cultural safety, than the standard assessments. By achieving these
aims we can expect to deliver the first culturally adapted valid cognitive assessment battery for American Indian
older adults. In doing so, this research will help to reduce disparities, accelerate research, and enhance access
to high quality clinical practice.
