review · Social Psychiatry and Psychiatric Epidemiology
Cognitive difficulties frequently affect people living with severe mental disorders, yet systematic evidence about the psychometric validity of cognitive assessment tools in low- and middle-income countries remains sparse. A systematic review examined twenty-three distinct measures evaluated across twenty-eight studies, finding that none originated from low-income countries. Most identified tools were performance-based, and the majority were validated specifically for individuals with schizophrenia. While known group, convergent, and divergent validity were the most frequently reported properties, the methodological quality across most studies was assessed as doubtful. Among the instruments evaluated for schizophrenia, four measures achieved the highest ratings for research and clinical recommendation: the Brief Assessment of Cognition in Schizophrenia, the Cognitive Assessment Interview, the MATRICS Consensus Cognitive Battery, and the CogState Schizophrenia Battery. Overall, existing evidence is of limited quality, highlighting the need for more robust validation methodologies.
Accurate cognitive assessments are critical for properly treating and supporting people with severe mental disorders. Because existing evaluation tools are rarely validated in low- and middle-income countries, healthcare providers may lack dependable instruments to guide care. Establishing robust, context-appropriate cognitive tests ensures clinical decisions and therapy allocations rely on sound evidence.
This work identifies four top-performing cognitive assessment batteries suitable for clinical and research use in schizophrenia within middle-income settings. Potential users include healthcare providers and clinical trial organisers needing reliable diagnostic or monitoring tools to allocate therapies. However, because methodological evidence remains limited and entirely absent for low-income countries, the commercial deployment and clinical adoption of these tools require further adaptation and rigorous validation.
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BACKGROUND: Cognitive difficulties are common in people with severe mental disorders (SMDs) and various measures of cognition are of proven validity. However, there is a lack of systematic evidence regarding the psychometric properties of these measures in low- and middle-income countries (LMICs). OBJECTIVE: To systematically review the psychometric properties of cognitive measures validated in people with SMDs in LMICs. METHODS: We conducted a systematic review of the literature by searching from four electronic databases. Two authors independently screened studies for their eligibility. Measurement properties of measures in all included studies were extracted. All eligible measures were assessed against criteria set for clinical and research recommendations. Results are summarized narratively and measures were grouped by measurement type and population. RESULTS: We identified 23 unique measures from 28 studies. None of these was from low-income settings. Seventeen of the measures were performance-based. The majority (n = 16/23) of the measures were validated in people with schizophrenia. The most commonly reported measurement properties were: known group, convergent, and divergent validity (n = 25/28). For most psychometric property, studies of methodological qualities were found to be doubtful. Among measures evaluated in people with schizophrenia, Brief Assessment of Cognition in Schizophrenia, Cognitive Assessment Interview, MATRICS Consensus Cognitive Battery, and CogState Schizophrenia Battery were with the highest scores for clinical and research recommendation. CONCLUSIONS: Studies included in our review provide only limited quality evidence and future studies should consider adapting and validating measures using stronger designs and methods. Nonetheless, validated assessments of cognition could help in the management and allocating therapy in people with SMDs in LMICs.
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DOI: 10.1007/s00127-021-02120-x
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