RESULTS:

This chapter presents the findings of the current study which aims to validate the “BIRT -
Memory and Information Processing Battery (BMIPB)” and the “Hotel test” in patients with
dementia and alcohol-related brain damage. The first phase & the primary objective of the
study is to translate the available tools in Tamil that is consistent with the language, culture,
and other related contexts. For analysing the obtained data, “Statistical Package for the Social
Sciences - 22.0 (SPSS - 22.0)” was used. Percentage, Frequency, Mean and Standard
Deviation were the various Descriptive Statistics used throughout the four phases of this
research.

During phase 2, “Cronbach’s alpha and Pearson’s Product moment correlation were used to
identify the internal consistency reliability of the tool. In phase 3 and 4, Cronbach’s alpha and
Pearson’s Product moment correlation were used to check the internal consistency of the
tools along with the establishment of factorial, and concurrent validity.

The results are presented in the following phases:

Phase 1: Translation & Adaptation of the BIRT - Memory and Information Processing
Battery (BMIPB)” and the “Hotel test” to Tamil

Phase 2: Pilot Testing

Phase 3: Normative data collection

Phase 4: Validity & Reliability of the Tool in patients with dementia and alcohol-related
brain damage.

Phase 5: Norms Development

Phase 1:

The translation and adaptation were made according to the critical evaluation of the existing
literature of tools and subject matter experts’ opinions.

Tamil Version of the Tools to be attached

Phase 2:
The second phases include Pilot Testing of the translated instruments and for this purpose, 15
individuals were selected. This preliminary administration of the translated tools were done
with a group consisting of three healthy controls, three patients with alcohol dependency, and
three patients with Alzheimer’s disease.

Table – 1.1: Frequency and percentage for Socio-Demographic variables (N = 15)

Demographic Category Frequency Percentage

Data
Age 16-25 2 13.3
26-40 3 20.0
41-55 8 53.3
56-70 2 13.3
70 < 0 0.0
Sex Male 14 93.3
Female 1 6.7
Education Illiterate 2 13.3
School 5 33.3
Collage (UG-PG) 7 36.7
Others (MPhil – Ph.D.) 1 6.7

From table 1.1, it is found that the majority of the sample was 41-55 years old (53.3%), are
male (93.3%), and have either an Undergraduate or Post Graduate Degree (36.7%).
Table – 1.2: Descriptive statistics for the variables (N=15)

Variable Mean Standard Variance

Deviation
MINI 1.26 2.08 4.35
ACE 90.33 10.97 120.38
Story Recall 85.20 13.50 182.45
Figure
242.20 26.93 725.74
Recall
List
77.73 22.22 494.06
Learning
Word
Memory 64.86 29.01 841.83
Recognition
BMIPB
Design
37.40 15.95 255.54
Learning
Design
37.66 7.76 60.23
Recognition
Information Processing 188.46 11.02 121.55
Speed
Hotel TMOS 3.80 1.42 2.02
TMES 1.86 2.26 5.12

Table 1.2 shows the descriptive statistics of the variables under study. Mean, Standard
Deviation and Variance are analysed for each of the subtests under the BIRT - Memory and
Information Processing Battery (BMIPB) and Hotel Tests.

Table 1.3: Internal Consistency of The Subtests of BMIPB (N=15)

Dimension Sub-Dimensions Cronbach Alpha

Memory Story Recall .781
Figure Recall .980
List Learning .571
 Word Recognition .877
Design Learning .683
Design Recognition .470
Total .918

Information Processing Speed .405

Table 1.3 show the internal consistency of BIRT - Memory and Information Processing
Battery (BMIPB). Cronbach’s Alpha was used in order to establish the internal consistency of
the tool. On analysis, it was found that Cronbach’s Alpha of the different subtests under the
Memory dimensions of BMIPB ranges from .470 to .980, and Cronbach’s Alpha of the total
Memory Test is .918 whereas the Cronbach’s Alpha of Information Processing Speed of
BMIPB has an internal consistency of .405.

Table 1.4: Correlation of TMOS & TMES subtests of the Hotel Test

TMES

TMOS .984**

** Correlation is Significant at the 0.01 level.

The above table shows the relationship between the two subtests of the Hotel Test. On
Statistical Analysis, it was found that there exists a significant and strong positive correlation
between the two subtests of the Hotel Test.

Phase 3:

Having found that the translated tests have adequate reliability (from the pilot study), the next

phase involves data collection from the normative population. For this purpose, 750

participants are recruited and administered the Tamil-translated “BIRT - Memory and

Information Processing Battery (BMIPB)” and the “Hotel test”. Internal Consistency,

Concurrent Validity, Factor Analysis and Test-Retest Reliability are all analysed for the

above-said tools. To check the reliability of the Tamil ACE III and M.I.N.I Test-retest

method is employed.
Table – 2.1: Frequency and percentage for Socio-Demographic variables (N = 750)

Demographic Category Frequency Percentage

Data
Age 16-25 170 22.7
26-40 150 20.0
41-55 180 24.0
56-70 170 22.7
70 < 80 10.7
Sex Male 608 81.1
Female 142 18.9
Education Illiterate 6 0.80
School 66 8.88
Collage (UG-PG) 653 87.1
Others (MPhil – Ph.D.) 25 3.30

From table 2.1, it is found that the majority of the sample was 41-55 years old (24%), are
male (81.1%), and are either Undergraduates or Post Graduates (87.1%).

Table – 2.2: Descriptive statistics for the variables (N=750)

Variable Mean Standard Variance

Deviation
MINI 00.36 00.29 .086
ACE 93.25 5.13 26.36
Story Recall 45.810 6.76 182.45
Figure 377.194 19.42 725.74
Recall
List 65.670 8.10 494.06
Learning
 Word 85.295 9.23 841.83
Memory Recognition
BMIPB Design 36.340 6.02 255.54
Learning
Design 26.749 5.17 60.2
Recognition
Information Processing 357.94 128120.837 357.94
Speed
Hotel TMOS .230 .053 .23
TMES .05 .048 5.12

Table 2.2 shows the Mean, Standard Deviation and Variance of the data collected from the
normative population.

Table 2.3: Internal Consistency of The Subtests of BMIPB (N=750)

Dimension Sub-Dimensions Cronbach Alpha

Memory Story Recall .781
Figure Recall .773
List Learning .515
Word Recognition .656
Design Learning .683
Design Recognition .789
Total .597

Information Processing Speed .565

The above table 2.3 shows the internal consistency of the subtests of BMIPB that were
administered with the normative sample. Cronbach’s Alpha was used to analyse the internal
consistency of the tests and it was found that the Memory Dimension had an alpha value of
0.597 and the Information Processing Speed had a value of 0.565.

Table 2.4: Correlation of TMOS & TMES subtests of the Hotel Test (N=750)
 TMES

TMOS .949**

** Correlation is Significant at the 0.01 level.

Pearson’s Product Moment Correlation is used to explore the relationship between TIME and
TNA subtests of the Hotel Tests and on Analysis both variables had a correlation coefficient
of .949 between them. This indicates that the two subtests have a significant, strong and
positive association between them.

Table 2.5: Test-Retest Reliability for the BMIPB Tool (using Form B) (N=250):

Dimensions Subtests Correlation

Coefficients
Memory Serial IR .83**
Recall DR .64*
Figure C% .60**
Recall IR-4% .825
DR% .453*
List LLT .427**
Learning LB .363*
AR .224*
Word AW .200*
Recognition BW .804*
TWR .542**
AL 0.70
LB 0.44*
TLR 0.74**
Design T 0.79*
Learning A 0.167**
B 0.377*
Design DRT 0.49
Recognition DIT 0.209**
Information Processing TMES .188*
Speed TMOS .204**
 ** Correlation is Significant at the 0.01 level.

* Correlation is Significant at the 0.05 level.

Table 2.5 shows the test-retest reliability of the various subtests of the BMIPB tool. A
parallel form – B was administered to 250 samples who reflected the general population's
age, education level, and gender distribution. The retest was conducted 4-8 weeks after the
initial administration of the BMIPB tool – Form 1. Pearson’s Product moment correlation
which analysed the relationship between scores of the initial BMIPB tool – Form 1 and the
retest Form B was employed here. Most of the subtests showed significant relationships
between the initial test and the retest and the results are tabulated.

Table 2.6: Test-Retest Reliability for the BMIPB Tool (using Form C):

Dimensions Subtests Correlation

Coefficients
Memory Serial IR .199**
Recall DR .164
Figure C% .790**
Recall IR-4% .421
DR% .350
List LLT .116
Learning LB .014*
AR .167*
Word AW .182
Recognition BW .308
TWR .042**
AL 0.14
LB 0.44*
TLR 0.167
Design T 0.149
Learning A 0.221*
B 0.301
 Design DRT 0.202*
Recognition DIT 0.209**
Information Processing TMES .217**
Speed TMOS .220**
** Correlation is Significant at the 0.01 level.

* Correlation is Significant at the 0.05 level.

The above table 2.6 shows the test-retest reliability of the initial form of BMIPB and a
parallel form C which was administered 4-8 weeks after the administration of Form B. For
the re-test purpose, 125 samples were recruited.

Table 2.7: Factor Analysis of BMIPB

KMO and Bartlett’s Test:

Kaiser-Meyer-Olkin Measure of .674

Sampling Adequacy
Bartlett's Test of Sphericity Approx. Chi-Square 8130.962
df 210
Sig. .000

The above table shows the result of the KMO and Bartlett’s Test which indicates that the
sampling is adequate.

Components
1 2 3 4 5 6 7
M-SR-IR .259 -.105 -.039 .100 .076 .506 -.255
M-SR-DR -.140 -.041 -.043 .078 -.194 -.274 .258
M-FR-C
-.066 .926 -.138 .017 .046 .047 .022
%-
M-FR-IR
-.066 .956 -.162 .017 .033 .029 .002
%-4
M-FR-DR -.062 .895 -.134 .031 .006 .043 .013
 %
M-LL-
.578 .092 .108 -.040 -.112 -.022 -.147
LLT
M-LL-LB .810 .094 .035 .057 -.027 -.388 -.061
M-LL-AR .796 .023 -.022 .021 -.351 .251 .188
M-WR-
.074 .051 .010 .095 -.678 .065 -.054
AW
M-WR-
.048 .092 .061 .137 -.743 -.129 -.078
BW
M-WR-
.468 .014 .106 -.058 .672 .216 .191
TWR
M-WR-AL .121 .043 -.051 -.011 .610 -.582 -.108
M-WR-LB . 454 -.015 -.025 -.001 -.608 .373 .285
M-WR-
.413 -.046 .139 .006 .707 .218 .169
TLR
M-DLT -.025 .177 .493 -.663 -.079 .004 -.058
M-DL-A -.047 .067 .351 .667 -.011 -.015 .043
M-DL-B -.074 .126 .483 .618 -.030 .030 .056
M-DR-
-.026 .159 .705 -.653 -.087 -.026 -.055
DRT
M-DR-
-.212 .092 .425 .342 -.047 -.161 -.043
DIT
IPS-TMES .009 .019 .033 .098 -.059 .183 .483
IPS-TMOS -.039 -.032 .047 -.051 -.047 .086 .453
Extraction Method: Principal Component Analysis.
a. 7 components extracted.

The above table 2.7 shows the factor loadings of each test item of the “BIRT - Memory and
Information Processing Battery (BMIPB)” test. 7 components were extracted using the
Principal Components Analysis method.

Table 2.8: Test-Retest Reliability for Tamil ACE III

 2ndAdministration of Tamil 3rd Administration of
ACE (4-8 weeks later) Tamil ACE (4-8 weeks
N=250 later) N=125
Initial Administration of .749* 583*
Tamil ACE (N=750)
* Correlation is Significant at the 0.05 level.

Table 2.9: Test-Retest Reliability for Tamil MINI

2ndAdministration of Tamil 3rd Administration of

MINI (4-8 weeks later) Tamil MINI (4-8 weeks
N=250 later) N=125
Initial Administration of .782* .426**
Tamil MINI (N=750)
** Correlation is Significant at the 0.01 level.

* Correlation is Significant at the 0.05 level.

Tables 2.8 and 2.9 show the Test-Retest Reliability of Tamil-translated ACE III and MINI
tools. For the analysis person, Pearson’s Product Moment Correlation is used. Both of the
instruments have been found to have adequate test-retest reliability.

Phase 4:

Ninety-Nine alcohol-dependent patients diagnosed by following criteria from DSM IV-TR or

ICD 10 was recruited from rehabilitation centres at Chennai/ SRM Medical College Hospital
& Research Centre. Another one hundred participants with Alzheimer’s disease were
recruited from patients treated in SRM Medical College Hospital & Research Centre. A final
set of one hundred and one participants with MCI were recruited by neurologists,
psychiatrists, or geriatricians following criteria from Peterson and colleagues or DSM V.

Table – 3.1: Frequency and percentage for Socio-Demographic variables of Patients

with Mild Cognitive Impairment (N = 101)

Demographic Category Frequency Percentage

Data
Age 16-25 - -
26-40 2 2.0
 41-55 41 40.6
56-70 43 42.6
70 < 15 14.9
Sex Male 55 54.5
Female 46 45.5
Education Illiterate 16 15.8
School 55 54.5
Collage (UG-PG) 30 29.7
Others (MPhil – Ph.D.) - -

From table 3.1, it is found that the majority of the sample was 56-70 years old (42.6%), are
male (54.4%), and are have completed their schooling (54.5%).

Table 3.2: Internal Consistency of The Subtests of BMIPB in Patients with Mild
Cognitive Impairment (N = 101)

Dimension Sub-Dimensions Cronbach Alpha

Memory Story Recall .504
Figure Recall .946
List Learning .613
Word Recognition .285
Design Learning .683
Design Recognition .744
Total .396

Information Processing Speed .378

The above table 3.2 shows the internal consistency of the subtests of BMIPB that were
administered in the Patients with Mild Cognitive Impairment. Cronbach’s Alpha was used to
analyse the internal consistency of the tests and it was found that the Memory Dimension had
an alpha value of 0.396 and the Information Processing Speed had a value of 0.378.
Table 3.3: Correlation of TMOS & TMES subtests of the Hotel Test (N=101)

TMES

TMOS .910**

** Correlation is Significant at the 0.01 level.

Pearson’s Product Moment Correlation is used to explore the relationship between TMES and
TMOS subtests of the Hotel Tests and on Analysis both variables had a correlation
coefficient of .910 between them. This indicates that the two subtests have a significant,
strong and positive association between them.

Table – 3.4: Frequency and percentage for Socio-Demographic variables of Alcohol

dependent Patients (N = 99)

Demographic Category Frequency Percentage

Data
Age 16-25 18 18.2
26-40 41 41.4
41-55 32 32.2
56-70 7 7.1
70 < 1 1.1
Sex Male 99 100
Education Illiterate - 15.8
School 39 39.4
Collage (UG-PG) 58 58.6
Others (MPhil – Ph.D.) 2 2.0

From table 3.4, it is found that the majority of the sample was 26-40 years old (41.4%), are
all male , and are Undergraduates or Postgraduates (58.6%).

Table 3.5: Internal Consistency of The Subtests of BMIPB in Alcohol dependent

Patients (N = 99)

Test Dimension Sub-Dimensions Cronbach Alpha

Memory Story Recall .629
 Figure Recall .766
List Learning .592
BMIPB
Word Recognition .205
Design Learning .808
Design Recognition .183
Total .476

Information Processing Speed .464

Hotel .308

The above table 3.5 shows the internal consistency of the subtests of BMIPB and Hotel Test
were administered in the Alcohol dependent Patients. Cronbach’s Alpha was used to analyse
the internal consistency of the tests and it was found that the Memory Dimension had an
alpha value of 0.476and the Information Processing Speed had a value of 0.308.

Table – 3.6: Frequency and percentage for Socio-Demographic variables of Patients

with Dementia (N = 100)

Demographic Category Frequency Percentage

Data
Age 16-25 - -
26-40 - -
41-55 - -
56-70 48 48
70 < 52 52
Sex Male 55 55
Female 45 45
Education Illiterate 27 27
School 42 42
Collage (UG-PG) 31 31
Others (MPhil – Ph.D.) - -
From table 3.6, it is found that the majority of the sample was 70 years old and above (52%),
are male(55%) , and have completed their schooling (42%).

Table 3.7: Internal Consistency of The Subtests of BMIPB in Patients with Dementia (N
= 100)

Test Dimension Sub-Dimensions Cronbach Alpha

Memory Story Recall .570
Figure Recall .266
List Learning .203
Word Recognition .501
BMIPB
Design Learning .231
Design Recognition .257
Total .388

Information Processing Speed .502

Hotel .220

The above table 3.7 shows the internal consistency of the subtests of BMIPB and Hotel Test
were administered Patients with Dementia. Cronbach’s Alpha was used to analyse the
internal consistency of the tests and it was found that the Memory Dimension had an alpha
value of 0.388 and the Information Processing Speed had a value of 0.502 and that of the
Hotel Test is .220.

Phase 5:

Norms Development

Based on the analysis, the norms were developed for Tamil version of Hoteling test in the
Tamil Nadu population.