Validation of the Adapted Picture Version of the Pyramids and Palm Trees Test for Thais with Dementia

Objective: We aimed to validate Pyramids and Palm Trees test (PPT) in dementia cohort and explore reliability measurement of this test. Materials and Methods: The study was designed as a cross-sectional study. A total of 30 subjects were recruited from the Memory Clinic at Siriraj Hospital, Thailand: 15 non-dementia adults and 15 dementia patients (mild to moderate stage). In content validation, the picture version of the PPT was given to experts to evaluate the content of the test. According to consensus, some pictures with cultural issues were adapted to be more culturally appropriate. For concurrent validation, the PPT was compared against standard tests (Thai Mental Status Examination (TMSE), Boston Naming Test (BNT), Animal Fluency Test) using Spearman correlation and Receiver Operating Characteristic (ROC) analysis. The internal reliability of the PPT was assessed using Intraclass Correlation Coefficient (ICC) and Cronbach’s Alpha. Results: Among the 52 pictures in the PPT, 25 pictures were changed. The median score of the PPT was 49 for non-dementia group and 43 for dementia group. The PPT was significantly correlated with the Animal Fluency Test, the BNT, and the TMSE. ROC analysis revealed an Area Under the Curve (AUC) of 0.8. ICC was 0.86 (95% CI, 0.78 to 0.92), and internal consistency was 0.87, indicating good to satisfactory reliability. Conclusions: The PPT demonstrated good concurrent validity compared to the TMSE, BNT, and Animal Fluency Test in dementia patients. Based on this study, it is recommended as a test for semantic memory in Thai individuals with dementia.