Validity and reliability of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for dementia assessment in rural South Africa.

Introduction: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is suitable for screening dementia, particularly in populations with limited education. However, its feasibility and psychometrics in South Africa remain unassessed.

Methods: We analyzed 1309 index participant-informant dyads from the Health and Aging in Africa: Longitudinal Study of an International Network for the Demographic Evaluation of Populations and Their Health Community in South Africa study in rural South Africa, assessing IQCODE completeness, associations with index participant/informant characteristics, single-factor structure and reliability via factor analysis, and validity through correlations with neuropsychological tests.

Results: Index participants averaged 71.9 years, with > 50% lacking formal education. IQCODE missingness declined across waves and was associated with index participant characteristics. IQCODE scores were correlated with both index participant and informant characteristics. The 16-item IQCODE demonstrated a single-factor structure explaining up to 66% of variance, strong internal consistency, and correlations with word and story recall, indicating high convergent validity.

Discussion: IQCODE is a reliable, valid dementia assessment tool in rural South Africa, supporting broader African applications and cross-national comparisons.

Highlights: Sixteen-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) responses in rural South Africa support a single-factor construct, explaining up to 66% of total observed variance. The single-factor structure is reliable, as the IQCODE items data show high internal consistency (omega hierarchical = 0.90). The IQCODE score shows strong convergent validity with significant correlation with word and story recall memory measures. Index participants' characteristics are mainly associated with IQCODE completion. IQCODE contributes to dementia assessment in rural South Africa and other settings with low education populations.