Translation and validation of cognitive failure questionnaire in Urdu among elderly

Background: The Cognitive Failure Questionnaire (CFQ) is widely used self-reported instrument for assessing everyday cognitive lapses but no validated Urdu version is available. Objective: to translate, culturally adapt the CFQ into Urdu (CFQ-U), and to evaluate the psychometric properties in the Urdu- speaking elderly population. Methodology: The CFQ was translated and cross culturally modified into Urdu following the Consensus based standards for the selection of health measurement instruments using COSMIN criteria this included forward and backward translation, expert review, content validity assessment (CVI), and pilot testing to ensure semantic, conceptual, and cultural equivalence before finalizing the Urdu version (CFQ-Urdu). Total n=250 community dwelling participants with age ≥60 years completed the questionnaire. Test-retest reliability was assessed in n=70 participants, and they completed questionnaire twice after a week interval. In subsample of n=35 participants, construct validity was assessed. The Urdu CFQ measures subjective cognitive failures in daily life, not objective cognitive impairment. Therefore, in subsample of n=35 participants for construct validity, we used the Urdu versions of Beck Depression Inventory, Beck Anxiety Inventory, and Patient Health Questionnaire-9, as subjective cognitive complaints are theoretically and empirically associated with depression and anxiety. In contrast, Montreal Cognitive Assessment is a performance-based screening tool for objective cognitive impairment, which assesses a different construct than the CFQ. Internal consistency, content validity, construct validity, and exploratory factor analysis were evaluated by using the method of KMO, Barlett's test. Results: The CFQ-U showed good internal consistency (Cronbach's α=0.74) and test-retest reliability (intra-class correlation coefficient=0.996). Three factor structure supported by exploratory factor analysis explained 48.6% of total variance. Non-significant and weak correlation was observed in between CFQ-U scores and anxiety, depression and general health measurement supporting discriminant validity. Small floor effect was identified with no ceiling effect. Conclusions: The CFQ-U is a reliable and psychometrically valid instrument for assessing cognitive failures among elderly Urdu-speaking individuals. It can be useful for research applications and clinical screening in geriatric population.