6
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2002; 17: 134±139. DOI: 10.1002/gps.541 Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka H. A. de Silva 1 * and S. B. Gunatilake 2 1 Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Sri Lanka 2 Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka SUMMARY Background Although the Sri Lankan population is ageing rapidly, dementia has not been systematically investigated here. The Mini Mental State Examination MMSE) is a brief global instrument used to assess cognitive abilities in the elderly. Objective This study aimed to develop and validate a Sinhalese translation of the MMSE, which could be used as a screen- ing instrument to detect impaired cognition in an epidemiological investigation of dementia in Sri Lanka. Methods Due to the high literacy rate in the country, the MMSE was translated and modi®ed slightly without having to make major changes to the original version. 380 randomly selected subjects over 65 years in a semi-urban area were screened with the translated version of the MMSE. The cut-off score for cognitive impairment was taken as 17. Of the 380 subjects screened, 33 scored 17, and were thus considered cases of suspected dementia. All 33 who scored 17 and 24 randomly selected subjects who scored > 17 on the MMSE, thus considered cognitively normal, underwent a brief clinical examination and neuropsychological assessment with the more comprehensive neuropsychiatric test battery, Cam- bridge Cognitive Score CAMCOG), to determine the presence of dementia. Results Evaluated against the performance at the CAMCOG, the sensitivity and speci®city of the translated MMSE were 93.5% and 84.6% respectively. Conclusion Therefore, the Sinhalese translation of the MMSE described here is a sensitive instrument to screen for dementia in Sri Lanka. Copyright # 2002 John Wiley & Sons, Ltd. key words Ð MMSE; Sri Lanka; Sinhalese; dementia; epidemiology; ageing INTRODUCTION In most countries declining fertility rates and increas- ing life expectancy have led to an increase in the population share of the elderly. In Sri Lanka too, the average life expectancy from birth for males has increased from 62 years in 1963 to 70 years in 1991, and for females from 61 years to 74 years Annual Health Bulletin, 1998). Thus, the percentage of the population aged over 60 years in this country is expected to increase rapidly from 8% currently, to reach 13% in 2010, and 21% in 2025 Hsiao, 2000). Dementia is one of the most distressing and bur- densome health problems associated with an ageing population. The prevalence of dementia increases exponentially with age at least up to age 90 or 95. Studies in North America, the United Kingdom and Europe have reported that dementia affects 1±6% of the population over the age of 65 and 10±20% over the age of 80 Clark and Goate, 1993; Canadian Study of Health and Aging, 1994; Ott et al., 1995) with the annual incidence approximately doubling for every ®ve years of age between the ages of 75 and 89 years Paykel et al., 1994). Interestingly, evidence from a few studies done in India Chandra et al., 1998), China Li et al., 1989; Zang et al., 1990) and Nigeria Hendrie et al., 1995) suggests that dementia in gen- eral and Alzheimer's disease AD) in particular may be considerably rarer in developing than in developed Received 16 November 2000 Copyright # 2002 John Wiley & Sons, Ltd. Accepted 26 June 2001 *Correspondence to: Dr H. A. de Silva, Department of Pharma- cology, Faculty of Medicine, PO Box 6, Thalagolla Road, Ragama, Sri Lanka. Tel: 00 941 956188. Fax: 00 941 958251/958337. E-mail: [email protected]

Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

Embed Size (px)

Citation preview

Page 1: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

������������� ����� �� �������� ��� ������

��� � ������ �� ����� ����� ��� ��������

���� ������������ ��

!"#" !$#%&' �%&%$ �(&)"#&%"*# "# �"#+&'$�$� & �$#�"%",$ %$�%%* �-.$$# /*. 0$)$#%"& "# �." �&#1&

�� �� 0$ �"',&�2 &#0 �� 3� �4#&%"'&1$�

���������� �� ��� ������ � ���� �� ���� ���� ���������� �� ������� ��� �� ���������� �� ���� ���� � ���� �� ���� ���� ���������� �� ������� ��� ��

�!!���

����� �� �'%+*4�+ %+$ �." �&#1&# �*�4'&%"*# "� &�$"#� .&�"0'56 0$)$#%"& +&� #*% 7$$# �5�%$)&%"-&''5 "#,$�%"�&%$0+$.$� �+$ !"#" !$#%&' �%&%$ �(&)"#&%"*# 8!!��9 "� & 7."$/ �'*7&' "#�%.4)$#% 4�$0 %* &��$�� -*�#"%",$ &7"'"%"$� "# %+$$'0$.'5���������� �+"� �%405 &")$0 %* 0$,$'*� &#0 ,&'"0&%$ & �"#+&'$�$ %.&#�'&%"*# */ %+$ !!��6 :+"-+ -*4'0 7$ 4�$0 &� & �-.$$#;"#� "#�%.4)$#% %* 0$%$-% ")�&".$0 -*�#"%"*# "# &# $�"0$)"*'*�"-&' "#,$�%"�&%"*# */ 0$)$#%"& "# �." �&#1&�������� <4$ %* %+$ +"�+ '"%$.&-5 .&%$ "# %+$ -*4#%.56 %+$ !!�� :&� %.&#�'&%$0 &#0 )*0"=$0 �'"�+%'5 :"%+*4% +&,"#� %*)&1$ )&>*. -+&#�$� %* %+$ *."�"#&' ,$.�"*#� �?� .&#0*)'5 �$'$-%$0 �47>$-%� *,$. @ 5$&.� "# & �$)";4.7&# &.$& :$.$�-.$$#$0 :"%+ %+$ %.&#�'&%$0 ,$.�"*# */ %+$ !!��� �+$ -4%;*// �-*.$ /*. -*�#"%",$ ")�&".)$#% :&� %&1$# &� �A� �/ %+$�?� �47>$-%� �-.$$#$06 �� �-*.$0� �A6 &#0 :$.$ %+4� -*#�"0$.$0 -&�$� */ �4��$-%$0 0$)$#%"&� �'' �� :+* �-*.$0� �A&#0 �� .&#0*)'5 �$'$-%$0 �47>$-%� :+* �-*.$0� �A *# %+$ !!��6 %+4� -*#�"0$.$0 -*�#"%",$'5 #*.)&'6 4#0$.:$#% & 7."$/-'"#"-&' $(&)"#&%"*# &#0 #$4.*��5-+*'*�"-&' &��$��)$#% :"%+ %+$ )*.$ -*)�.$+$#�",$ #$4.*��5-+"&%."- %$�% 7&%%$.56 &);7."0�$ *�#"%",$ �-*.$ 8 �! ��96 %* 0$%$.)"#$ %+$ �.$�$#-$ */ 0$)$#%"&���� ��� �,&'4&%$0 &�&"#�% %+$ �$./*.)&#-$ &% %+$ �! ��6 %+$ �$#�"%","%5 &#0 ��$-"=-"%5 */ %+$ %.&#�'&%$0 !!�� :$.$��� B &#0 ?��@B .$��$-%",$'5������ ���� �+$.$/*.$6 %+$ �"#+&'$�$ %.&#�'&%"*# */ %+$ !!�� 0$�-."7$0 +$.$ "� & �$#�"%",$ "#�%.4)$#% %* �-.$$# /*.0$)$#%"& "# �." �&#1&� *�5."�+% � ���� *+# C"'$5 D �*#�6 �%0�

��� �����E!!��� �." �&#1&� �"#+&'$�$� 0$)$#%"&� $�"0$)"*'*�5� &�$"#�

�����< ����

�# )*�% -*4#%."$� 0$-'"#"#� /$.%"'"%5 .&%$� &#0 "#-.$&�;"#� '"/$ $(�$-%&#-5 +&,$ '$0 %* &# "#-.$&�$ "# %+$�*�4'&%"*# �+&.$ */ %+$ $'0$.'5� �# �." �&#1& %**6 %+$&,$.&�$ '"/$ $(�$-%&#-5 /.*) 7".%+ /*. )&'$� +&�"#-.$&�$0 /.*) @� 5$&.� "# ��@� %* A� 5$&.� "#����6 &#0 /*. /$)&'$� /.*) @� 5$&.� %* A� 5$&.�8�##4&' �$&'%+ 34''$%"#6 ���?9� �+4�6 %+$ �$.-$#%&�$*/ %+$ �*�4'&%"*# &�$0 *,$. @� 5$&.� "# %+"� -*4#%.5 "�$(�$-%$0 %* "#-.$&�$ .&�"0'5 /.*) ?B -4..$#%'56 %*.$&-+ ��B "# ����6 &#0 ��B "# ��� 8��"&*6 ����9�

<$)$#%"& "� *#$ */ %+$ )*�% 0"�%.$��"#� &#0 74.;0$#�*)$ +$&'%+ �.*7'$)� &��*-"&%$0 :"%+ &# &�$"#��*�4'&%"*#� �+$ �.$,&'$#-$ */ 0$)$#%"& "#-.$&�$�$(�*#$#%"&''5 :"%+ &�$ &% '$&�% 4� %* &�$ �� *. � ��%40"$� "# �*.%+ �)$."-&6 %+$ #"%$0 F"#�0*) &#0�4.*�$ +&,$ .$�*.%$0 %+&% 0$)$#%"& &//$-%� ��@B */%+$ �*�4'&%"*# *,$. %+$ &�$ */ @ &#0 �����B *,$.%+$ &�$ */ ?� 8 '&.1 &#0 �*&%$6 ����� &#&0"&# �%405*/ �$&'%+ &#0 ��"#�6 ����� �%% �� �!6 ��� 9 :"%+ %+$&##4&' "#-"0$#-$ &��.*(")&%$'5 0*47'"#� /*. $,$.5=,$ 5$&.� */ &�$ 7$%:$$# %+$ &�$� */ A &#0 ?� 5$&.�8�&51$' �� �!6 ����9� �#%$.$�%"#�'56 $,"0$#-$ /.*) &/$: �%40"$� 0*#$ "# �#0"& 8 +&#0.& �� �!6 ���?96 +"#& 8�" �� �!6 ��?�� G&#� �� �!6 ����9 &#0 �"�$."&8�$#0."$ �� �!6 ��� 9 �4��$�%� %+&% 0$)$#%"& "# �$#;$.&' &#0 �'H+$")$.I� 0"�$&�$ 8�<9 "# �&.%"-4'&. )&57$ -*#�"0$.&7'5 .&.$. "# 0$,$'*�"#� %+&# "# 0$,$'*�$0

"� ����� #$ %����&�� '((( *�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ) ����� '$ ���� '((#

2 *..$��*#0$#-$ %*� <. �� �� 0$ �"',&6 <$�&.%)$#% */ �+&.)&;-*'*�56 �&-4'%5 */ !$0"-"#$6 �� 3*( @6 �+&'&�*''& �*&06 �&�&)&6�." �&#1&� �$'� �� ��� � @�??� �&(� �� ��� � ?� ��� ?��A��;)&"'� &�"%&J)/&-�1'#�&-�'1

Page 2: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

-*4#%."$�� �+"� -*4'0 7$ 04$ %* 0"//$.$#-$� "# �&);�'"#� �.*-$04.$� &#0 %+$ 0"&�#*�%"- -."%$."& 4�$0 /*."0$#%"/5"#� �47>$-%� :"%+ 0$)$#%"&� �+4�6 -*#=.)&;%"*# &#0 $'&7*.&%"*# */ %+"� 0"�-.$�&#-5 .$K4".$ )*.$�.*��$-%",$ �%40"$� "# 0$,$'*�"#� -*4#%."$�6 4�"#�&��.*�."&%$'5 +&.)*#"H$0 0"&�#*�%"- �.*-$04.$���+$ 0"//$.$#-$ "# 0"�$&�$ /.$K4$#-56 "/ �$#4"#$6 )"�+%�4��$�% �$*�.&�+"-&' ,&."&%"*# "# %+$ 0"�%."74%"*# */-."%"-&' ."�1 &#0 �.*%$-%",$ /&-%*.� /*. &#0 &�&"#�%0$)$#%"&�

<$)$#%"& +&� #*% 7$$# �5�%$)&%"-&''5 "#,$�%"�&%$0"# �." �&#1&6 &#0 &� & .$�4'% %+$.$ &.$ #* $�"0$)"*'*;�"-&' $�%")&%$� */ %+$ 0"�$&�$ "# %+"� -*4#%.5� ��"0$;)"*'*�"-&' �%40"$� */ 0$)$#%"& .$K4".$ -*))4#"%5�-.$$#"#� */ �47>$-%� /*. -*�#"%",$ ")�&".)$#% :"%+#$4.*��5-+"&%."- %$�%� �4"%&7'$ /*. %+$ -4'%4.&' 7&-1;�.*4#0 */ %+$ �%405 �*�4'&%"*#� �+"� .$K4".$� %.&#�'&;%"*# &#0 -4'%4.&' &0&�%&%"*# */ �4-+ �-.$$#"#�"#�%.4)$#%�� �+$ '&-1 */ �4-+ -4'%4.&''5 &��.*�."&%$�-.$$#"#� "#�%.4)$#%� )&5 +&,$ �.$-'40$0 �%40"$�*# 0$)$#%"& "# %+"� -*4#%.5�

�+$ !"#" !$#%&' �%&%$ �(&)"#&%"*# 8!!����*'�%$"# �� �!6 ��A 9 "� 4�$0 :"0$'5 &� & �-.$$#"#�"#�%.4)$#% %* 0$%$-% 0$)$#%"& 7*%+ "# %+$ -'"#"-&' �$%;%"#� &#0 "# -*))4#"%5 7&�$0 $�"0$)"*'*�"-&' �%40"$�6&#0 &��$&.� %* 7$ %+$ 7$�% 7."$/ -*�#"%",$ %$�% -4.;.$#%'5 "# 4�$ 83.&5#$6 ���?9� �+$ !!�� �.*,"0$� &)$&�4.$ */ -*�#"%"*#6 :+"-+ "� 7&�$0 *# &# "#%$.;,"$:$. &�1"#� �A K4$�%"*#� $&-+ */ :+"-+ "� #*%$0&� -*..$-% *. "#-*..$-%� �+$�$ K4$�%"*#� -*,$. & 7.*&0�$% */ -*�#"%",$ 0*)&"#�� *."$#%&%"*#6 .$�"�%.&%"*#6�+*.%;%$.) )$)*.56 &%%$#%"*#6 -&'-4'&%"*#6 ,"�4*;��&%"&' �1"''� &#0 �.&("�� �+$ !!��6 ,&."*4�'5 )*0;"=$0 &#0 %.&#�'&%$0 "#%* �$,$.&' '&#�4&�$�6 +&� 7$$#4�$0 �4--$��/4''5 "# �$,$.&' "#0$�$#0$#% -.*��;#&%"*#&' �%40"$� */ 0$)$#%"& $�"0$)"*'*�5 83.&5#$6���?9� �+$ &") */ %+"� �%405 :&� %* 0$,$'*� &#0 ,&'";0&%$ & %.&#�'&%$0 8%* �"#+&'$�$6 %+$ '&#�4&�$ 4�$0 75)*.$ %+&# ?�B */ %+$ �*�4'&%"*#9 &#0 -4'%4.&''5&��.*�."&%$ !!�� %+&% -*4'0 7$ 4�$0 &� & �-.$$#"#�%$�% /*. -*�#"%",$ ")�&".)$#% "# �." �&#1&� �+$ .$�4'%;"#� "#�%.4)$#% :"'' 7$ 4�$0 "# &# $�"0$)"*'*�"-&'"#,$�%"�&%"*# */ 0$)$#%"& %* 0$%$.)"#$ %+$ �.$,&'$#-$*/6 &#0 ."�1 /&-%*.� /*.6 0$)$#%"& "# & �$)";4.7&#�*�4'&%"*# "# �." �&#1&�

!����<�

��&*� ��

�+$ �%405 :&� -*#04-%$0 "# �&�&)& 8& �$)";4.7&#%*:# � 1) �*.%+ */ *'*)7*6 %+$ &0)"#"�%.&%",$-&�"%&' */ �." �&#1&96 :+$.$ %+$ /&-4'%5 */ )$0"-"#$

&#0 %+$ 4#",$.�"%5 +*��"%&' &.$ �"%4&%$0� �&�&)& :&�-+*�$# &� %+$ �&)�'$ &.$& %* %&1$ &0,&#%&�$ */ "%�0$#�$ �$)";4.7&# �*�4'&%"*# &#0 "%� �*-"*;$-*#*)"-+$%$.*�$#$"%5� �+$ '&#�4&�$� ��*1$# &.$ )&"#'5�"#+&'$�$ &#0 �#�'"�+6 &#0 %+$ �.$&% )&>*."%5 */$'0$.'5 "#0","04&'� '","#� "# %+"� %*:# &.$ '"%$.&%$&#0 +&,$ +&0 &% '$&�% & /$: 5$&.� */ /*.)&' $04-&%"*#�

�&�&)& "� 0","0$0 "#%* $"�+% �.")&.5 +$&'%+-&.$0","�"*#� 8�47'"- +$&'%+ )"0:"/$ &.$&�9� �?� �47>$-%�*,$. @ 5$&.� */ &�$ 8)$&# &�$� @?�� 5$&.���<� A��A9 :$.$ �$'$-%$0 .&#0*)'5 /.*) %:* �47'"-+$&'%+ )"0:"/$ &.$&� 8�*�4'&%"*# */ ?�� 9 /*. %+$ �4.;,$5� �'' �?� �47>$-%� :$.$ "#%$.,"$:$0 %* *7%&"# 7&�"-0$)*�.&�+"- 0&%&6 &#0 �-*.$� *# %+$ !!�� 8)&(";)4) �-*.$� ��9� �+$ �47>$-%� :$.$ &'' '","#� "# %+$".*:# +*)$� *. "# %+&% */ & /&)"'5 )$)7$.� �� #* '*-&'*. #&%"*#&' &�$;�%.&%"=$0 +*4�$+*'0 '"�%� $("�%6 %+$"#"%"&' -*#%&-% :"%+ %+$ �47>$-%� :&� )&0$ %+.*4�+ &�47'"- �$&'%+ !"0:"/$ 8& -*))4#"%5 +$&'%+-&.$:*.1$.9� �+$ &��$��)$#% */ &'' �47>$-%� :&� 0*#$ 75%+$ &4%+*.� &% & -*))4#"%5 -$#%.$ "# %+$ #$"�+7*4.;+**0� �'' �47>$-%� +&0 %* 7$ L4$#% "# $"%+$. �#�'"�+*. �"#+&'$�$6 &#0 %+*�$ :"%+ )&>*. "''#$��$�6 0$&/#$��67'"#0#$��6 )$#%&' .$%&.0&%"*# &#0 )&>*. �+5�"-&' 0"�;&7"'"%5 :$.$ $(-'40$0 /.*) %+$ �%405�

�����������

�+$ *."�"#&' !!�� :&� %.&#�'&%$0 "#%* �"#+&'$�$ &#07&-1 %.&#�'&%$0 75 %+$ &4%+*.� 8:+* &.$ 7"'"#�4&'96&#0 %+$ &--4.&-5 &#0 -4'%4.&' &��.*�."&%$#$�� */ %+$%.&#�'&%"*# :$.$ &��$��$0 75 %+$ �"#�4"�%"-� #"%&#0 %+$ <$�&.%)$#% */ �"#+&'&6 #",$.�"%5 */F$'&#"5&6 �." �&#1&� �# *.0$. %* )&1$ %+$ �"#+&'$�$%.&#�'&%"*# */ %+$ !!�� &��'"-&7'$ %* �47>$-%� :+*&.$ "''"%$.&%$ *. :+* +&,$ +&0 '"%%'$�#* /*.)&' $04-&;%"*# &� :$''6 �*)$ )*0"=-&%"*#� )&0$ "# %+$ +"#$�$8F&%H)&# �� �!6 ��??9 &#0 �"#0" 8�&#�4'" �� �!6��� 9 ,$.�"*#� */ %+$ %$�% :$.$ "#-*.�*.&%$0 :+$.$.$'$,&#%� �&7'$ � �.*,"0$� & -*)�&.&%",$ 7."$/0$�-."�%"*# */ %+$ *."�"#&' &#0 %.&#�'&%$0 ,$.�"*#� */%+$ !!���

!*�% "%$)� *# %+$ !!�� -*4'0 7$ 0".$-%'5 %.&#�;'&%$0 %* �"#+&'$�$ &% %+$ %")$ */ &0)"#"�%$."#� %+$ %$�%6&#0 & /$: .$K4".$0 )"#*. )*0"=-&%"*#� �%%$#%"*# :&��",$# %* )&1$ $&-+ "%$) "# %+$ K4$�%"*##&".$ &��.*;�."&%$ /*. 4�$ "# %+$ �." �&#1&# -*#%$(% "# %$.)� *//&)"'"&."%5 &#0 -4'%4.&' .$'$,&#-$� �+$ "%$) %+&%.$K4".$0 )&>*. %.&#�'&%"*# :&� %+$ .$�$%"%"*# �+.&�$6M#* "/�6 &#0�6 *. 74%�I� �+$ )*0"=$0 "%$)� "# %+$ %.&#�;'&%$0 ,$.�"*# */ %+$ !!�� &.$ 7."$L5 0"�-4��$07$'*: "# .$'&%"*# %* "%$)� "# %+$ *."�"#&' �#�'"�+ ,$.;�"*# */ %+$ %$�%�

� ��� � �� �� �� � ��� � ��� ���� ��

*�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ��� � ������ �� ����� ����� ��� ��������

Page 3: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

�"#-$ %+$.$ &.$ #* )&>*. �$&�*#&' ,&."&%"*#� "# %+$-'")&%$ "# �." �&#1&6 %+$ K4$�%"*# *# M�$&�*#I :&�.$�'&-$0 :"%+ & K4$�%"*# */ M%")$ */ 0&5I� !*�%$'0$.'5 .$�"0$#%� "# �&�&)& 1#$: &#0 1$�% %.&-1 */5$&.� &--*.0"#� %* %+$ �*)&# -&'$#0&.� �+$.$/*.$6:$ 0"0 #*% +&,$ %* .$�'&-$ %+"� K4$�%"*# :"%+ &#*%+$.%* %$�% %$)�*.&' *."$#%&%"*# &� 0*#$ "# %+$ �"#0" ,$.;�"*# */ %+$ !!�� 8�&#�4'" �� �!6 ��� 9�

M���'$I6 M%&7'$I &#0 M�$##5I "# %+$ *."�"#&' !!��:$.$ �47�%"%4%$0 :"%+ M*.&#�$I6 M%&7'$I &#0 M.4�$$I6"%$)� )*.$ /&)"'"&. %* �$*�'$ "# �." �&#1&�

�+*�$ :+* +&0� =,$ 5$&.� /*.)&' $04-&%"*# :$.$&�1$0 %* �47%.&-% �$."&' %+.$$� 7&-1:&.0� /.*) ��6:+"'$ %+*�$ :+* +&0 )*.$ %+&# �"( 5$&.� $04-&%"*#:$.$ &�1$0 %* �47%.&-% �$."&' �$,$#� 7&-1:&.0� /.*)��� &� .$K4".$0 "# %+$ *."�"#&' ,$.�"*# */ %+$ !!���

�*. %+$ .$&0"#� &#0 :."%"#� %$�%�6 "''"%$.&%$ �47>$-%�:$.$ &�1$0 %* M-'*�$ 5*4. $5$�I "#�%$&0 */ .$&0 &#0/*''*: & :."%%$# "#�%.4-%"*#6 &#0 �&5 & �$#%$#-$"#�%$&0 */ :."%$� �+"� :&� 0*#$ %* �4&.0 &�&"#�% /&"';4.$ *# %+$�$ "%$)� 04$ %* "''"%$.&-5�

������ ��� �����

3&�$0 *# %+$ .$�4'%� */ %:* �.$,"*4� �%40"$� 0*#$ "# +"#&6 %+$ -4%;*// �-*.$ *# %+$ !!�� �4��$�%",$ */-*�#"%",$ ")�&".)$#% :&� %&1$# &� �A *4% */ & )&(";)4) �� 8�" �� �!6 ��?�� G+&#� �� �!6 ����9� �+$'*:$. -4%;*//6 "#�%$&0 */ %+$ )*.$ �%&#0&.0 -4%;*//�*"#% */ ��6 +&� 7$$# /*4#0 %* 7$ &# &��.*�."&%$ �-*.$%* 0$%$-% -&�$� */ -*�#"%",$ ")�&".)$#% "# -*))4#"%5�4.,$5� 83.&5#$ &#0 &''*:&56 ����9� �*#;.$��*#�$*. .$/4�&'� *# &#5 ��$-"=- "%$) :&� �-*.$0 &� H$.* "#

&--*.0&#-$ :"%+ *%+$. �%40"$� 8�"''$#7&4) �� �!6��?�9�

�+*�$ �-.$$#"#� �*�"%",$ /*. -*�#"%",$ ")�&".)$#%8!!��� �A9 &#0 & .&#0*)'5 �$'$-%$0 �&)�'$ */%+*�$ �-.$$#"#� #$�&%",$ 8!!��� �A9 :$.$ &�1$0%* 4#0$.�* & -'"#"-&' $(&)"#&%"*# &#0 & -*�#"%",$&��$��)$#% :"%+ %+$ )*.$ -*)�.$+$#�",$ #$4.*��5;-+"&%."- %$�% 7&%%$.56 &)7."0�$ *�#"%",$ �-*.$8 �! ��96 %* 0$%$.)"#$ %+$ �.$�$#-$ */ 0$)$#%"&��+$ �! �� "� %+$ -*�#"%",$ &��$��)$#% �$-%"*# */%+$ &)7."0�$ !$#%&' <"�*.0$.� */ %+$ �'0$.'5�(&)"#&%"*# 8 �!<�N9 8�*%+ �� �!6 ��?@9� �+$/&)"'5 &#0 -*�#"%",$ +"�%*.5 */ %+$ �&%"$#% :&�*7%&"#$0 /.*) %+$ ��*4�$ *. & /&)"'5 )$)7$. 4�"#��$-%"*# � */ %+$ �!<�N� �+$ -'"#"-&' $(&)"#&%"*#&#0 %+$ -*�#"%",$ &��$��)$#% :"%+ %+$ �! ��:$.$ 0*#$ "# +*��"%&'� �+$ �! �� :&� &'�*%.&#�'&%$0 %* �"#+&'$�$ &% %+$ %")$ */ &0)"#"�%.&%"*#6&#0 & /$: "%$)� "# %+$ %$�% 7&%%$.5 :$.$ )*0"=$0 %*)&1$ %+$ %$�% )*.$ &��.*�."&%$ %* �." �&#1&#�47>$-%� 8$��� M:+* "� %+$ -4..$#% �.")$ !"#"�%$. */�#�'&#0I .$�'&-$0 :"%+ M:+* "� %+$ -4..$#% �.$�"0$#%*/ �." �&#1&I9� �+$ -4%;*// �-*.$ /*. �! �� %*�4��$�% -*�#"%",$ ")�&".)$#% :&� %&1$# &� ?� *4%*/ & )&(")4) �*��"7'$ �-*.$ */ �� 8�*%+ �� �!6��?@9�

������

�+$ &�$ &#0 �$( -*)�*�"%"*# */ %+$ �&)�'$ "� �+*:#"# �&7'$ �� �# %+$ �&)�'$ */ �?� �47>$-%�6 %+$.$ :$.$��@ 8����B9 )&'$� &#0 � � 8@@��B9 /$)&'$�6 )*.$%+&# +&'/ 8 � B9 */ :+*) :$.$ 7$%:$$# @ �A� 5$&.�

�&7'$ �� �%$);:"�$ -*)�&."�*# */ %+$ %.&#�'&%$0 *."�"#&' !!�� &#0 %.&#�'&%$0 ,$.�"*# 8=�4.$� "# �&.$#%+$�$� "# %+$ %&7'$ �+*: )&(")4)�-*.$ /*. $&-+ "%$)9

�%$) !!�� �.&#�'&%$0 ,$.�"*#

�� �."$#%&%"*# %* %")$ <&%$6 0&56 )*#%+6 5$&.6 �$&�*# 8 9 <&%$6 0&56 )*#%+6 5$&.6 %")$ */ 0&5 8 9�� �."$#%&%"*# %* �'&-$ *4#%.56 %*:#6 �%.$$%6 �'&-$6 L**. 8 9 *4#%.56 %*:#6 �%.$$%6 �'&-$6 L**. 8 9�� �+.$$ *7>$-%� .$�"�%.&%"*# ���'$6 %&7'$6 �$##5 8�9 �.&#�$6 %&7'$6 .4�$$ 8�9�� &'-4'&%"*# �47%.&-% �$."&' �$,$#� 7&-1:&.0� /.*) ��� 8 9 �47%.&-% �$."&' %+.$$� 7&-1:&.0� /.*) ��22 8 9 � �$-&'' �&)$ %+$ %+.$$ *7>$-%� '$&.#$0 $&.'"$. 8�9 �&)$ %+$ %+.$$ *7>$-%� '$&.#$0 $&.'"$. 8�9@� �&#�4&�$ 8�&)"#�9 �$#-"'6 :&%-+ 8�9 �$#-"'6 :&%-+ 8�9A� �$�$%"%"*# M�* "/�6 &#0� *. 74%�I 8�9 M�* "/�6 &#0� *. 74%�I "# �"#+&'$�$ 8�9?� �&#�4&�$ 8 *)�.$+$#�"*#9 �$&0 &#0 /*''*: -*))&#0 ��1$0 %* /*''*: ,$.7&' -*))&#06

M '*�$ 5*4. $5$�I 8�9 M '*�$ 5*4. $5$�I2 8�9�� �+.$$ �%$� %&�1 �*''*: "#%$.,"$:$.I� "#�%.4-%"*#� M%&1$ �&�$. �*''*: "#%$.,"$:$.I� "#�%.4-%"*#� M%&1$ �&�$.

"# ."�+% +&#06 /*'0 "# +&'/ &#0 �4% *# %+$ %&7'$ 8�9 "# ."�+% +&#06 /*'0 "# +&'/ &#0 �4% *# %+$ %&7'$ 8�9��� �$#%$#-$ -*#�%.4-%"*# C."%$ & -*)�'$%$ �$#%$#-$ 8�9 �� & -*)�'$%$ �$#%$#-$2 8�9��� *�5"#� =�4.$ �,$.'&��"#� �$#%&�*#� 8�9 �,$.'&��"#� �$#%&�*#� 8�9

2�*. "''"%$.&%$ �47>$-%��22�*. �47>$-%� :+* +&,$ +&0 '$�� %+&# 5$&.� /*.)&' $04-&%"*#�

��@ �� � �� ��� �� �� �� ��� �� ��

*�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ��� � ������ �� ����� ����� ��� ��������

Page 4: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

*/ &�$� �04-&%"*# '$,$'� :$.$ �$#$.&''5 '*:6 $��$;-"&''5 &)*#� %+$ ,$.5 *'0 �47>$-%� &#0 :*)$#�!*.$ %+&# +&'/ 8 ���B9 +&� +&0 '$�� %+&# �"( 5$&.�*/ /*.)&' $04-&%"*#6 ���@B #* /*.)&' $04-&%"*#6&#0 �� �47>$-%� 8 � B9 :$.$ "''"%$.&%$�

�/ %+$ �?� �47>$-%� :+* :$.$ "#%$.,"$:$0 ���-*.$0� �A *# %+$ !!�� 8�-.$$#$0 �*�"%",$96 &#0:$.$ %+4� -*#�"0$.$0 -&�$� */ �4��$-%$0 0$)$#%"&��'' �� �47>$-%� :+* �-.$$#$0 �*�"%",$6 &#0 �� .&#;0*)'5 �$'$-%$0 �47>$-%� :+* �-*.$0� �A *# %+$!!�� 8�-.$$#$0 #$�&%",$96 %+4� -*#�"0$.$0 -*�#";%",$'5 #*.)&'6 4#0$.:$#% & 7."$/ -'"#"-&' $(&)"#&%"*#&#0 & #$4.*��5-+*'*�"-&' &��$��)$#% :"%+ %+$ �!; �� 8%*%&' */ A �47>$-%�9� �+$.$ :$.$ %:* "''"%$.&%$�47>$-%� &)*#� %+$ �-.$$# �*�"%",$� &#0 *#$ "''"%$.&%$�47>$-% &)*#� %+$ �$'$-%$0 �-.$$# #$�&%",$�� �+$.$:$.$ �$,$# �47>$-%� :"%+� �"( 5$&.� */ /*.)&' $04-&;%"*# &)*#� %+$ �-.$$# �*�"%",$� &#0 =,$ :"%+� �"(5$&.� */ /*.)&' $04-&%"*# &)*#� %+$ �$'$-%$0 �-.$$##$�&%",$��

�/%$. &��$��)$#% :"%+ %+$ �! �� &#0 -'"#"-&'$(&)"#&%"*#6 �� *4% */ %+$ �� �47>$-%� :+* �-.$$#$0�*�"%",$ *# %+$ !!�� �+*:$0 $,"0$#-$ */ 0$)$#%"&:+"'$ /*4. �47>$-%� �-*.$0 &7*,$ -4%;*// *# %+$ �!; �� &#0 �+*:$0 #* -'"#"-&' �"�#� */ 0$)$#%"&� �/%+$ �� .&#0*)'5 �$'$-%$0 �47>$-%� :+* �-.$$#$0#$�&%",$ *# %+$ !!��6 �� �+*:$0 #* $,"0$#-$ */0$)$#%"& :+"'$ %:* �-*.$0 7$'*: -4%;*// *# %+$ �! �� &#0 �+*:$0 -'"#"-&' $,"0$#-$ */ 0$)$#%"&��+$.$/*.$6 %+$ �$#�"%","%5 &#0 ��$-"=-"%5 */ %+$ %.&#�;'&%$0 ,$.�"*# */ %+$ !!�� 4�$0 75 4� 8:+$# �A :&�4�$0 &� %+$ -4%;*// �*"#%9 :$.$ .$��$-%",$'5 ��� B &#0?��@B� �+$ �$#�"%","%5 &#0 ��$-"=-"%5 &#0 *%+$. ,&'"0;"%5 )$&�4.$� �4-+ &�6 '"1$'"+**0 .&%"*� /*. �*)$ -4%;*// �*"#%� */ %+$ �"#+&'$�$ ,$.�"*# */ %+$ !!�� 4�$075 4� 04."#� %+"� �%405 &.$ �+*:# "# �&7'$ �� �"#-$%+"� "� %+$ =.�% %")$ %+"� ,$.�"*# */ %+$ !!��+&� 7$$# 4�$0 "# &#5 �*�4'&%"*#6 &# "%$);:"�$�$./*.)&#-$ */ %+$ "#�%.4)$#% "# .$'&%"*# %* �!; �� �-*.$� *7%&"#$0 75 &'' A �47>$-%� "� �+*:# "#�&7'$ ��

<�� �����

�+$ !!��6 ,&."*4�'5 %.&#�'&%$0 &#0 &0&�%$0 %* �4"%)&#5 -4'%4.$�6 +&� 7$$# 4�$0 &� & �-.$$#"#� "#�%.4;)$#% &)*#� $'0$.'5 �$*�'$ "# )&#5 -*4#%."$�6 :+"-+"� �$#$.&''5 -*#�"0$.$0 &� %+$ =.�% �%$� "# �.$,&'$#-$�4.,$5� "# %+$ "0$#%"=-&%"*# */ "#0","04&'� :"%+ & +"�+�.*7&7"'"%5 */ 7$"#� 0$)$#%$0 8�&4#$.6 ����9� �+$%$�% %&1$� ,$.5 '"%%'$ %")$ :"%+ &# "#%&-% "#0","04&'6&#0 $,$# :"%+ %+*�$ :+* &.$ �$,$.$'5 ")�&".$064�4&''5 7$%:$$# ��� )"#6 74% -&# %&1$ '*#�$. :"%+%+*�$ :+* &.$ )"'0'5 ")�&".$0 *. :+* +&,$ &40"%*.5&#0 -*))4#"-&%"*# 0"/=-4'%"$��

�� %+$ "#�%.4)$#% +&� �$,$.&' "%$)� %+&% .$K4".$ '"%;$.&-5 �1"''�6 �$./*.)&#-$ &% %+$ !!�� "� "#L4$#-$075 '$,$' */ $04-&%"*# &#0 '"%$.&-5 8C$"�� �� �!6 ��� 9��4-+ & �.$-*#0"%"*# */ '"%$.&-5 "� ")�.&-%"-&' "# )*�%0$,$'*�"#� -*4#%."$� :+$.$ "''"%$.&-5 &#0 �*-"&' 7&-1;:&.0#$�� &.$ :"0$'5 �.$,&'$#%6 �&.%"-4'&.'5 &)*#� %+$$'0$.'5 �*�4'&%"*#� �*. $(&)�'$6 "# %+$ �%405 0*#$ "#3&''&7�&.+6 �#0"&6 %+$ �%405 �*�4'&%"*# :&� '&.�$'5"''"%$.&%$ 8A�B96 )&#5 0"0 #*% 1#*: *. 1$$� %.&-1 */5$&.�6 &'' 74"'0"#�� "# %+$ �%405 &.$& 0"0 #*% +&,$�%.$$% #4)7$.� &#0 �%.$$%� 0"0 #*% +&,$ #&)$�

�&7'$ �� ��$ &#0 �$( -*)�*�"%"*# */ %+$ �&)�'$ �%40"$0

��$ 8�$&.�9 !&'$ �$)&'$ �*%&'

�4)7$. B �4)7$. B �4)7$. B

@ �A� A ���? ��@ � �A ��� � A��A �� A�� A� ���� ��� �A��A@�?� �� �� �� ?�@ � ����?��? E E ��� ���O ? � ��� A ��? ? ���

�*%&' ��@ ���� � � @@�� �?� ���

�&7'$ �� P&'"0"%5 )$&�4.$�E�$#�"%","%5 &#0 ��$-"=-"%56 '"1$;'"+**0 .&%"*� &#0 �*40$#I� "#0"-$�E/*. �*)$ -4%;*// �*"#%� /*.%+$ �"#+&'$�$ ,$.�"*# */ %+$ !!�� ,&'"0&%$0 &�&"#�% �! ���-*.$� 8�� A9

!!�� �$#�"%","%5 ��$-"=-"%5 �"1$'"+**0 �*40$#I�-4%;*// B B .&%"* "#0$(�-*.$

�� ��� @��� ��� ��@��� ��� A��� ��A ��A��� ��� A@�� ��� ��AA�� ��� ?��? �� ��?��� ��� ?��@ @� ��? �? �@�? ?��@ @�� ��?��A2 ��� ?��@ @�� ��A?�@ A��� �@�� ���� ��A�

2 4%;*// �*"#% 4�$0 75 4��

� ��� � �� �� �� � ��� � ��� ���� ��A

*�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ��� � ������ �� ����� ����� ��� ��������

Page 5: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

8�&#�4'" �� �!6 ��� 9� �� & .$�4'%6 .$�$&.-+$.� +&,$+&0 %* �.$&%'5 )*0"/5 %+$ !!�� %* )&1$ "% &��'";-&7'$ %* '&.�$'5 "''"%$.&%$ .4.&' �*�4'&%"*#� "#-*4#%."$� �4-+ &� �#0"& 8�&#�4'" �� �!6 ��� 9 &#03&#�'&0$�+ 8F&7". &#0 �$.'"%H6 ����9� C$ 0"0 #*%$#-*4#%$. %+"� �.*7'$) 04."#� *4. �%405 7$-&4�$ */%+$ +"�+ '"%$.&-5 .&%$ "# %+$ -*4#%.5 8��B9 "# �$#$.&'6&#0 %+$ �%405 &.$& "# �&.%"-4'&. 8� B9 8�##4&' �$&'%+34''$%"#6 ���?9� �'%+*4�+ ���@B */ %+$ �%405 �*�4'&;%"*# +&0 #* /*.)&' $04-&%"*# &#0 ���B +&0 '$�� %+&#�"( 5$&.� */ /*.)&' $04-&%"*#6 &'' -*�#"%",$'5 "#%&-%�47>$-%� :$.$ /&)"'"&. :"%+ :."%"#� "#�%.4)$#%�6 &#0-*)/*.%&7'$ :"%+ "%$)� %$�%"#� &7�%.&-% )$#%&' &."%+;)$%"- �1"''� &#0 -*�5"#� *,$.'&��"#� �$#%&�*#� &�.$L$-%$0 "# %+$ �-*.$� *7%&"#$0 75 %+$) /*. %+$�$�47%$�%� 8�&7'$ �9� �� $(�$-%$06 �47>$-%� :"%+")�&".$0 -*�#"%"*# /&.$0 �&.%"-4'&.'5 7&0'5 "# %+$�&)$ "%$)� .$K4"."#� '"%$.&-5 �1"''� 8�&7'$ �9�

�+$ �$'$-%$0 �%405 �*�4'&%"*# "# �&�&)& 0*$� #*%,&.5 �"�#"=-&#%'5 "# $04-&%"*#6 '"%$.&-56 &#0 -4'%4.&'�*�+"�%"-&%"*# /.*) *%+$. 4.7&#��$)";4.7&# &.$&� */%+$ -*4#%.56 &#0 "� .$�.$�$#%&%",$ */ %+$ �$#$.&' �."�&#1&# �*�4'&%"*#� �+$.$/*.$6 %+$ "#�%.4)$#% :&�%.&#�'&%$0 %* �"#+&'$�$ &#0 )&0$ )*.$ &��.*�."&%$%* *4. -4'%4.$ :"%+*4% +&,"#� %* )&1$ )&>*. )*0"=-&;%"*#� %* %+$ *."�"#&' ,$.�"*#� �+$ &7�%.&-% -&'-4'&%"*#*/ �47%.&-%"#� �$."&' �$,$#� 7&-1:&.0� /.*) ���6 &�.$K4".$0 "# %+$ *."�"#&' !!��6 :&� �47�%"%4%$0 :"%+�47%.&-%"#� �$."&' %+.$$� 7&-1:&.0� /.*) �� /*. %+*�$:"%+ '$�� %+&# =,$ 5$&.� */ /*.)&' $04-&%"*#� �%$)� "#%+$ *."�"#&' !!�� :+"-+ .$K4".$0 %+$ &7"'"%5 %* .$&0&#0 :."%$ �4-+ &� /*''*:"#� & -*))&#0 75 .$&0"#� &:."%%$# "#�%.4-%"*# 8$��� M-'*�$ 5*4. $5$�I9 &#0 :."%"#�& -*)�'$%$ �$#%$#-$ .$��$-%",$'56 :$.$ �47�%"%4%$0:"%+ "%$)� :+"-+ :*4'0 %$�% %+$ 0$�".$0 -*�#"%",$

'$,$' :"%+*4% #$-$��"%&%"#� '"%$.&-5 �1"''� /*. %+$ 7$#;$=% */ %+$ �)&'' �$.-$#%&�$ */ "''"%$.&%$ �47>$-%�� �4-+�47>$-%� :$.$ � �� %* /*''*: & ,$.7&' -*))&#0 &#0&'�* %* �� & -*)�'$%$ �$#%$#-$ &� :$.$ &'�* %+$"#�%.4-%"*#� �",$# "# %+$ +"#$�$ ,$.�"*# */ %+$!!�� 4�$0 "# %+$ �+&#�+&" �%405 8G+&#� �� �!6����9� �+$�$ )*0"=-&%"*#� :$.$ "#-*.�*.&%$0 %* %+$�"#+&'$�$ ,$.�"*# */ %+$ !!�� %* �.$,$#% "''"%$.&-5&#0 �**. $04-&%"*# &//$-%"#� �$./*.)&#-$ &% %+$�-.$$#"#� %$�%�

3&�$0 *# %+$ .$�4'%� */ %:* �.$,"*4� �%40"$�8�" �� �!6 ��?�� G+&#� �� �!6 ����96 *#$ */ :+"-+ 4�$0'$,$' */ $04-&%"*#;0$�$#0$#% -4%;*// �*"#%� %* �-.$$#/*. 0$)$#%"& 8G+&#� �� �!6 ����96 :$ 4�$0 �A &� %+$-4%;*// /*. *4. ,$.�"*# */ %+$ !!�� "#�%$&0 */ %+$)*.$ �%&#0&.0 -4%;*// �*"#% */ ��� C$ 0"0 %+"� %* )"#";)"H$ %+$ '"1$'"+**0 */ #*% 0$%$-%"#� �47>$-%� :"%+-*�#"%",$ ")�&".)$#% 04."#� �-.$$#"#�� �*:$,$.6 "#%+$ �*�4'&%"*# :$ �%40"$06 %+$ 7$�% �$#�"%","%5 &#0��$-"=-"%5 /*. *4. "#�%.4)$#% :*4'0 +&,$ 7$$#&-+"$,$0 "/ �� :&� 4�$0 &� %+$ -4%;*// �*"#%8�&7'$ �9� �'%+*4�+ %+$ -4%;*// 4�$0 75 4� 8�A *4% */��9 �&,$ & �'"�+%'5 '*:$. �$#�"%","%5 %+&# ��6 %+$.$ :&�#* 0"//$.$#-$ "# ��$-"=-"%5 /*. %+$ %:* -4%;*// �*"#%�8�&7'$ �9� �+$.$/*.$6 7&�$0 *# %+$�$ .$�4'%� �� "� & 7$%;%$. -4%;*// �*"#% %+&# �A %* �-.$$# /*. 0$)$#%"& :"%+%+$ )*0"=$0 !!�� "# *4. �%405 �*�4'&%"*#�

�+$ )&"# �4.�*�$ */ %+$ �.$�$#% �%405 :&� %*0$,$'*� & ,$.�"*# */ %+$ !!��6 %.&#�'&%$0 %*�"#+&'$�$ &#0 )&0$ )*.$ &��.*�."&%$ &#0 .$'$,&#%%* %+$ -4'%4.&' -*#%$(% */ �." �&#1&� �# *.0$. %*$,&'4&%$ %+$ �$#�"%","%5 &#0 ��$-"=-"%5 */ %+$ )*0"=$0"#�%.4)$#%6 %+$ !!�� �-*.$� */ &'' �47>$-%� "# *4.�%405 :$.$ $,&'4&%$0 &�&"#�% �$./*.)&#-$� &% %+$ �! ��6 %+$ -*�#"%",$ �$-%"*# */ %+$ �!<�N�

�&7'$ �� �%$) :"�$ �$./*.)&#-$ 75 %+$ %:* �.*4�� &% %+$ %.&#�'&%$0 !!�� 8=�4.$� "# �&.$#%+$�$� /*. $&-+ �47%$�%�"%$) �+*: )&(")4)�-*.$ /*. $&-+ "%$)9

�47%$�%�"%$) �*#;0$)$#%$0 �&)�'$ <$)$#%$0 �&)�'$ �! �� 8� 9 �! �� 8� 9

8�� �@9 8�� ��9

�-*.$ B �-*.$ B

�."$#%&%"*# %* %")$ 8 9 ��� 8��?9 ?� ��� 8���9 @��."$#%&%"*# %* �'&-$ 8 9 �� 8��A9 �� ��� 8���9 @@�;*7>$-% .$�"�%.&%"*# 8�9 ��@ 8�� 9 ?@ ��� 8�� 9 @��$."&' �$,$#��%+.$$ 8 9 ��? 8���9 A@ �� 8��?9 ���;*7>$-% .$-&'' 8�9 ��� 8���9 @� ��? 8��@9 �A�&)$ �$#-"' &#0 :&%-+ 8�9 ��� 8�9 ��� ��? 8��@9 ���$�$&% �+.&�$ 8�9 ��? 8���9 ?� ��� 8�� 9 ���;�%$� %&�1 8�9 ��A 8��@9 �� ��A 8��?9 A�$&0�,$.7&' -*))&#0 8�9 ��� 8���9 �� ��� 8���9 ��C."%$��&5 �$#%$#-$ 8�9 ��@ 8�� 9 @� ��� 8���9 �� *�5 0.&:"#� 8�9 ��@ 8�� 9 @� ��� 8���9 ��

��? �� � �� ��� �� �� �� ��� �� ��

*�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ��� � ������ �� ����� ����� ��� ��������

Page 6: Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka

�+$ �! �� &''*:� *7�$.,&%"*# */ & 7.*&0 .&#�$ */")�&".)$#%� &��*-"&%$0 :"%+ 0$)$#%"& "# & .$'&%",$'5�+*.% %")$ 8����� )"#9� �+$ %*%&' -*�#"%",$ $(&)"#&;%"*# :"%+ %+$ �! �� -*#�"�%� */ @? "%$)�6 :+"-+&��$�� *."$#%&%"*#6 '&#�4&�$ 8-*)�.$+$#�"*# &#0$(�.$��"*#96 )$)*.5 8.$-$#% &#0 .$)*%$96 #$: '$&.#;"#�6 &%%$#%"*#6 -&'-4'&%"*#6 �.&("�6 &7�%.&-% %+"#1"#�6�$.-$�%"*# &#0 $($-4%",$ /4#-%"*#� �+4�6 "# -*)�&.";�*# %* %+$ !!��6 �! �� �.*,"0$� & :"0$. -*,$.;&�$ */ -*�#"%",$ /4#-%"*#� &#0 0$%$-%� )"'0$. 0$�.$$�*/ -*�#"%",$ ")�&".)$#%� �+"� )&1$� %+$ �! �� &,$.5 -*)�.$+$#�",$ %$�% 7&%%$.5 %* 0"&�#*�$ 0$)$#;%"&6 &#0 &'�* %* $,&'4&%$ %+$ �$#�"%","%5 &#0 ��$-"=-"%5*/ �-.$$#"#� "#�%.4)$#%� �4-+ &� %+$ !!�� 8�*%+�� �!6 ��?@9�

�+"� �4.,$5 "� %+$ =.�% %")$ %+&% & %.&#�'&%$0 !!��+&� 7$$# 4�$0 &� & �-.$$#"#� "#�%.4)$#% /*. -*�#"%",$")�&".)$#% "# �." �&#1&6 &#0 %+"� �%405 +&� �+*:#%+&% %+$ )*0"=$0 ,$.�"*# */ %+$ !!�� 4�$0 75 4�%* 7$ �")�'$ %* 4�$ &#0 &��.*�."&%$ %* %+$ �*�4'&%"*#�%40"$0� �+$.$/*.$6 :$ -*#-'40$ %+&% %+$ �'"�+%'5 )*0;"=$0 �"#+&'$�$ %.&#�'&%"*# */ %+$ !!�� 0$�-."7$0+$.$ "� & 4�$/4' &#0 �$#�"%",$ "#�%.4)$#% %* �-.$$#/*. -*�#"%",$ ")�&".)$#% "# �." �&#1&�

������� ��

�##4&' �$&'%+ 34''$%"#� ���?� !"#"�%.5 */ �$&'%+6 �." �&#1&�3.&5#$ � ���?� �+$ !"#" !$#%&' �%&%$ �(&)"#&%"*#6 :"'' :$ 7$

4�"#� "% "# ����Q ��� � ��� �� ����� ��� �? �����3.&5#$ 6 &''*:&5 �� ����� �+$ -&�$ "0$#%"=-&%"*# */ 0$)$#%"& "#

%+$ -*))4#"%5� & -*)�&."�*# */ )$%+*0�� ��� � ��� �� ������� ������@�

&#&0"&# �%405 */ +$&'%+ &#0 &�"#�� �%405 )$%+*0� &#0 �.$,&'$#-$*/ 0$)$#%"&� ����� +� ��� )��� � ���� ?�������

+&#0.& P6 �&#�4'" !6 �&#0&, �6 *+#�%*# 6 3$''$ �6 <$ F*�15 ������?� �.$,&'$#-$ */ �'H+$")$.I� 0"�$&�$ &#0 *%+$. 0$)$#%"&� "#.4.&' �#0"&� %+$ �#0*;� �%405� %�������� ��� ��������?�

'&.1 ��6 �*&%$ �!� ����� !*'$-4'&. �$#$%"-� */ �'H+$")$.I� 0"�;$&�$� )� � %����� ��� ��@����A��

�"''$#7&4) ��6 �$*.�$ �F6 3'&H$. <�� ��?�� �-*."#� #*#;.$��*#�$ "# %+$ !"#" !$#%&' �%&%$ �(&)"#&%"*#� �� ��� ������ �������� �

�*'�%$"# !�6 �*'�%$"# ��6 !-�4�+ ��� ��A � !"#" )$#%&' �%&%$� &�.&-%"-&' )$%+*0 /*. �.&0"#� %+$ -*�#"%",$ �%&%$ */ �&%"$#%� /*.%+$ -'"#"-"&#� � �� ����� "�� � � �?����?�

�&#�'4" !6 �&%-'"// �6 +&#0.& P6 �+&.)& �6 �"'75 6 �&#0&, ����� � � �"#0" ,$.�"*# */ %+$ !!��� %+$ 0$,$'*�)$#% */ & -*�;#"%",$ �-.$$#"#� "#�%.4)$#% /*. & '&.�$'5 "''"%$.&%$ .4.&' $'0$.'5�*�4'&%"*# "# �#0"&� ��� � ��� �� ����� ��� �@A��AA�

�$#0."$ � 6 ��4#%*14# 3�6 �&'' F�6 ��4##"5" ��6 �&" ��6#,$.H&�% �C6 �� �! ��� � �.$,&'$#-$ */ �'H+$")$.I� 0"�$&�$&#0 0$)$#%"& "# %:* -*))4#"%"$�� �"�$."&# �/."-&#� &#0�/."-&# �)$."-&#�� )� � �� ����� �� � ��? ������

��"&* C� ����� ) ��������� )��������� �� ��� �� ,� -������ ��� �� ����� ���.��! �#�%"%4%$ */ �*'"-5 �%40"$�� �." �&#1&����

F&7". G�6 �$.'"%H �� ����� �+$ 3&#�'& &0&�%&%"*# */ %+$ !"#" !$#;%&' �%&%$ �(&)"#&%"*# 83�!��9� &# "#�%.4)$#% %* &��$�� -*�#";%",$ /4#-%"*# "# "''"%$.&%$ &#0 '"%$.&%$ "#0","04&'�� ��� � ����� ����� ��� ����� ��

F&%H)&# �6 G+&#� !6 �&;R4 �6 C&#� G6 �"4 C�6 �4 �6 �� �!��??� +"#$�$ ,$.�"*# */ %+$ !"#" !$#%&' �(&)"#&%"*#� ")�&-%*/ "''"%$.&-5 "# & �+&#�+&" 0$)$#%"& �4.,$5� � +��� /�������� !���A���A?�

�&4#$. �� ����� �,$.,"$: */ "#-"0$#-$ �%40"$� */ 0$)$#%"& -*#;04-%$0 "# �4.*�$� %������������� ��� �����

�" �6 �+$# � 6 +$# �6 G+&* �C6 �" ��6 �4 !� ��?�� �# $�";0$)"*'*�"-&' �4.,$5 */ &�$;.$'&%$0 0$)$#%"& "# &# 4.7&# &.$& */3$">"#�� ) � �� ���� � �� �"� A� @��

�%% �6 3.$%$'$. !!6 ,&# �&.�1&)� �� ��� � �.$,&'$#-$ */�'H+$")$.I� 0"�$&�$ &#0 ,&�-4'&. 0$)$#%"& � %+$ �*%%$.0&)�%405� 0 ��� � 1#(� �A���A��

�&51$' ��6 3.&5#$ 6 �4��$.% ��6 �"'' 6 3&.1'$5 6 �$+'+&&. �6�� �! ����� �#-"0$#-$ */ 0$)$#%"& "# & �*�4'&%"*# *'0$. %+&# A 5$&.� "# %+$ #"%$0 F"#�0*)� )� � ��� �� ����� ��� �� �����

�*%+ !6 �5) �6 !*4#%>*5 R6 �4��$.% ��6 �$#0."$ �6 P$.)& �6�*00&.0 �� ��?@� �!<�N� & �%&#0&.0"H$0 "#�%.4)$#% /*. %+$0"&�#*�"� */ )$#%&' 0"�*.0$. "# %+$ $'0$.'5 :"%+ ��$-"&' .$/$.$#-$%* %+$ $&.'5 0$%$-%"*# */ 0$)$#%"&� 0� � �� ����� �!"� @�?�A���

C$"�� 3<6 �$$0 �6 F'"�)&# �C6 �75&0 �� ��� � �"%$.&-5 &#0 �$.;/*.)&#-$ *# %+$ !"#" !$#%&' �%&%$ �(&)"#&%"*#� � )� �������� !�� ?�A�?���

G+&#�!6 F&%H)&# �6 �&')*# <6 "# �6 &" �6 C&#� G6 �� �! ������+$ �.$,&'$#-$ */ 0$)$#%"& &#0 �'H+$")$.I� 0"�$&�$ "# �+&#�;+&"6 +"#&� ")�&-% */ &�$6 �$#0$. &#0 $04-&%"*#� )�� %����� ����?���A�

� ��� � �� �� �� � ��� � ��� ���� ���

*�5."�+% � ���� *+# C"'$5 D �*#�6 �%0� ��� � ������ �� ����� ����� ��� ��������