Pengembangan Instrumen Penilaian Afasia dalam Bahasia Indonesia melalui Pendekatan Korelasi Network Bahasa pada Primary Progressive Aphasia

Abstract

Background: Primary Progressive Aphasia (PPA) is a neurodegenerative syndrome characterized by progressive impairment of language, with substantial implications for patient care, early intervention, and long-term management. Despite its clinical importance, there is no Indonesian-language assessment tool specifically designed to capture the linguistic deficits of PPA. Linguistic features of Bahasa Indonesia—such as limited inflectional morphology and distinct syntactic and semantic structures—pose additional challenges for adopting instruments developed in English. This study aimed to develop and validate the Instrumen Afasia Neurodegeneratif Indonesia (IRFANI) as a culturally and linguistically appropriate tool for diagnosing and characterizing PPA in Indonesian speakers. Methods:This multi-phase study included: (1) identification of relevant linguistic domains in PPA; (2) development of test specifications and item generation; (3) qualitative evaluation through expert review to establish content validity; (4) pilot testing; (5) quantitative psychometric evaluation; (6) assessment of construct validity and reliability using first- and second-order Confirmatory Factor Analysis (CFA); (7) establishment of normative data and cut-off scores based on 300 healthy adults, (8) analysis of IRFANI performance in relation to cortical atrophy patterns in patients with PPA, and (9) diagnostic algorithm development. All procedures adhered to ethical standards. Results: IRFANI was successfully developed, comprising seven core language domains aligned with the linguistic features that distinguish PPA variants. Expert review demonstrated strong content validity. CFA supported acceptable model fit for both subtest-level and second-order factor structures. Most items met psychometric criteria, and subtests showed high reliability. Normative scores and demographic-adjusted cut-offs were established. IRFANI scores correlated significantly with TADIR and MoCA-INA, and were sensitive to differences based on peak neuronal atrophy patterns, supporting its clinical utility. These findings informed the development of an IRFANI-based diagnostic algorithm for PPA. Conclusion: IRFANI is a valid and reliable Indonesian-language assessment instrument for evaluating linguistic deficits in PPA. It provides a robust framework for early diagnosis, monitoring disease progression, and guiding individualized speech-language interventions. The tool contributes substantially to the advancement of neurocognitive assessment in Indonesia and holds potential as a national standard for PPA evaluation.